On Friday, June 24, 2022, the Supreme Court took action that has a profound effect on Nurses and the care they provide to their patients. The U.S. Supreme Court overturned the right to abortion in the United States in its ruling on Dobbs v. Jackson Women’s Health Organization. This decision overturned the 50-year-old precedent set in Roe v. Wade and the more recent Casey [Planned Parenthood of Southeastern Pennsylvania v. Casey, 1992] that had enshrined and defined the right to abortion in the United States.
While much of the attention on the court’s decision has focused on those seeking to terminate their pregnancies, the ruling also represents a sea change for abortion centers, healthcare systems, and individual healthcare practitioners, including nurses, around the country.
Currently, there are 64 million women of reproductive age (15 to 44 years) in the United States. Of these, 43% (29 million) live in states with a high number of abortion restrictions.
Almost every Nurse specialty affected
The court’s decision will impact every aspect of reproductive care, and as a result, every Registered Nurse or Nurse Practitioner who cares for child-bearing patients or children will also be affected. The changes to the laws will likely create ripple effects in specialty areas and departments, across acute care and ambulatory settings (inpatient and outpatient) including:
- Emergency / Trauma
- Labor & Delivery
- Pediatric
- Psychiatric & Mental Health
- NICU
- PICU
- Family Health
- Public Health
Though the state bans’ intention is a cessation of abortions, research shows that abortion bans do not stop people from terminating their pregnancies. Note that “abortion” is the medical term for termination of a pregnancy – encompassing both unwanted and wanted pregnancies, including spontaneous and induced expulsion. Many patients who are denied access to legal and safe abortions will seek risky alternatives and need emergency care, or may travel farther distances to clinics in states where the service is still legal and safe.
It’s important to note that the states’ bans apply to wanted pregnancies too, and a wide range of conditions. Nurses are likely to see more patients who require treatment for ectopic pregnancies, miscarriages, and other life-threatening physical conditions exacerbated or created by their pregnancies, including mental health emergencies. There is also a high likelihood that NICU and PICU Nurses will see higher numbers of newborns in distress, and pediatric Nurses may find themselves caring for more pregnant and postpartum patients.
Nurses are likely to see increased patient loads to treat these cases, and there are challenging questions of how to counsel, support, and manage patient care in states where providing care carries a risk of legal action for the healthcare professional.
Wide range of patients affected and more maternal death
While care in many states and the District of Columbia will be unaffected by the court’s ruling, there are 13 states that have so-called “trigger laws” designed to outlaw abortion as soon as Roe was overturned. These states’ abortion bans have either already gone into effect or are likely to be implemented in the coming days.
While the minority of people impacted by these restrictions will be patients seeking unwanted pregnancy termination at abortion clinics, the majority will be others seeking wanted pregnancy-induced abortions and non-abortion-related treatments. These include people experiencing:
- Ectopic pregnancies
- Life-threatening pregnancies
- Stillbirths
- Miscarriages
- Congenital issues from IVF
- Side effects of drugs that cause birth defects
- Non-viable pregnancies
Research studies show that estimated pregnancy-related deaths increase by 21% when there is an abortion ban in place. Public health studies demonstrate that denying all wanted induced abortions in the United States would increase pregnancy-related mortality substantially even if the rate of unsafe abortion does not increase.
Marginalized patients especially at risk
The wide range of medical conditions does not account for marginalized groups who will feel outsized impacts from the change. Nurses should be aware that certain groups will be more affected than others.
Patients who already experience discrimination in the healthcare system based on race, ethnicity, disability, sexuality, gender presentation, or other factors will face an outsized impact from new laws restricting abortion access.
Hispanic and Black patients are two such groups. According to the Centers for Disease Control and Prevention, as of April 2022, Black patients are three times more likely to die from pregnancy-related causes than white patients, due to “variation in quality of healthcare, underlying chronic conditions, structural racism, and implicit bias.”
A full abortion ban may exacerbate this more, according to Amanda Jean Stevenson, a sociologist at the University of Colorado Boulder. She estimates that a full abortion ban could lead to a 33% increase in pregnancy-related deaths for Black patients, compared to a 21% increase overall, “even if people denied legal access to abortion do not resort to unsafe procedures.”
