COMMENTARY

Back to 1973: Family Practice and the Abortion Crisis

Alexa Mieses Malchuk, MD, MPH

Disclosures

June 29, 2022

Alexa Mieses Malchuk, MD, MPH

A 35-year-old G2P2 woman with a history of depression came into my office to discuss a positive at-home pregnancy test. I last saw her about a month earlier when she wanted to undergo a bilateral tubal ligation, certain that she did not want any more children. However, the gynecologist she saw in the interim discouraged this permanent solution in view of her still-young age, and instead offered an IUD. The patient wanted to think it over and during that time, she became pregnant.

Now she sits across from me in tears. She and her husband made a firm decision not to have another child. The two children they already have are nearly in junior high school. Starting over seems unfathomable. My patient was finally promoted after reentering the workforce several years ago. A third child would strain her job, her marital relationship, and her finances. Now the only type of medical care I can offer her is treatment for depression and a referral to our social worker for mental health therapy services.

Later that day, a 41-year-old woman with a history of secondary infertility came in for a follow-up visit. I was delighted to see her. She'd had a child 10 years earlier with her partner. She later tried for a second child without success. She underwent an extensive workup and several rounds of IVF but did not become pregnant. She had given up on the hope of providing her daughter with a sibling.

Then, 3 months ago, she missed a period. She thought she was starting menopause because her mother went through menopause at age 42, but she was absolutely thrilled to discover that she was pregnant! She was so excited that she even brought the at-home pregnancy test into the office for me to see.

Today she returned to learn the results of her prenatal tests. Sadly, despite a normal first-trimester ultrasound, genetic testing was abnormal. Subsequent chorioamniotic villus sampling confirmed a chromosomal abnormality in the fetus, which meant that the child would be born with significant mental and physical impairments.

We scheduled a follow-up visit to discuss her options after she had time to process the test results. No matter the potential danger she and her fetus were in, she would have to see this pregnancy through.

That same week, another patient came to my primary care office complaining of abdominal pain. She was a 21-year-old with no significant medical history. The pain began 2 days ago, and today she woke up with a fever. Without even beginning my exam, I could tell she was very unwell. Her skin was pale, cool, and clammy. When I finished taking her vital signs, I nearly fell off my chair — her blood pressure was 87/50 mmHg.

I alerted my medical assistant to grab a few bags of saline while I called an ambulance. As my patient fainted on the table, her mother begged me through teary eyes not to tell anyone that she had taken her daughter to a friend's house to undergo an abortion. Unfortunately, this was not the only time I would see life-threatening complications from a medical procedure performed outside of the healthcare system.

These cases weren't real, but they may certainly become a reality now that Roe v Wade has been overturned and states are enacting legislation to severely restrict or ban abortion entirely. In fact, these clinical scenarios may have been like those encountered by my primary care colleagues prior to 1973. A return to unsafe abortions can lead to life-threatening complications, infertility, and death. When women are forced to carry unintended pregnancies to term, entire families can be negatively affected physically, mentally, and socially. Unintended pregnancy can impair social mobility, education, and earning power and have significant consequences for the fetus and child.

In the United States today, approximately 600,000-900,000 abortions are performed annually. The range is large owing to different methods of collecting data from various institutions, such as the Centers for Disease Control and Prevention and the Guttmacher Institute, but the bottom line is that abortions are common. The women who seek abortions are of all races, all socioeconomic backgrounds, both married and unmarried, and range in age from 13 years to their 40s. The unifying theme is that they no longer wish to be pregnant or have a child, and that is reason enough to seek an abortion.

Overturning Roe v Wade will not stop people from having abortions. Instead, it will increase the likelihood of complications from unsafe abortions and disproportionately affect poor people and people of color. This misguided Supreme Court decision poses a threat to life; it does not protect it.

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