State Laws and Court Decisions Bring More Uncertainty to Reproductive Health
April 1, 2024
In recent months, abortion-ban states have seen even more drastic bills and changes to their citizens’ reproductive health and lives. While abortion bans have closed clinics and prevented physicians from providing standard care to women experiencing pregnancy crises, the states have gone even further, now threatening contraceptives and fertility treatment.
For example, the Oklahoma State Legislature advanced House Bill 3216, named Oklahoma Life Is a Human Right Act. State Democrats and abortion rights groups say it will ban intrauterine devices (IUDs) and over-the-counter emergency contraception and will create a state database of people who had an abortion.1
It has these features:
- Defines pregnancy as starting at fertilization;
- Declares that the term “abortion” is not used to describe medical care that removes “a dead unborn human being caused by miscarriage,” or to “remove an ectopic pregnancy,” or to “perform a pre-viability separation procedure when such procedure is necessary to preserve the life of the pregnant woman”;
- Bans people from knowingly administering, prescribing, or selling an abortion drug to any pregnant woman. Violations would lead to physicians losing their medical license;
- Requires physicians to “make reasonable medical efforts under the circumstances to preserve both the life of the pregnant woman and the life of her unborn child in a manner consistent with reasonable medical practice” when performing a previability separation procedure permitted by the law;
- Requires physicians to file a state health report of any “pre-viability separation procedure” performed;
- Bans drugs and devices intended to prevent implantation of a fertilized egg.
The new bill appears to amplify the abortion ban already in place in Oklahoma since the Supreme Court overturned Roe v. Wade in June 2022.
According to an Oct. 24, 2023, #WeCount Report by the Society of Family Planning, the number of abortions provided in Oklahoma dropped from more than 400 in April 2022 to fewer than 10 each month after the abortion ban was enforced.2
Abortion rights advocates have predicted that some forms of contraception would be targeted in abortion-ban states, including emergency contraception and IUDs because of misconceptions about how they work. Anti-abortion groups say IUDs and emergency contraception prevent implantation of fertilized eggs, even though research shows this is not the case. The primary mechanism of action of emergency contraception is to inhibit or delay ovulation, according to the American College of Obstetricians and Gynecologists.3
Attacks aimed at limiting people’s access to highly effective contraception feeds into fears about becoming pregnant in a hostile environment for people who would choose abortion. This could be contributing to increased demand for permanent contraception.
“We saw an increase in desire for and completion of permanent contraception — both female and male procedures,” says Kavita Shah Arora, MD, MBE, MS, division director in the division of general obstetrics and gynecology and an associate professor with tenure at the University of North Carolina at Chapel Hill. “It is unsettling that patients may desire permanent surgery due to these external political pressures.”
Another recent change is the Alabama Supreme Court’s decision in a “wrongful death” case that zygotes and embryos created via in vitro fertilization (IVF) treatment of infertile couples have the same rights as babies and children.4
Alabama has enforced an abortion ban since June 2022. The state’s attorney general threatened to prosecute anyone who helped someone travel to another state for abortion care. Now, the state’s top judges say that an 1872 statute pertaining to the wrongful death of a minor child applies to unborn children, with no exception for “extrauterine children.” Chief Justice Tom Parker’s opinion cited Christian biblical scripture in his rationale for the decision.4
Reproductive medicine advocates and scientists said the decision could end common practices in IVF, such as freezing embryos. They predict that physicians will not want to train and practice fertility care medicine in Alabama as a result of the court ruling.4
“In its medically and scientifically unfounded decision, the court held that a fertilized frozen egg in a fertility clinic freezer should be treated as the legal equivalent of an existent child or a fetus gestating in a womb,” Paula Amato, MD, president of the American Society for Reproductive Medicine, said in a media statement. “By insisting that these very different biological entities are legally equivalent, the best state-of-the-art fertility care will be made unavailable to the people in Alabama. No healthcare provider will be willing to provide treatments if those treatments may lead to civil or criminal charges.” If it stands, the decision will end modern fertility care in Alabama, she predicted.5
Court decisions and state laws based on the “personhood” of embryos and fetuses continue to be promoted in other states — even in states that currently protect abortion rights, such as Kansas. The state’s law allows abortions up to 22 weeks after gestation and later in pregnancy if the mother’s life is in danger.6
In February, Kansas Republicans promoted legislation to allow women to receive child support at any time after the date of conception. State Bill 425 in Kansas would change its family statute to include “unborn children” in the legal definition of child. Courts would be required to include medical and pregnancy-related expenses as factors they consider when deciding child support. Abortion care is excluded. The bill’s goal appears to be to make it easier to enact anti-abortion laws, according to critics.6
Florida also is toying with fetal personhood through House Bill 651 and Senate Bill 476, which would allow wrongful death lawsuits over abortions or the intentional end of pregnancy at any stage, even if the fetus would never have survived to birth. Anti-abortion advocates said the bill did not go far enough because it does not protect the unborn children that are frozen as human embryos. On Feb. 26, the bill’s sponsor postponed the legislation in light of the Alabama ruling.7
REFERENCES
- State of Oklahoma 2nd Session of the 59th Legislature. House Bill 3216. 2024. http://webserver1.lsb.state.ok...
- Society of Family Planning. #WeCount Report, April 2022 to June 2023. Oct. 24, 2023. https://societyfp.org/wp-conte...
- Downing NR, Avshman E, Valentine JL, et al. Forensic nurses’ understanding of emergency contraception mechanisms: Implications for access to emergency contraception. J Forensic Nurs 2023;19:150-159.
- Rabin RC, Ghorayshi A. Alabama rules frozen embryos are children, raising questions about fertility care. The New York Times. Feb. 20, 2024. https://www.nytimes.com/2024/0...
- Amato P. ASRM condemns profoundly misguided and dangerous court decision in Alabama. Feb. 18, 2024. https://www.asrm.org/news-and-...
- Mipro R. New legislation would redefine fetuses as Kansas children. Kansas Reflector. Feb. 12, 2024. https://kansasreflector.com/20...
- Ellenbogen R. Florida’s unborn child wrongful death bill appears stalled. Tampa Bay Times. Feb. 26, 2024. https://www.tampabay.com/news/...
In recent months, abortion-ban states have seen even more drastic bills and changes to their citizens’ reproductive health and lives. While abortion bans have closed clinics and prevented physicians from providing standard care to women experiencing pregnancy crises, the states have gone even further, now threatening contraceptives and fertility treatment.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content