University leadership sent out the following formal statement June 24, following the Supreme Court’s decision to revoke Roe v. Wade in the Dobbs v. Jackson Women’s Health case — “While people are obviously free to voice their opinions about this ruling based on their beliefs and experiences, we urge members of our community to do so with empathy and understanding for all.” Furthermore, part of the University mission statement asserts a “universal dedication to excellence and affordable access.”
In our opinion, the Dobbs decision contradicts the values and mission of the University. Given the impending midterm elections Nov. 8, and, as private citizens, we wish to provide the community with information and scientific data surrounding the topic of abortion.
First, per Virginia Code 18.2-72 through 18.2-74.1, abortion is and remains legal in the Commonwealth of Virginia. Second, comprehensive and safe Family Planning Services are an integral part of healthcare, and are readily available at the University Medical Center and throughout the Commonwealth — for example, with U.Va. Department of OB/GYN and Planned Parenthood.
Third, safe abortions, as defined by the World Health Organization as ones that are “performed by trained health care providers with proper equipment, correct technique and sanitary standards,” have a very low rate of complications. In one California study of nearly 55,000 trained provider-based abortions, the overall rate of complication was 2.1 percent. Drilling down further, the rate of major complications, defined as surgery, transfusion, need for hospital admission, was equally low — namely, 0.16 percent for first trimester aspiration and 0.31 percent for medical abortion. Other complications are likewise rare — hemorrhage less than 1 percent, ongoing pregnancy 0.5 percent, infection less than 1 percent and uterine perforation less than 0.3 percent.
Fourth, maternal death rates from safe abortion (0.567 per 100,000 terminations) are less than those of a miscarriage (1.19 per 100,000 miscarriages), a live birth (7.06 per 100,000 live births), or a tubal/ectopic pregnancy (31.9 per 100,000 ectopic pregnancies). Maternal death from an unsafe, illegal abortion is 30 per every 100,000 unsafe abortions in resource-rich countries, and much higher in resource-limited settings — 220 deaths per 100,000 unsafe abortions. In addition, these rates likely underestimate the true incidence due to underreporting. After Roe v. Wade legalized abortion in 1973, abortion-related deaths decreased by 80 percent from 40 per million live births in 1970 to 8 per million live births in 1976. After the Dobbs decision, the number of abortion-related deaths is expected to rise.
Fifth, as noted in a recent article in the “New England Journal of Medicine,” by Kozhimannil, Hassan and Hardeman, the lack of access to safe reproductive services — including abortion — disproportionally affects women of color, Indigenous people, migrants and those who live in states with higher rates of maternal morbidity and mortality. Over 50 percent of abortion need is among those who identify as Black or Latina and/or are younger women living on low incomes with limited access to health insurance. A nationwide abortion ban is estimated to increase maternal mortality by 21 percent overall, and by 33 percent among Black Americans.
Sixth, excerpts of statements from leading professional medical organizations — such as The American College of Obstetricians and Gynecologists or The American Medical Association — following the Dobbs decision reiterate that safe abortion is part of healthcare, to be readily available to all regardless of race, residence or socioeconomic status. They further state that abortion decisions should remain within the domain of the patient-physician relationship without interference from lawmakers. Similar positions can be found in a comprehensive statement from more than 75 leading American medical societies, including the Association of American Medical Colleges, representing academic-based medicine institutions throughout the U.S.
In closing, we recognize that individuals have varying personal opinions about reproductive health services, and while respecting these differences, we remain dedicated to providing the necessary facts on the topic to our community at large. As physicians, healthcare providers and citizens, we remain committed to serving our patients throughout the Commonwealth and beyond with equitable care on the premise of the paramount oath “Do No Harm.” Limiting or eliminating safe abortion services is indeed harmful, resulting in an increase in pregnancy-related complications, maternal deaths and the untoward effects of unwanted pregnancy. False information and myths, as well as litigation fears about pregnancy termination result in confusion about treating patients with miscarriages and ectopic, or tubal, pregnancies. As healthcare providers and physicians, we have and will always commit to the sanctity of the patient-provider relationship, using the best scientific evidence available to enhance and advance individual and community healthcare. Restricting access to safe abortions does not align with either of those principles, and in fact, will harm the most underserved, vulnerable and oppressed individuals within our society. Quality and equitable healthcare can only continue to exist with the unobstructed access to legal and safe abortion.
Kathie L. Hullfish, M.D.
Nina J. Solenski, M.D.
Carol A. Manning, Ph.D.
Angela M. Taylor, M.D.
Kathie L. Hullfish is an obstetrics and gynecology professor in the School of Medicine. Nina J. Solenski and Carol A. Manning are neurology professors in the School of Medicine. Angela M. Taylor is a cardiovascular medicine professor in the School of Medicine.