Unlike wealthier residents of abortion-restricted states, low-income residents likely won’t be able to travel in order to access legal abortions, according to Northeastern economist Alicia Modestino.
Restricted access to abortion will exacerbate existing economic disparities between patient populations. One study published in the American Journal of Public Health found that when compared with those who received an abortion, “women denied an abortion were more likely to experience economic hardship and insecurity lasting years.”
Limitations to counsel patients and legal risk for nurses
Among the challenges, Nurses will encounter is the tension between the American Nurses Association Code of Ethics and the laws newly enacted by their states.
Under the code of ethics, Nurses have vowed to do the following:
“compassion and respect for the inherent dignity, worth, and unique attributes of every person. The Nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. The Nurse promotes, advocates for, and protects the rights, health, and safety of the patient.”
However, now many healthcare professionals may find themselves prohibited from upholding this commitment.
With the current lack of clarity, hospitals may encourage Nurses to seek legal approval before providing their patients with any guidance, advocacy, or even support, even in emergency situations.
Nurses are likely to see patients who need procedures that were recently considered standard care but now require special approvals. The delays put patients’ lives at risk.
These procedures include treatment of ectopic pregnancies, providing dilatation and curettage, emotional support as aftercare for miscarriages, and even care for patients who have suffered the tragedy of stillbirth.
Debates in the workplace
Beyond the legal and ethical issues that Nurses must face in the wake of the Supreme Court’s decision, it is likely that they will face challenges in the workplace as colleagues take sides in this emotional issue.
Just as happened during the COVID-19 pandemic – including hospital and health systems or state vaccine mandates, it is likely that coworkers will disagree over how to best manage patients negatively affected by the new laws. Understandably, this may make an already stressful work environment even more challenging.
It is important that Nurses and other healthcare professionals maintain professionalism and remain calm, remembering that the well-being of patients is their primary goal. If you need additional support, seek help from management or your human resources department.
Conclusion
Nurses dedicated to — and responsible for — patient care will need a full understanding of what is and is not legal in the states where they work, and what they are and are not allowed to do. While some states will allow abortion services under certain circumstances, others make assisting in an abortion or abortion-associated services under any circumstances, punishable by imprisonment.
Sources
- “13 States Have Abortion Trigger Bans—Here’s What Happens When Roe Is Overturned.” guttmacher.org. Accessed June 27, 2022.
- “A narrative analysis of anti-abortion testimony and legislative debate related to Georgia’s fetal “heartbeat” abortion ban.” tandfonline.com. Accessed June 27, 2022.
- “An Overview of Abortion Laws.” guttmacher.org. Accessed June 27, 2022.
- “Dobbs v. Jackson Women’s Health Organization.” supremecourt.gov. Accessed June 27, 2022.
- “Global and Regional Estimates of Unintended Pregnancy and Abortion.” guttmacher.org. Accessed June 27, 2022.
- “Overturning roe v. Wade will put even more of an economic burden on women, northeastern economist says.” news.northeastern.edu. Accessed June 27, 2022.
- “A Preview of the Dangerous Future of Abortion Bans — Texas Senate Bill 8.” nejm.org. Accessed. June 27, 2022.
- “Predicted changes in abortion access and incidence in a post-Roe world.” pubmed.ncbi.nlm.nih.gov. Accessed June 27, 2022.
- “Preterm Birth: Causes, Consequences, and Prevention.” ncbi.nlm.nih.gov. Accessed June 27, 2022.
- “Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States”. ajph.aphapublications.org. Accessed June 27, 2022.
- “The New Abortion Battleground.” scholarship.law.pitt.edu. Accessed June 27, 2022.
- “The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant.” dukepress.edu. Accessed June 27, 2022.
- “View the Code of Ethics for Nurses.” nursingworld.org. Accessed June 27, 2022.
- “Working Together to Reduce Black Maternal Mortality.” cdc.gov. Accessed June 27, 2022.
