LAUSR

“Happy are you, Hester, that wear the scarlet letter openly upon your bosom! Mine burns in secret....The letter was the symbol of her calling.”1 Why are we so reluctant or hesitant to say the A word out loud? Abortion is a highly prevalent procedure, with the Guttmacher Institute’s estimates of 1 in 4 US women reporting having had one by age 45 years.2 Abortion is an evidence-based, standard-of-care option, supported by numerous, respected professional societies for all persons who are pregnant. Abortion is a part of my own specialty’s board certification requirement that all obstetrics and gynecology physicians have the “knowledge, skills, and judgment relative to reproductive health rights, including access to contraception as well as to safe and legal pregnancy termination.”3 Indeed, abortion is part of comprehensive care to which every pregnant person should have access, as it is essential to routine pregnancy care. The American Board of Obstetrics and Gynecology states, “our commitment to these principles is firm and unwavering in support of OBGYNs [obstetrics and gynecology physicians] who wish to provide comprehensive reproductive health care to the patients and families they serve. Patients place their trust in the sanctity of the patient-physician relationship, and they must have confidence that their OBGYNs can provide the evidence-based counseling and care that they need without intimidation, retribution, or litigation.” The June 24, 2022, Supreme Court decision regarding Dobbs v Jackson Women’s Health Organization overturning Roe v Wade4 was not based on standard-of-care medical practice, science, nor empathy related to 50% of the US population that can experience pregnancy up to 30 to 35 years each. So, why don’t we, as health care professionals and leaders in our fields, enunciate the word abortion loudly and repeatedly? The World Health Organization estimates that more than 73 million induced abortions take place worldwide annually, 6 of 10 pregnancies globally end in induced abortion, 97% take place in developing countries, and unsafe abortion is a leading global cause of maternal mortality.5 Abortion is a safe procedure, regardless of the method, medication, or surgical procedure.6-8 Abortion is one of the most performed surgeries next to cesarean delivery (through which one-third of all births occur) and is safer than childbirth; pregnant persons are almost 14 times more likely to die during childbirth than from complications due to abortion.9 When over half the US population can potentially become pregnant for about one-third to 40% of each of their lifetimes, why is the full spectrum of safe, well-studied effective care that is a part of pregnancy care banned or severely restricted by about half of the US states? Why do we allow politicians to use abortion as a voting strategy for their career benefit? The politicization of abortion causes creation of policies that directly affect abortion access and legalization as identified in 2 studies published in JAMA this week.10,11 Access has many dimensions; it is far more than just physical distance from clinical care. However, these 2 studies clearly detail the consequence of abortion restriction on access to care with respect to distance traveled. Other barriers include emotional, logistic, and financial challenges, not to mention, many experience discrimination, distrust, health literacy, and social and economic factors further exacerbating access. Rader and colleagues10 performed a spatial analysis that depicted travel time to abortion facilities in the US to be significantly greater post– vs pre–Supreme Court decision to overturn Roe. In the post-Roe decision, the proportion of women who were located more than 60 minutes away from an abortion facility approximately doubled. They calculated the nearest abortion facility in the state of Texas increased by almost a full workday (8 hours) post-Dobbs decision. This is in the setting of Texas having over 60 000 abortions annually and a state with one of the highest rates of uninsured individuals.12,13 Similarly, White and team11 depicted a decrease in total facilitybased abortions among Texas residents in response to a Texas ban on early-pregnancy abortion in September 2021. This study detailed the impact of one state’s abortion ban on surrounding states that absorb many of those cases, including detailing potential issues with capacity resulting in prolonged wait time for appointments and thus more procedures done at advanced gestational ages. Surgical abortion after 12 weeks’ gestation often requires multiple visits and costs more for patients.14 In addition, although rare, complications can be increased with more advanced gestational ages.15 Finally, challenges of travel along with fear and disinformation could contribute to pregnant individuals self-managing their abortion or continuing their pregnancies. We need to find our path back to depoliticizing the A word. There is well-established communication research that the moment that voters decline to vote based on abortion is the minute our politicians will stop creating policies that promulgate harm impacting over 50% of the US population.16 Plain and simple, abortion is health care. In this circumstance, where the health autonomy of people who can become pregnant and their health care team is in jeopardy, we must relentlessly and without political influence defend patients’ clear autonomy along with abiding by our Hippocratic Oath to first do no harm. Abortion should never be susceptible to political whim. Abortion counseling and proviRelated articles at jama.com Opinion