Dobbs and disability: Implications of abortion restrictions for people with chronic health conditions

Abstract

The United States has a long history of undermining the reproductive autonomy of people with chronic conditions. This includes people with disabilities that are seen or unseen, and related or not related to health. The Dobbs decision, a June 2022 Supreme Court ruling which reversed the long-held constitutional right to an abortion, carries tremendous impact on all people. However, people managing chronic health conditions are particularly at risk of harm by the constellation of abortion bans and restrictions emerging across the United States. For example, people with disabilities experience disproportionate exposure to sexual violence, higher rates of unwanted pregnancy, and are at greater risk of maternal and infant mortality and morbidity.

Before Dobbs, comprehensive and medically accurate pregnancy-options counseling, inclusive of abortion, was standard of care, but the shifting legal landscape has greatly limited choice for both patients and providers. When examining states with the highest prevalence of chronic health conditions, it is concerning that these are also among the states with some of the most severe abortion restrictions. For people with chronic health conditions, reproductive autonomy is rarely prioritized in state policy, health care institutions or clinical practice; therefore, health services researchers invested in making quality care attainable for this population must weigh the implications of a present and future health care system where abortion is no longer an option.

This commentary examines the intersecting and compounding issues of ableism, racism, and sexism in producing reproductive health challenges for people with chronic health conditions in a post-Dobbs United States. We, the authors, define chronic health conditions as long term and persistent health challenges that require medical treatment or routine accommodation and recognize that although many chronic health conditions are disabilities, not all disabilities are chronic health conditions. Furthermore, people with chronic health conditions, like all people, deserve reproductive justice—“the human right to maintain personal bodily autonomy, have children, not have children, and parent the children they have in safe and sustainable communities”. Health services research as a discipline has a role to play in supporting these rights and in interrogating the systems which diminish them.