Journal of Science Policy & Governance
Volume 25, Issue 01 | October 28, 2024

Policy Brief: Navigating the Post-Dobbs Landscape: A Roadmap for Interstate Abortion Care 

Stella A. Fors1, Alexis R. Myers2, Marlotte C.L. de Jong3, Meredith K. Sutton4, Sophia Vicente5
  1. Northwestern University, Department of Chemistry, Evanston, IL, USA
  2. National Renewable Energy Laboratory, Golden, CO, USA
  3. University of Michigan, School for Environment and Sustainability, Ann Arbor, MI, USA
  4. University of Nebraska - Lincoln, Department of Civil and Environmental Engineering, Lincoln, NE, USA
  5. Elizabethtown College, School of Engineering and Computer Science, Elizabethtown, PA, USA
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​Corresponding author:  [email protected] ​​​
Keywords: Dobbs v. Jackson; abortion; maternal health; provider shield laws; telehealth; reproductive justice; healthcare infrastructure
https://doi.org/10.38126/JSPG250105

Executive Summary

In June 2022, the Supreme Court issued an unprecedented ruling in the case of Dobbs v. Jackson, revoking the constitutional right to abortion for the first time in 50 years. To date, fourteen U.S. states have completely banned abortion. Consequently, individuals residing in states with restrictive legislation are forced to travel to neighboring states to access abortion care and other reproductive services. Extended travel time disproportionately affects individuals from communities of color, low-income patients, and rural residents, increasing the risk for maternal health complications and death. The United States holds the highest maternal mortality rate among developed nations, with 33 deaths per 100,000 births (Katella 2023). Alarmingly, 84% of these deaths are considered preventable (Katella 2023). Thus, it is imperative that state healthcare policymakers prioritize equitable access to comprehensive reproductive healthcare for all patients (Katella 2023). This care should incorporate strategies to decrease on-site patient volume, such as implementing shield laws to protect abortion providers treating out-of-state patients, enhancing telehealth services for abortion medication services, and incentivizing the establishment of physical infrastructure. For state officials in destination states, specifically the 23 governors of the non-partisan Reproductive Freedom Alliance, we recommend immediately prioritizing the establishment and anticipated enforcement of provider shield laws. To ensure widespread and equitable access to reproductive healthcare services, a more robust three-tiered approach is outlined herein, prioritizing: (1) shield laws, (2) telehealth services, and (3) physical infrastructure.

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Background header image courtesy of newrepublic
Stella Fors is a Ph.D. candidate at Northwestern University and a former Christine Mirzayan Science and Technology Policy Fellow at the National Academies of Sciences, Engineering, and Medicine (NASEM). During her fellowship, she contributed to the Committee on Science, Technology, and Law, focusing on the intersections of legislation with scientific and medical issues, including abortion access and deaths in custody. Previously, Stella served as a technical writer for Northwestern’s Science Policy Outreach Taskforce and acted as a university-sponsored observer at the UNFCCC’s Conference of the Parties 28. She is dedicated to connecting legislators with scientific experts and developing evidence-based solutions for complex challenges at the intersection of science, law, and emerging technology.

Alexis R. Myers, PhD (she/her) is a researcher at the National Renewable Energy Laboratory. She specializes in renewable energy planning that focuses on community involvement and researches human factors that affect energy use patterns and technology uptake. Alexis is also a former Christine Mirzayan Science and Technology Policy Fellow at the National Academy of Sciences, Engineering, and Medicine, where she worked on the Board on Gulf Education and Engagement on strategies to increase and maintain engagement with historically black colleges and universities in the Gulf region. Alexis strives to leverage her scientific and policy knowledge to empower marginalized communities and spark grassroots movements for change.

Marlotte (Lotte) de Jong (she/her) is a Ph.D. candidate at University of Michigan and a former Christine Mirzayan Science and Technology Policy Fellow at the National Academy of Sciences, Engineering, and Medicine (NASEM) with the Board on Environmental Change and Society. In addition to her academic pursuits, Lotte is a Resource Mobilization Coordinator for The World Agroforestry Center and the Center for International Forestry Research, where she supports scientific teams to develop mechanisms for policy and research advancement. With a passion for community engaged work, she strives to encourage the plurality of environmental knowledge and its merging with policymaking.

