Updated on February 22, 2024.
The Supreme Court of Alabama recently ruled that frozen embryos may be considered children under state law. The ruling has raised concerns about how it could affect in vitro fertilization (IVF)—one of the most widely used types of assisted reproductive technology (ART). In the U.S., about 4 million births each year, or roughly 1 to 2 percent of all births, are the result of IVF.
Following the Alabama Supreme Court's ruling, the University of Alabama at Birmingham Hospital paused IVF treatments as the decision may make clinics and medical centers vulnerable to lawsuits or criminal prosecution.
Why this is happening
For half a century, Americans lived under the protection of Roe v. Wade, the 1973 Supreme Court ruling which established the constitutional right to abortion. On June 24, 2022 the Court overturned Roe in a 5-4 decision, holding that this federal constitutional right no longer exists. As a result, people will lack access to abortion in many parts of the country as states move to restrict or outlaw the medical procedure.
The United States is now one of only four countries to roll back protections for safe and legal abortions in more than 25 years.
“At a time when dozens of other countries around the world are codifying protections for reproductive decision making for their citizens, we are turning the clock backward to take these rights away from our citizens,” the editors of the New England Journal of Medicine (NEJM) commented in a June 24 editorial.
Wading through political rhetoric and religious ideals, health experts in the U.S. and around the world have sought to clarify and reinforce one guiding principle: Abortion is health care.
Understanding the medical procedure
The American College of Obstetrics and Gynecology (ACOG) points out that abortion is included in the core curriculum and examination for physicians seeking to specialize and become board certified in the field of obstetrics and gynecology. The group has also issued several evidence-based practice guidelines and official statements on abortion for healthcare professionals, noting it’s “an essential component” of health care.
And like any other medical issue and treatment, ACOG concludes that decisions about abortion should be private, confidential, and made by patients with the help and guidance of their healthcare team.
The reasons why abortions may be sought or necessary are rarely simple. Birth control failure, lack of access to birth control, rape, incest, intimate partner violence, abnormalities with a fetus, illness during pregnancy, and exposure to medications that can affect the development of an embryo or fetus are all possible factors that may be involved.
Potentially fatal complications can also arise during pregnancy, such as placental abruption (when the placenta separates from the wall of the uterus), bleeding from placenta previa (when the placenta completely or partially covers the cervix), preeclampsia or eclampsia (types of high blood pressure) as well as heart and kidney conditions. In these cases, abortion may be the only option to save lives and preserve maternal health, ACOG points out.
When access to healthcare is denied
Like any other health issue or condition, lacking access to potentially lifesaving therapies has dire consequences.
When carried out by trained healthcare professionals in a medical setting, abortion is safe. When faced with barriers to care, however, pregnant people often resort to dangerous alternatives, according to the World Health Organization (WHO). In places where abortion is illegal, pregnant people may self-inflict abdominal harm, consume drugs or dangerous chemicals, or rely on unqualified abortion providers.
About 21 million people around the world undergo unsafe, illegal abortions each year, the WHO reports. Unsafe procedures can result in injury to the reproductive tract, infection, organ failure, and death. In fact, complications associated with these dangerous procedures account for about 13 percent of all maternal deaths.
Decades of research shows that laws which ban or restrict abortions are not only detrimental to the physical safety of women and girls, but also their social and mental well-being. Denying access to abortion services may contribute to more stress, anxiety, and depression.
The reversal of Roe, however, has other, far-reaching ramifications:
Certain groups will be disproportionately affected. The Supreme Court ruling does not immediately ban abortion across the U.S. The Roe reversal makes abortion access a state decision. Those who are physically able and have the necessary resources may seek out, find, and travel as far as necessary to obtain the care they need.
Laws that deny or restrict access to abortion will not only threaten the lives of those facing medical emergencies but also target those with low incomes, people of color, sexual and gender minorities, and those living in rural or medically underserved communities, the editors of the NEJM caution.
Pregnancy comes with inherent risks. But it’s even riskier for people who face racial health disparities and lack access to quality prenatal care. Black pregnant people are three times more likely to die from pregnancy-related causes than those who are white, the Centers for Disease Control and Prevention (CDC) reports. Restricting access to abortions takes away the power for pregnant people to decide for themselves what risks they are willing and able to accept.
It may affect treatment for a range of other conditions. The drug, Mifeprex (mifepristone) is used in combination with another medication called misoprostol, to end an early pregnancy. Mifepristone, which works by blocking the hormone progesterone, also blocks the stress hormone cortisol when given at higher doses. It’s been used to effectively treat Cushing’s syndrome, a rare disease marked by high levels of cortisol. The drug is also under investigation as a treatment for a range of conditions, including certain forms of cancer, endometriosis, mood disorders, and psychosis. The Roe reversal could complicate access to mifepristone in some areas or disrupt ongoing research into the drug’s other therapeutic uses.
It may negatively affect assisted reproduction, like IVF. The landmark Roe v. Wade decision in 1973 predated the first successful attempt at in vitro fertilization (IVF) by five years. Right now, about 2 percent of all U.S. births result from IVF and other assisted reproductive technologies, which may result in multiple embryos. In addition to the recent Alabama Supreme Court ruling and pause of IVF treatment by the University of Alabama at Birmingham Hospital, the reversal of Roe may affect other standard IVF procedures, such as selective reduction, which are designed to protect pregnant people and their fetuses. The Court’s decision also calls into question the fate of thousands of unused embryos, the editors of the NEJM cautioned.
Evidence suggests abortion rates will not fall significantly. Years of data show that restricted access to abortion doesn’t stop pregnant people from getting abortions, according to the Guttmacher Institute, a U.S.-based reproductive health non-profit. It does, however, prevent them from obtaining safe abortions. The group notes that death rates may climb as a result of the Court’s decision.
Making abortion less necessary
Making abortions illegal may not prevent them from happening but making them less necessary might, according to the American Progress Action Fund, an independent nonpartisan policy institute. The group cited the need for access to adequate education about reproductive health, quality prenatal care as well as health care to prevent and manage chronic disease, insurance coverage for family planning, greater access to effective birth control, including emergency contraception, and social programs designed to prevent domestic violence and sexual abuse.
Family support programs are essential to assist parents physically, mentally, and economically in the postpartum period, such as paid maternity and paternity leave. Those facing health disparities due to social determinants, like race and poverty, also need greater access to education, job opportunities, healthcare, childcare, low-income housing, services for disabled children and other essential resources required beyond pregnancy and birth.
