I am an abortion provider in Missouri, a “Trigger Law” state. This is how life will change after Roe.

Imagine you were in a situation where, after talking with your doctor, you decided to have a common and safe medical procedure, one of the most commonly performed procedures in the United States; even safer than a colonoscopy, which is so safe that it is used as a screening test.

Now imagine that you cannot legally get this procedure in your state, and any place you might have the procedure is several hours away or a plane flight away. Your insurance will not cover this medical care. To continue, you will need to: take time off work; find childcare, transportation and accommodation; and navigate a new state and a different part of the medical system.

Even worse, you could be in legal danger to try to have this safe and common procedure, the right of which is supported by all major medical associations, including the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG).

Now that the Roe vs. Wade decision guaranteeing the right to abortion was officially overturned by the Supreme Courtthis is the reality faced by women and all pregnant people in Missouri, where I practice medicine and where a “trigger law” immediately banned all abortions “except in a medical emergency.”

Ever since medical school, I knew I wanted to provide full-spectrum reproductive health care, including abortion care. As an OB/GYN, I have cared for hundreds of patients who have been through everything from birth control failure to rape or incest to pregnancy complicated by serious fetal diagnosis. Through referrals from other OB/GYN colleagues, I have helped many patients through the devastating experience of terminating a longed-for pregnancy due to fetal or maternal medical complications. I trust my patients to make decisions about their health that are best for them, and I do my best to guide them. A question that runs through my head and keeps me up at night is: what are my patients going to do now?

Almost one in four women will have an abortion in her lifetime. And yet, laws restricting abortion are often created by lawmakers with little or no understanding of the consequences.

These laws come between clinicians and their patients and prevent doctors from doing what is best for the health of their patients. They are an attack on bodily autonomy and freedom. When I begin to think about the consequences of this court decision, a cascade of questions crosses my mind. Here are some of the questions that my colleagues and I have asked: what if my patient has a serious condition such as pulmonary hypertension, which has a mortality rate of almost 50% during pregnancy, but is not seriously ill? at this moment? Will she be able to have an abortion with her OB/GYN? Should we wait until she is seriously ill to intervene? What about my patients who need hospital procedures due to medical issues? Where can they get the care they need?

Some people will have the ability to travel and navigate this incredibly unfair new system. However, the criminalization of abortion deprives vulnerable communities of their rights. This has always been true and new restrictions will make this access chasm even wider. Vulnerable communities include low-income, LGBTQ+, Black, Indigenous, undocumented, disabled, and other people of color. Imagine how difficult it can be to get care for someone with multiple marginalized identities.

We know from “natural experiments” of maternal morbidity and mortality before and after the abortion ban in this country (as well as in other countries) that the abortion ban does not diminish not the number of abortions that occur, but that it increases maternal mortality by about 21 percent.

While not a panacea, there is one aspect of this current abortion landscape that is less terrifying than before.deer times, in terms of public health consequence – and that is the availability of medical abortion.

Medical abortion is available at a clinic, via telemedicine, or by mail, depending on where you live. Some people will choose to self-manage the abortion with pills, that is, to have a medical abortion outside of the standard health care system. Although research clearly shows that medical abortion is safe and effective, self-directed medical abortion may be criminalized depending on where you live.

Current scientific evidence overwhelmingly shows that people can safely and effectively self-manage abortions when they have access to accurate information, medical abortion (with or without a clinician), and rescue care in the rare case it is necessary. In its latest abortion care guidelines, the World Health Organization (WHO) clearly and unequivocally stated that pregnant women can safely abort alone with pills. However, self-directed abortion may put you at legal risk depending on your location.

Access to abortion pills may help mitigate some potential damage from reversal Roe vs. Wade, but it can’t undo the fact that gutting these legal protections dismantles people’s basic rights to health and bodily autonomy. I fear for the health and safety of members of my community. As an OB/GYN, I will continue to care for patients as best I can, using evidence-based medicine, and I will continue to try to lower barriers to abortion wherever possible.

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