Meredith K. Sutton (they/them) is a Ph.D. student at the University of Nebraska – Lincoln and a former Christine Mirzayan Science and Technology Policy Fellow at the National Academy of Sciences, Engineering, and Medicine with the Water Science and Technology Board. Their research explores the impact of microplastic and nitrate contamination on water quality in agricultural environments as well as methods to facilitate more inclusive participation in citizen science. They are a strong advocate for making science and engineering accessible to all audiences and are passionate about connecting scientists with communities and local policymakers to encourage evidence-based solutions to policy questions.

Sophia Vicente, Ph.D. (she/her) is an engineering education researcher and a former Christine Mirzayan Science and Technology Policy Fellow at the National Academy of Sciences, Engineering, and Medicine with the Science and Engineering Capacity Development unit. Her research focuses on STEM workforce development and experiential learning. Sophia is currently supporting a $1.2 Million National Science Foundation grant to launch and evaluate the Greenway Center for Sustainability and Equity in Engineering. She is passionate about connecting research, practice, and policy.

Disclaimer 
The findings, conclusions and recommendations published herein are solely attributed to the authors and do not necessarily reflect the official position of their respective institutions.​

References

  1. Alfonseca, Kiara. 2022. "Why abortion restrictions disproportionately impact people of color." ABC News. June 24, 2022. ​https://abcnews.go.com/Health/abortion-restrictions-disproportionately-impact-people-color/stor y?id=84467809.
  2. Andino, Juan J, Nicholas W. Eyrich, and Richard J. Boxer. “Overview of telehealth in the United States since the COVID-19 public health emergency: a narrative review.” mhealth. 9, no. 26 (2023). https://doi.org/10.21037/mhealth-23-15.
  3. Archambault, Josh, Vittorio Nastasi and Ally Perkins. “State Policy Agenda for Telehealth Innovation: 2024 Update.” Cicero Institute. 2024. https://reason.org/wp-content/uploads/2024-state-policy-agenda-for-telehealth-innovation.pdf. 
  4. Banerjee, Asha. “The economics of abortion bans.” Economic Policy Institute. January 18, 2023. https://www.epi.org/publication/economics-of-abortion-bans/
  5. BBC. "Texas abortion: Doctor sued in first known challenge of new law." BBC. September 20, 2021. https://www.bbc.com/news/world-us-canada-58633515
  6. Belluck, Pam. “Abortion Shield Laws: A New War Between the States.” New York Times. February 22, 2024. https://www.nytimes.com/2024/02/22/health/abortion-shield-laws-telemedicine.html. 
  7. Beam, Adam. "California Budget to Cover Some Out-of-State Abortion Travel." KQED. August 28, 2022. https://www.kqed.org/news/11923873/california-budget-to-cover-some-out-of-state-abortion-travel
  8. Carey, Julie. “Alexandria Poised to Clear Zoning Hurdles for Abortion Clinics.” NBC Washington. March 31, 2023. https://www.nbcwashington.com/news/local/alexandria-poised-to-clear-zoning-hurdles-for-aborti on-clinics/3319998/
  9. Center for Connected Health Policy (CCHP). “Cross State Licensing.” 2024. https://www.cchpca.org/topic/cross-state-licensing-professional-requirements/. 
  10. Cohen, David, Greer Donely and Rachel Rebouche. "Abortion Shield Laws." NEJM Evidence 2, no. 4 (2023). https://doi.org/10.1056/EVIDra2200280
  11. Columbus School of Law. “Legislation, Regulation, and Public Policy.” The Catholic University of America (2024). https://www.law.edu/academics/pathways/pathway-legislation.html 
