Navigating the Storm: Building Institutional Solutions in the Face of Restrictive Abortion Laws
By: Justin Lappen, MD, Chair, SMFM Reproductive Health Advisory Group
The aftermath of the Dobbs decision sent shockwaves through our MFM community in Ohio, as state officials swiftly acted to restrict abortion care by overturning the injunction on the fetal “heartbeat” bill. At that critical moment, an interdisciplinary collaborative effort to unite healthcare professionals and institutions emerged as a source of hope and a potential model for other states and networks. We brought together a team of clinicians from various disciplines, department chairs, and legal experts from hospitals across the state to navigate the new landscape in Ohio with the goal of standardizing care in our hospital and developing a uniform interpretation of the law statewide.
The actions we took in Ohio can serve as a model in your state and institutions, and you can learn more about this work through a free webinar, Statewide and Regional Strategies: Networks and Partnerships for Access, available on the SMFM website. Below are action elements to consider in your own communities:
Partner with experts in reproductive health law. To address the complex legal landscape, we clinicians sought the expertise of legal professionals well-versed in constitutional law and reproductive health. While hospital counsel typically possess a wide breadth of general legal knowledge, they can lack specialized expertise in reproductive health law. Collaborating with experts at law schools affiliated with our institutions helped to ensure our accurate interpretation of laws and prevent the implementation of institutional policies more restrictive than state law. For those without reproductive health-related legal expertise within their institutions, the Abortion Defense Network can provide pro bono support.
Form an institutional task force. Creating an institutional task force was a crucial step in addressing the issues raised by restrictive abortion laws. The task force, comprised of representatives from various disciplines and hospital leadership, worked together to navigate the complexities of the legal landscape while prioritizing open lines of communication and a comprehensive patient-centered approach to reproductive health care. Meaningful discussions about abortion care were actively pursued with emergency room personnel, primary care providers, pediatricians, and adolescent specialists, significantly enhancing patient care. We also emphasized the importance of involving other departments in pre-pregnancy care discussions, referrals, and the provision of contraception, thereby reinforcing our commitment to reproductive health services.
Engage institutions across the state. By engaging with institutions across the state, we established a strong network for collective clinical advocacy. This led to more consistent interpretation of the law across institutions and fostered seamless communication and referral pathways among healthcare professionals, enabling them to work together more efficiently.
Encourage responsible corporate citizenship. Sustainable structural and institutional solutions are crucial to ensuring continued access to reproductive health care, and encouraging responsible corporate citizenship is vital to safeguard the well-being of patients and communities. By identifying allies and partnering with department chairs and hospital leadership, we were able to advocate for institutional approaches to improving access to care, such as dedicated contraceptive clinics and prenatal care scheduling adaptations that facilitate earlier visits. During public health crises like this one, allocating resources to maintain quality of care should be a top priority, and neglecting these responsibilities can cause harm, including the exacerbation of health disparities.
Additional suggestions for action are available from SMFM and leaders in our field. In addition, you can connect with others in your state concerned about policy impacts on public health and access to care by joining the SMFM State Liaison Network. Together, we can more effectively navigate these challenging times and advocate for equitable reproductive health care for all.
Justin Lappen, MD, is a maternal-fetal medicine (MFM) subspecialist in Cleveland, Ohio, and the Chair of the Society for Maternal-Fetal Medicine’s Reproductive Health Advisory Group.
Brianna Alfaro contributed to this post. She is an MPH candidate at Emory University and an intern at SMFM.