Confusion and Obstacles to Patient Care

Patients seeking women’s reproductive care in red states like Oklahoma have experienced a range of obstacles since the Supreme Court’s Dobbs decision. The rapidity of these changes has been dizzying. In a matter of weeks, women’s rights to abortion and bodily autonomy were reversed and replaced with draconian restrictions. State laws criminalize standard-of-care treatment and require doctors to delay care to women with pregnancy complications until a “medical emergency” exists or until the issue becomes “life threatening.” Some physicians refuse care that is not illegal simply because of difficulty interpreting the legal barriers. Studies already show an increase in admissions to intensive care units for pregnancy complications. Our current dismal maternal mortality rates can only increase with these restrictions on women’s health care.

Very unexpected and concerning are assumptions that laypeople make about the availability of other aspects of women’s health care. This has not gained much attention but also concerns me greatly and will require education to overcome. Soon after the Dobbs decision, a patient asked me, “Will I be required to have my IUD removed?” Other patients inquire about continued availability of contraception. I visited with my local public radio news staff, and they have multiple women sending them questions such as “Can I still go in for my annual gynecologic exam?” These are intelligent women who are listening to media reports of criminalization of care and extrapolating it to services beyond abortion. How many women will be harmed when they fail to seek care because of this confusion?

A privately insured patient in our practice was denied payment of a claim following her emergency salpingectomy for ectopic pregnancy. The note accompanying the denial stated: “Due to the recent overturn of Roe v. Wade, we do not cover this diagnosis code.” The claim had been coded correctly, and further inquiries led to the discovery that denying this code was not the insurance plan’s policy. The clerk processing the claim unilaterally chose to decline payment based on her own beliefs. It took many contacts with the insurer and patient’s employer to realize this overreach and lead to payment of the claim. How many patients and practices will not recognize this type of interference and fail to advocate for the patient?

The Dobbs decision denies women bodily autonomy to make decisions about abortion care, so it really should come as no surprise that health care professionals, laypeople, and legislators assume restrictions apply to other aspects of reproductive health care as well. Now that the law has defined women as lesser human beings who lack inherent rights, one can only expect further erosion of the ability to make personal decisions free of government and private policy interference.

Disclaimer: Published submissions reflect the experiences of individual ACOG members and may not represent official organizational opinions of ACOG. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. It does not constitute legal advice; clinicians should be familiar with and comply with federal, state, and local restrictions on abortion, including medication abortion, and are encouraged to consult with a lawyer when navigating local abortion laws and regulations. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of a treating clinician.

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