In medical school, we first learn about human anatomy and physiology. Then, we progress to understanding diseases and their treatment. Integral to this process is learning how to make medical decisions. In this, we are taught two major tenets: to respect patient autonomy and to adhere to evidence-based care.
Our future role as physicians is to provide patients with the information they need to make decisions best for their health and well-being. These core principles are being threatened for women seeking legal abortion in Missouri and across the United States.
Legislators are creating laws and regulations that alter medical care and violate these fundamental values of autonomy and evidence-based medicine. House Bill 126, which was signed by Gov. Mike Parson in May, is one of these laws. Although a federal judge has stopped the bill from going into effect, the effort to intervene in the doctor-patient relationship is far from over.
Banning abortion after eight-weeks gestation, as this law sought, would prohibit women from making certain health care decisions before many even know they are pregnant. For current and future health care providers in Missouri, we face a troubling conflict between following laws and following evidence-based practices and our patients’ choices.
Extensive data show that abortion is one of the safest medical procedures. In fact, maternal mortality decreases when safe, legal abortion is available. However, maternal mortality is rising in the United States, and women today face a greater risk of dying during and right after pregnancy than their mothers. Unfortunately, Missouri has the eighth-highest maternal mortality rate of any state.
Geographic location, income and race are some of the many factors that contribute to the heath care disparities propagating this crisis. To address the increase in maternal mortality, we need to improve women’s reproductive health care, not further restrict access. Multiple professional medical societies, including the American Medical Association and American College of Obstetrics and Gynecology, oppose laws such as HB 126 because these laws do not protect women; rather they put women’s health and lives at even greater risk.
As medical students in Missouri, along with our colleagues across the U.S., making decisions about what field of medicine to enter, where to train, and ultimately where to practice, laws like HB 126 will shape our decisions. One in 4 women in the United States will have an abortion during their lifetimes. To put this number into perspective, 1 in 10 Americans will develop diabetes. To provide comprehensive reproductive care for women, regardless of our personal beliefs, we must be exposed to abortion care during medical school and during residency training.
Concerns about the future of obstetrics and gynecology and the role of politics in medical practice will impact whether students decide to enter into this field. Students who are passionate about providing women’s health care may choose to train in another state where they know they can receive the training necessary to provide comprehensive reproductive health care as physicians. Ultimately, they may choose to practice in a state where they can provide women with the care they desire.
Furthermore, these laws will undoubtedly contribute to physician burnout and dissatisfaction, as physicians are forced to abide by burdensome restrictions that prohibit them from being able to provide compassionate care. Missouri already faces significant provider shortages and poor health outcomes when compared to many of our neighbors. Laws like HB 126 will compound these issues, and Missouri women deserve better.
A solution to this conflict is to treat abortion no differently than any other procedure in medicine. We must return to the core principles of patient autonomy and evidence-based care to ensure that medicine is dictated by facts, not ideology. The decision to become pregnant and the decision to remain pregnant is deeply personal and should be treated as such. We must return medical decision-making back to the provider and patient. We are already receiving the medical education necessary to provide excellent reproductive care to patients; we just need to be able to practice it.
Bronwyn Bedrick and Samantha Lund are medical students at Washington University in St. Louis.