  12. Davis, Martha. “Down Where the Grass Grows”: Municipal Abortion Policies After Dobbs.” Colorado Law Review 95, no. 2 (2024). https://lawreview.colorado.edu/print/volume-95/down-where-the-grass-grows-municipal-abortion-policies-after-dobbs/
  13. Department of Health and Human Services. “Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-for-Service, and Medicaid Managed Care Programs for Years 2020 and 2021.” Federal Register 83, no. 212 (November 1, 2018): 54982. https://www.govinfo.gov/content/pkg/FR-2018-11-01/pdf/2018-23599.pdf.
  14. Dobbs v. Jackson Women’s Health Organization. 597 U.S. (2022). https://www.supremecourt.gov/DocketPDF/19/19-1392/193084/20210920175559884_19-1392bs acEconomists.pdf
  15. Emmet, Shannon. "Illinois Steps Up to Meet Rising Regional Needs for Reproductive Care." Institute for Women's Policy Research. November 30, 2023. https://iwpr.org/illinois-steps-up-to-meet-rising-regional-needs-for-reproductive-care/. 
  16. Gray, Veronica, Stephanie Green, Ariel Adelman and Blen Asres. "Black Women's Maternal Health." National Partnership for Women and Families. December 2023. https://nationalpartnership.org/wp-content/uploads/black-womens-maternal-health.pdf. 
  17. Grossman, Daniel and Nisha Verma. “Self-managed abortion in the US.” Jama, 328, no. 17 (2022). DOI:10.1001/jama.2022.19057. 
  18. Guttmacher. “State Bans on Abortion Throughout Pregnancy.” last modified July 29, 2024. https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans 
  19. Harris, Lisa H., and Daniel Grossman. "Complications of unsafe and self-managed abortion." New England Journal of Medicine 382, no. 11 (2020): 1029-1040. http://doi.org/10.1056/NEJMra1908412. 
  20. Hunter, Caitlin, Joshua Jensen, Biaka Imeah, Michelle McCarron and Megan Clark. "A Retrospective Cost-Effectiveness Analysis of Mifepristone-Misoprostol Medical Abortions in the First Year at the Regina General Hospital." J Obstet Gynaecol Can. 43 (2): 211–218. August 25, 2022. http://doi.org/10.1016/j.jogc.2020.08.008.
  21. Katella, Kathy. “Maternal Mortality Is on the Rise: 8 Things To Know.” Yale Medicine. 2023. https://www.yalemedicine.org/news/maternal-mortality-on-the-rise. 
  22. KFF. "Abortion Policy Tracker." State Health Facts. KFF. Last modified November 2, 2023. https://www.kff.org/other/state-indicator/abortion-policy-tracker/
  23. KFF. “The Availability and Use of Medication Abortion.” KFF Women’s Health Policy. March 20, 2024. https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/
  24. Koenig, Leah R. "The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis." JMIR Public Health Surveillance 9 (2023). http://doi.org/10.2196/45671. 
  25. Maddow-Zimet, Issac, Kelly Baden, Rachel K Jones, Isabel DoCampo, and Jesse Philbin. “New State Abortion Data Indicate Widespread Travel for Care.” Guttmacher Institute. September 7, 2023. https://www.guttmacher.org/2023/09/new-state-abortion-data-indicate-widespread-travel-care. 
  26. Marblestone, Claire and Samantha Robbins Jamali. “A Post Roe World: California's Response to Dobbs v. Jackson Women's Health." Foley and Gardner LLP. August 29, 2022. https://www.foley.com/insights/publications/2022/08/post-roe-world-california-response-dobbs-v -jackson
  27. Myers, Caitlin. “Myers Abortion Facility Database.” Center for Open Science (OSF). 2021. http://doi.org/0.17605/OSF.IO/8DG7R. 
  28. National Committee for Quality Assurance (NCQA). “Taskforce on Telehealth Policy (TTP): Findings and Recommendations.” NCQA. September, 2020. https://www.ncqa.org/wp-content/uploads/2020/09/20200914_Taskforce_on_Telehealth_Policy_ Final_Report.pdf.
  29. Nixon, Nicole, Scott Maucione, Rick Pluta, Bente Birkeland, Mawa Iqbal, Dirk VanderHart, Dana Ferguson and Molly Ingram. "A year since Dobbs, there are many ways states are protecting abortion." NPR. June 23, 2023. https://www.npr.org/2023/06/23/1183646356/dobbs-roe-abortion-protections-illinois-maryland michigan-colorado-minnesota.
