Full-text editorial from the New England Journal of Medicine on the inhumane overturning of Roe v. Wade. Remember, this will not only make criminal obtaining or conducting an abortion, it is going to criminalize in vitro fertilization for sterile couples in states like Oklahoma as well:
Lawmakers v. The Scientific Realities of Human Reproduction
The Editors
The just-announced U.S. Supreme Court decision
in Dobbs v. Jackson Women’s Health Organization repre-
sents a stunning reversal of precedent that inserts
government into the personal lives and health
care of Americans. Yet it was not unexpected. In
the long, painful prelude to the decision, many
states have severely limited access to reproduc-
tive health care. The fig-leaf justification behind
these restrictions was that induced abortion was
a dangerous procedure that required tighter regu-
lation to protect the health of persons seeking
that care. Facts belie this disingenuous rhetoric.1,2
The latest available U.S. data from the Centers
for Disease Control and Prevention and the Na-
tional Center for Health Statistics are that ma-
ternal mortality due to legal induced abortion is
0.41 per 100,000 procedures, as compared with
the overall maternal mortality rate of 23.8 per
100,000 live births.3,4
Experience around the world has demonstrat-
ed that restricting access to legal abortion care
does not substantially reduce the number of pro-
cedures, but it dramatically reduces the number
of safe procedures, resulting in increased morbid-
ity and mortality. Millions of persons in states
lacking protections for abortion care are also
likely to be denied access to medication-induced
abortions. It may be difficult for many Ameri-
cans in 2022 to fully appreciate how complicat-
ed, stressful, and expensive, if even attainable,
their most private and intimate decisions will
become, now that Roe has been struck down. A
recent New York Times article recounted the expe-
riences of women, now in their 60s and 70s,
who sought abortions before Roe.5 They described
humiliating circumstances, unsafe procedures lit-
erally performed in back alleys, and the deep
shame and stigma they endured. Common com-
plications of illegal procedures included injury
to the reproductive tract requiring surgical repair,
induction of infections resulting in infertility,
systemic infections, organ failure, and death.6 We
now seem destined to relearn those lessons at the
expense of human lives.
Without federal protection, recent state laws
curtailing or eliminating the right to abortion care
will deny Americans’ reproductive autonomy and
create an Orwellian dystopia. Examples are the
Oklahoma law enacted on May 25, 2022, that de-
clares life to begin at fertilization and the Texas
bill enacted on September 1, 2021, that empowers
third parties to bring civil suits and collect dam-
ages against persons who perform, aid, or abet
abortions. Defendants in such suits will bear
their legal costs, while plaintiffs are indemnified
against countersuits for bringing groundless ac-
tions. Use of postcoital contraception, either hor-
monal contraception or placement of an intra-
uterine device, could be equated with abortion
and prosecuted; some jurisdictions (e.g., Missis-
sippi) are already considering such actions. A
single act of coitus not timed with respect to the
menstrual cycle has a 3% probability of causing
conception.7 After conception, approximately 14
days elapse before chorionic gonadotropin reach-
es detectable levels in maternal blood. Approxi-
mately 30% of recognized pregnancies result in
miscarriages. Thus, in some jurisdictions, people
could be prosecuted for aborting a pregnancy
by using postcoital contraception, despite a 98%
probability that their actions did not cause an abor-
tion, but there is no way to prove or disprove that
they were pregnant.
New laws in a post-Roe America declaring that
life begins at conception may have additional
ramifications. In vitro fertilization (IVF) did not
exist before Roe. Since its development in 1978,
use of IVF has grown, and 2% of all U.S. births
now result from assisted reproductive technology,
most commonly IVF.8 IVF procedures usually re-
sult in numerous oocytes ovulated per cycle, and
fertilization frequently creates numerous embryos.
Because modern IVF practice favors single-embryo
transfers whenever possible, to reduce risks of
multiple gestation and attendant complications,
unused embryos are generally frozen for poten-
tial future transfer. Nationwide, there are tens of
thousands of human embryos cryopreserved in
IVF laboratories. While “adoption” programs ex-
ist to allow persons to donate their unused em-
bryos to others who would like to implant them,
many people are uncomfortable with this op-
tion, and unused embryos are often destroyed. If
these embryos are declared human lives by the
stroke of a governor’s pen, their destruction may
be outlawed. What will be the fate of abandoned
embryos, of the people who “abandon” them,
and more broadly of IVF centers in these juris-
dictions?
For nearly 50 years, Americans have lived un-
der the protection of Roe v. Wade, free to determine
their own reproductive destinies. 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. As has been pointed out by oth-
ers,9-11 the most privileged members of U.S. so-
ciety will always be able to work around restric-
tive laws and find abortion care in jurisdictions
that permit it. Currently proposed changes in
our laws will be most burdensome and unfair to
the low-income persons and persons of color
who are least able to overcome the impediments
placed in their paths. These changes will inevi-
tably exacerbate our already vast disparities in
wealth and health.
By abolishing longstanding legal protections,
the U.S. Supreme Court’s reversal of Roe v. Wade
serves American families poorly, putting their
health, safety, finances, and futures at risk. In view
of these predictable consequences, the editors of
the New England Journal of Medicine strongly condemn
the U.S. Supreme Court’s decision.
Disclosure forms provided by the authors are available with
the full text of this editorial at NEJM.org.
This editorial was published on June 24, 2022, at NEJM.org.
1. Melbye M, Wohlfahrt J, Olsen JH, et al. Induced abortion and
the risk of breast cancer. N Engl J Med 1997;336:81-5.
2. Munk-Olsen T, Laursen TM, Pedersen CB, Lidegaard Ø,
Mortensen PB. Induced first-trimester abortion and risk of men-
tal disorder. N Engl J Med 2011;364:332-9.
3. Kortsmit K, Mandel MG, Reeves JA, et al. Abortion surveil-
lance — United States, 2019. MMWR Surveill Summ 2021;70:
1-29.
4. Hoyert DL. Maternal mortality rates in the United States,
2020. NCHS Health E-Stats, February 23, 2022 (https://dx.doi
.org/10.15620/cdc:113967).
5. Panich-Linsman I, Kelley L. Before Roe. New York Times,
January 21, 2022 (https://www.nytimes.com/interactive/2022/01/
21/opinion/roe-v-wade-abortion-history.html).
6. Harris LH, Grossman D. Complications of unsafe and self-
managed abortion. N Engl J Med 2020;382:1029-40.
7. Wilcox AJ, Dunson DB, Weinberg CR, Trussell J, Baird DD.
Likelihood of conception with a single act of intercourse: pro-
viding benchmark rates for assessment of post-coital contracep-
tives. Contraception 2001;63:211-5.
8. Centers for Disease Control and Prevention. State-specific
assisted reproductive technology surveillance (https://www.cdc
.gov/art/state-specific-surveillance/index.html).
9. The Lancet. Why Roe v. Wade must be defended. Lancet
2022;399:1845.
10. The US Supreme Court is wrong to disregard evidence on the
harm of banning abortion. Nature 2022;605:193-4.
11. Foster DG. The court is ignoring science. Science 2022;376:
779.
DOI: 10.1056/NEJMe2208288
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