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The June 24, 2022 Dobbs v. Jackson landmark decision by the United States Supreme Court held that the Constitution of the United States does not confer the right to abortion. This decision returned to individual states the power to regulate any aspect of abortion not protected by federal law. Since this ruling, multiple states have limited or completely banned abortion care for people who are pregnant. In at least nine states, abortion is blocked with no exceptions for rape or incest.
Multiple states have banned abortion after 18, 15, or even 6 weeks gestation. These time restrictions make it impossible for patients to use medical information from ultrasounds and/or genetic testing, available later in pregnancy, to determine if a fetus has an anomaly and/or a life-threatening or lethal condition.
These abortion restrictions and laws permitting any citizen to sue anyone “aiding or abetting” an illegal abortion for up to $10,000 has created uncertainty and fear among health care providers trying to provide medical care to pregnant patients experiencing miscarriage, tubal or ectopic pregnancy (when the embryo implants in the fallopian tube, where it cannot become a full term pregnancy; can be lethal to the mother if not treated promptly and correctly), or those who need prenatal genetic counseling. Clinicians are unclear where the lines stand between providing care and committing a felony that could equal jail time, and this means that pregnant people aren’t getting the appropriate and timely care they need, even outside of a healthy, viable pregnancy.
But did you know that the Dobbs decision has also prevented non-pregnant women from receiving the medications they need to treat lupus, rheumatoid arthritis, and other conditions treated with medications like methotrexate?
Chris Stallman, MLS, MS, is a certified genetic counselor, an expert in medication impact during pregnancy, and a Clinical Instructor of Pharmacy Practice-Science at the University of Arizona R. Ken Coit College of Pharmacy. “Methotrexate is a medication used to treat many conditions, including lupus, rheumatoid arthritis, Crohn’s disease, and other autoimmune diseases. If a person who is pregnant uses methotrexate, it could increase the chance of miscarriage, birth defects, and other issues in pregnancy or after birth.” For this reason, girls and women of child-bearing age who are taking methotrexate as treatment for their autoimmune or other diseases are not able to take methotrexate – even if they are not pregnant.
This critical problem is not hypothetical – treatment with methotrexate has already been withheld from female, non-pregnant patients with serious medical conditions in multiple states.
A 48-year-old woman in Tellico Plains, TN received an automated call from her CVS pharmacy in July 2022 indicating that her prescription for methotrexate wouldn’t be refilled. This patient, who has inflammatory arthritis and a neuromuscular disease called myasthenia gravis, stated that methotrexate allowed her to resume simple, yet previously painful tasks like putting on her pants and rolling over in bed.
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In June 2022, not 24-hours after the Dobbs ruling, a patient in Maryland who has Crohn’s disease received a call from her insurance company indicating that methotrexate, used to treat the chronic inflammation and pain associated with this condition, would no longer be available to her.
Within a week of the Dobbs ruling, a woman in Virginia who has Lupus received a letter from her doctor’s office indicating that it was pausing all prescriptions and refills of methotrexate because of the Supreme Court decision on abortion. Before taking methotrexate she experienced flares of Lupus so severe that she had trouble walking and needed to use a shower chair to wash.
Another woman from Missouri had been taking methotrexate to treat rheumatoid arthritis. When she went to the pharmacy to pick up her refill she learned from the pharmacist that they needed a specific direction from her doctor that the medication would not be used for an abortion. The pharmacy, Walgreens, confirmed with this customer that they do not require the same procedure from their male clients.
A 14-year old girl in Arizona was denied a refill of methotrexate to treat her debilitating rheumatoid arthritis and osteoporosis. Her angry physician tweeted that her patient was denied this critical medication because she was female. The withholding of life-saving or -altering medications from the women who need them has forced some of them to consider surgical sterilization.
Could denying women of childbearing age (who may or may not be sexually active, fertile, heterosexual, or pregnant) methotrexate be just the beginning of problems for women who need prescription or over-the-counter medications? Stallman says, “This certainly could lead to more medication denials – and not just for people who can get pregnant. If my husband or children need medication that could increase risks to a pregnancy, would they be denied the medication simply because they live with a person who could get pregnant? Will health care providers have to stop handling or dispensing such medications if they or their partner could get pregnant? And before saying ‘that will never happen’, remember that is what people said about the overturning of Dobbs. We don’t know how far this will go.”
Let’s take this thought experiment a step further. Is it possible that young girls will have to present a letter from their pediatricians indicating whether they’ve started having periods before they can receive the medications they need? Will adult women have to present written proof of tubal ligation, menopause, or infertility from their physicians before filling their life-saving medications? Will other medications that can affect the health of a fetus, even the highly regulated acne medication Accutane, require such additional proof? Could pharmacies use the data they have on prior purchases, like tampons and lubricant, to determine if a woman may be of child-bearing age and/or is sexually active?
The Dobbs decision is just the beginning of our government interfering with womens’ bodies, their personal choices, and their medical care. This decision is already impacting health care outside of pregnancy and could force women and their family members to disclose personal information about their fertility, sexuality, sexual and medical history with pharmacists, medical systems, the government, and the databases that all of them use. Our federal government must act swiftly to ensure that this decision doesn’t lead to further government overreach, discrimination, interference in proper medical care, and tragedy.
***Co-author Chris Stallman, MLS, MS, CGC is a genetic counselor interested in health law and policy, expanding access to accurate health information, and finding the perfect pair of shoes.
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