  30. Office of Governor Gavin Newsom. “California Expands Access and Protections for Reproductive Health Care.” State of California. September 27, 2023. https://www.gov.ca.gov/2023/09/27/california-expands-access-and-protections-for-reproductive health-care/
  31. Planned Parenthood of Se. Penn. v. Casey. 505 U.S. 833. (1992). 
  32. Predmore, Zachary and Julia Rollison. "Telemedicine Abortion? It's Not as Easy as It Sounds." RAND. August 19, 2022. https://www.rand.org/pubs/commentary/2022/08/telemedicine-abortion-its-not-as-easy-as-it-soun ds.html.
  33. Price, Asher. “Texas and other states crack down on abortion pills.” Axios. June 23, 2022. https://www.axios.com/local/austin/2021/12/15/texas-crack-down-abortion-pills.
  34. Roe v. Wade. 410 U.S. 113. (1973). 
  35. Rovner, Julie. "Abortion bans drive off doctors and close clinics, putting other healthcare at risk." NPR. May 23, 2023. https://www.npr.org/sections/health-shots/2023/05/23/1177542605/abortion-bans-drive-off-doctors-and-put-other-health-care-at-risk.
  36. Sanger-Katz, Margaret, Claire Cain Miller and Josh Katz. "Interstate Abortion Travel is Already Straining Parts of the System." New York Times. July 23, 2022. https://www.nytimes.com/2022/07/23/upshot/abortion-interstate-travel-appointments.html.
  37. Ravindrane, Ramyadevi and Jay Patel. “The environmental impacts of telemedicine in place of face-to-face patient care: a systematic review.” Future Healthcare Journal. 9, no. 1 (2022): 28–33. DOI: 10.7861/fhj.2021-0148. 
  38. Seigel, Randi and Alice B Leiter. “State Abortion Shield Laws: Key Findings and Infographic.” Manatt Health. September 26, 2023. https://www.manatt.com/insights/white-papers/2023/state-abortion-shield-laws-key-findings-and -infogr
  39. Shpachuk, Alex. True Cost of Implementing a Telehealth System. Empeek. June 5, 2024. https://empeek.com/insights/telehealth-system-development-cost/
  40. Simmons-Duffin, Selena and Shelly Cheng. “How many miles do you have to travel to get abortion care? One professor maps it.” NPR. June 21, 2023. https://www.npr.org/sections/health-shots/2023/06/21/1183248911/abortion-access-distance-to-care-travel-miles
  41. Snoswell, Centaine L, Monica L Taylor, Tracy A Comans, Anthony C Smith, Leonard C Gray and Liam J Caffery. "Determining if Telehealth Can Reduce Health-System Costs: Scoping Review." Journal of Medical Internet Research. 22, no. 10 (2020). http://doi.org/10.2196/17298. 
  42. Society of Family Planning. "#WeCount Report. April 2022 to December 2022" Society of Family Planning. April 11, 2023. https://doi.org/10.46621/143729dhcsyz. 
  43. Talington, Vira. “Which States Allow Telehealth Across State Lines?” ChartRequest. February 12, 2024. https://chartrequest.com/which-states-allow-telehealth-across-state-lines/
  44. Thomsen, Carly, Zach Levitt, Christopher Gernon, and Penelope Spencer. "Presence and absence: Crisis pregnancy centers and abortion facilities in the contemporary reproductive justice landscape." Human Geography. 16, no. 1 (2023): 64-74. http://doi.org/10.1177/19427786221109959. 
  45. Ungar, Laura. “It’s taking longer to get an abortion in the US. Doctors fear riskier, more complex procedures.” AP News. December 9, 2023. 
  46. https://apnews.com/article/abortion-care-wait-times-us-roe-dobbs-7b0a328bb34b0acb3d37e359a 63712fc. 
  47. Upadhyay, Ushma D, Leah R. Koenig, Karen Meckstroth, Jennifer Ko, Ena Suseth Valladares and Antonia Biggs. “Effectiveness and safety of telehealth medication abortion in the USA.” Nature Medicine. 30 (2024): 1191–1198. https://doi.org/10.1038/s41591-024-02834-w.
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