For 50 years, debates on abortion in the United States and in Missouri have been sucked into a hellish political vortex. More recently, birth control, medication abortion and fertility treatment have been entangled in the political game being played with women’s rights and health.
With an understanding of history and the current situation, perhaps this issue can be returned to women and the medical profession.
Lest anyone place all the blame on politicians, policing of women’s bodies in the American colonies can be traced to a 1625 statute adopted from Britain that asserted women who gave birth to stillborn children would be found guilty of infanticide if they hadn’t taken certain steps to prepare for the birth: preparing the appropriate child bed linens, for example.
America’s first anti-abortion movement in 1857 was driven by physicians on a mission to regulate medical care. The American Medical Association took aim at the purview of midwives who historically provided women’s health care. Midwives were competition. The AMA began a letter writing campaign that resulted in anti-abortion laws going on the books in most states by 1880.
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Fast forward to today’s political vortex. While The American College of Obstetricians and Gynecologists opposes to any effort that impedes access to abortion care, some politicians in the U.S. and Missouri with no comprehensive medical education continue attempts to trample women’s ability to choose their medical care.
This trampling is having untoward emotional, physical and financial effects on women, physicians in training, physicians in practice, medical schools and hospitals’ medical ethics committees.
The gynecological training of medical residents was interrupted in June 2022 (including at Washington University) with the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which effectively overturned Roe v. Wade and its nearly half-century of constitutional protections for abortion rights. Missouri and multiple other states almost immediately instituted abortion bans; some states revived bans that had been on their books in the 1800s.
In Missouri, Constitutional Amendment 3 would restore reproductive legal rights as they stood under Roe, if the state’s voters approve it on Nov. 5.
Meanwhile, similar to the experiences of University of Wisconsin, medical schools in Missouri that would send OB/GYN residents for GYN training in states where abortion remains legal will incur financial costs of travel, housing, malpractice insurance, out-of-state licenses. The residents at U of W had to leave their families, spouses, children and pets for weeks at a time. The work burden in their absence was added to the residents who remained behind.
“Physicians are experiencing moral injury that occurs when health care professionals know the right thing to do but are prevented from taking action by external forces,” reported the New England Journal of Medicine (NEJM) on Sept. 26. “This situation poses a significant threat to the current OB/GYN work force in our country which has the highest maternal mortality [death rate] among all high income countries. The 2022 Dobbs decision purports to advance the good of the embryo or fetus. But no one can truly value an embryo or fetus if they devalue the woman carrying it.”
A state’s laws show what its lawmakers value.
“Violence against women, including rape, intimate partner violence, and firearm-related injury and homicide, receives far too little attention from policymakers and courts,” wrote NEJM July 25. “Post Dobbs, states that have implemented abortion bans have further signaled that women’s reproductive autonomy and safety are expendable.”
Missouri colleges and universities saw a 25% drop in OB/GYN residency applicants decrease in 2023 OB/GYN residency applicants since abortion became almost entirely illegal in mid-2022, according to a report by the Association of American Medical Colleges. Missouri needs every OB/GYN it can possibly attract. Women’s health depends on not driving even one OB/GYN away.
It is estimated that there is approximately one OB/GYN for about every 1,050 Missouri women of childbearing age. OB/GYNs are increasingly women, which means they need good maternal care in Missouri if they choose to have a family.
Missouri ranks 40th out of 51 states plus the District of Columbia in women’s health and reproductive care, according to the 2024 state scorecard on women’s health and reproductive care published by the Commonwealth Fund. More than 41% of counties in Missouri have no maternity providers or birthing facilities. Missouri scored a D- grade for preterm births in a 2023 March of Dimes report.
And due to political action in Jefferson City this year, Planned Parenthood in Missouri is now prohibited from being reimbursed for serving Medicaid patients, thus depriving them of cancer screenings and wellness checks as well.
Missouri citizens should ponder who and what is stopping Missouri from becoming a leader in valuing women and their health.
The Missouri Right to Reproductive Freedom Amendment, or Amendment 3, will be on Missouri’s Nov. 5 ballot this year. The proposal recently defeated a court challenge by anti-abortion opponents. Video by Jenna Jones.
Cooksey is a retired nurse with extensive experience working with women during their prenatal, birth and postpartum care, as well as teaching first-year Washington University medical students for 13 years at the bedside in labor and delivery.
