Author: Kathleen Dinoso

Medication Abortion in a Post-Dobbs Era

In 2022, the U.S. Supreme Court issued an unprecedented ruling in Dobbs v. Jackson Women’s Health Organization which eliminated the constitutional right to abortion. This decision has led to widespread repercussions with abortion bans in effect in forty-one states, twelve of which have imposed a ban as early as six weeks from conception when many do not know they are pregnant. Pregnancies may result from sexual assault or pose a severe health risk to the pregnant individual; however, exceptions for such circumstances are inconsistent. For instance, both Louisiana and Arkansas have enacted a complete abortion ban with no exceptions for rape or incest whereas Alabama only provides an exception for rape. Despite the diminishing access to abortions in these states, studies have shown that almost all other states have experienced an increase in the number of abortion procedures sought and provided.

As states continue to implement stringent abortion restrictions, alternative options such as medication abortion have become more commonly pursued by pregnant individuals. Medication abortion, also known as “abortion pills,” is a process of ending a pregnancy through remedial measures. The process entails oral administration of two capsules that stop the pregnancy and induce uterine contractions which expel the pregnancy tissue. Notably, in the six months after Dobbs, the provision of prescriptions for self-managed abortions increased. However, anti-abortion groups have encouraged the criminalization of these alternative methods. Notwithstanding political opposition, the Food and Drug Administration (FDA) has approved the use of the medication to safely and effectively end pregnancies of up to eleven weeks.

Amid state bans and limitations on medication abortion, novel constitutional questions about interstate relationships have surfaced. On January 31, 2025, a grand jury in West Baton Rouge Parish, Louisiana indicted a New York physician for allegedly prescribing and mailing abortion pills to a minor. After the indictment, New York Governor Kathy Hochul denied Louisiana Governor Jeff Landry’s request to extradite the physician under the authority of New York’s shield law. While various states have passed “shield laws” to protect doctors from extradition for mailing abortion pills out of state, this is the first instance in which such laws have been tested. In its aftermath, this case sparked fear among medical professionals that merely providing telehealth abortion care, even if permitted by their state, may ultimately lead to persecution.

In light of escalating constraints placed on access to reproductive health care, studies have further revealed that there are many facing significant consequences. Namely, racial and ethnic minority groups are disproportionately represented in pregnancy-related deaths and individuals face increased barriers barring access to contraceptives. Such restrictions are associated with surging infant and neonatal mortality rates and an 11% increase in foster care entries. Hence, the most recently discussed case on medication abortions and shield laws is crucial to safeguard those providing and receiving essential reproductive health care. 

The Pandemic’s Reminder: Addressing Disparities in Health Care

At the height of the pandemic, the public became increasingly aware of the socioeconomic disparities in health care. The prevalent news coverage of the pandemic and Black Lives Matter (“BLM”) movement shone a spotlight on the inequality suffered by people of color and its effects. Studies revealed that racial and ethnic minorities were infected and killed by COVID-19 at higher rates in comparison to their White counterparts due to inadequate access to testing and vaccines. Essential workers, whose numbers predominantly consisted of racial and ethnic minorities, had a higher likelihood of exposure to infectious diseases and often faced workplace mistreatment to the detriment of their health. In other instances, Black Americans seeking treatment for a range of symptoms were turned away by medical professionals who refused to believe their symptoms were genuine.

In a post-pandemic world, an essential aspect of improving such disparities is to acknowledge and address the role of institutional racism in the healthcare sector. Various institutions have created educational opportunities specifically on this topic to encourage inclusive and effective conversations on how to combat such issues. The Morehouse School of Medicine designed the Community Health Course (CHC) to train first-year medical students to identify deep-seated biases, understand disadvantaged communities’ struggles to access quality care, and recognize ways to advocate for said communities through future work. Similarly, other institutions, such as Vanderbilt University and Rutgers New Jersey Medical School, crafted curricula that explore the relationship between social factors, health, and healthcare. Such educational programs among healthcare professionals signal an upcoming generation of health professionals determined to address these issues.

Workforces have taken a similar approach, using policies and training to encourage diversity, equity, and inclusion. The American Medical Association (“AMA”) adopted guidelines and anti-discrimination policies to promote awareness and safety among workers. The AMA’s new policies promote education on systemic racism and its effects in healthcare settings. Additionally, these policies detail the protocol for handling complaints with urgency and seriousness. Many hospitals have followed suit by implementing diversity initiatives, creating training programs, and refining recruitment practices. More specifically, several residency training programs have improved their screening process to ensure underrepresented minorities (“URM”) have mentorship opportunities, minority faculty representation, and implicit bias training. For places lacking programming, “Safe Space” was founded by Dr. Deanna Stewart to provide a free diversity training program for healthcare employees and hospitals. Dr. Stewart’s program focuses on concepts such as systemic racism, privilege, unconscious bias, and discriminatory beliefs.  

Educational and workplace efforts to combat disparities in health care have laid the groundwork for future advancements in diversity, equity, and inclusion. While disparities will not be solved through these methods alone, such efforts encourage further policy improvements in various settings to tackle issues the pandemic brought forth.