A tragedy that everyone in the medical community dreads to see is making a comeback: the back-alley abortion. In the past, unsafe practices to end pregnancies claimed the lives of too many desperate women. Illogical and complicated abortion and contraception restrictions interfered with the responsible practice of medicine. Are we headed down that dark, dangerous road once again?

States Banning Abortion or Considering Legislation

In today’s climate of increasing interest in and passage of abortion bans and birth control restrictions, the specter of the dangerous back-alley abortion is again rearing its head. How far will the trend will go, and how will it affect the medical community? Many states have passed abortion restrictions, many of which are inconsistently enforced, arcane, and convoluted. Other states are considering personhood legislation, which effectively bans birth control that inhibits fertilized eggs from implantation in the uterus, which may include the pill, IUD, and emergency contraception, or morning-after pills.

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Societal Advantages of Access to Abortion Are Still Debated

Controversy continues about whether Roe v Wade created a positive difference in overall public health. Some sociology experts have noted that making abortion less available also results in more unwanted and neglected children, possibly bringing increased societal problems such as poverty and crime; however, popular opinion is by no means unanimous. Roe v Wade made abortion legal, accessible, affordable, and medically safe. The reduced number of unwanted pregnancies could mean that there are now more available resources to help troubled children. The Court’s ruling was an effort to settle the matter for good, but instead, it polarized the issue. Debates and studies continue on how the “Roe effect” has had implications on everything from a decline in crime rates to changes in the political landscape in America. These theories continue to fuel debates among pro-choice and pro-life advocates.

Health Scare Tactics Are Still Being Employed in the Anti-abortion Cause

Are illogical arguments beginning to win the day? There will always be political interests emphasizing the danger of “unnatural hormones” introduced into women’s bodies, increased cancer risk from birth control pills, the idea that IUDs are actually mini-abortions, and more. However, a tipping point seems near. In its recent Supreme Court case, Hobby Lobby objected specifically to 4 (out of 20 total) methods of contraception the Affordable Care Act (ACA) requires to be covered by health insurers. The company believes morning-after pills (Plan B and Ella) and hormonal and copper IUDs to be equivalent to abortion. The Supreme Court ruling’s effect could eventually be extended by creating a legal precedent to ban other forms of contraception, as Planned Parenthood Federation of America recently pointed out.

Insurance Restrictions to Birth Control Recently Sanctioned by the Supreme Court

With companies such as Hobby Lobby restricting their employees’ access to birth control, and opening the door for more companies to do so, insurance company rules may tighten or at the very least become more complicated. Here’s how the American Congress of Obstetricians and Gynecologists (ACOG) reacted to Burwell v Hobby Lobby, which allowed closely held corporations to skirt the ACA mandate that health insurers cover contraceptives: “All health care decisions—including decisions about contraception—should be made by a woman and her doctor, based on the patient’s needs and her current health.…Lawmakers must not see this decision as a green light to roll back essential insurance coverage.”

ACOG Not Alone in Voicing Opposition

In its own response to the Supreme Court decision, the Twitterverse immediately created the hashtag #DrHobbyLobby and began asking for contraceptive and medical advice from the retailer. Planned Parenthood chimed in to dispel some myths about how far-reaching and intrusive the ruling actually is. ACOG was also quick to support the Protect Women’s Health From Corporate Interference Act bill introduced by Sen. Patty Murray (D-WA).

Because anti-abortion laws don’t reduce the frequency of abortions, but instead tend to decrease the incidence of safe abortions, will current anti-abortion or contraception legislation send the medical community into a time warp? As Guttmacher.org points out, there were somewhere between 200,000 and 1.2 million illegal or self-induced abortions annually in the 1950s and 1960s. Will pro-life advocacy continue to affect and impede the health care system? Must we accept the return of the back-alley abortionist? Has pro-life legislation affected your gynecology practice, insurance acceptance policies, and/or malpractice coverage costs? If you work in emergency medicine, have you felt the impact? 


  1. 2013 state level abortion restriction: an extreme overreach into women’s reproductive health care. National Women’s Law Center website. January 2014.
  2. ACOG statement on the Supreme Court decision on Hobby Lobby v Burwell. ACOG website. June 30, 2014. www.acog.org/About-ACOG/News-Room/News-Releases/2014/ACOG-Statement-on-the-Supreme-Court-Decision-on-Hobby-Lobby-v-Sebelius.
  3. Bahadur N. #DrHobbyLobby is the funniest Twitter response to the SCOTUS ruling. Huffington Post website. July 1, 2014. www.huffingtonpost.com/2014/07/01/drhobbylobby-twitter-hashtag-response-scotus_n_5548368.html.
  4. Benson Gold R. The Guttmacher Report on Public Policy. Guttmacher Institute website. March 2003;6(1). www.guttmacher.org/pubs/tgr/06/1/gr060108.html.
  5. Berg M. Myths v facts on the Supreme Court’s Hobby Lobby ruling. July 8, 2014. Planned Parenthood Action website. www.plannedparenthoodaction.org/elections-politics/blog/myths-v-facts-hobby-lobby-birth-control/.
  6. Birth control. Parents Against Personhood website. www.parentsagainstpersonhood.com/resources/birth-control/.
  7. NCVS victimization analysis tool (NVAT). Bureau of Justice Statistics website. www.bjs.gov/index.cfm?ty=nvat.
  8. Protect Women’s Health from Corporate Interference Act. Senator Patty Murray website. www.murray.senate.gov/public/_cache/files/30554052-0f84-485a-babc-ccc04af85bb6/protect-women-s-health-from-corporate-interference-act—one-page-summary—final.pdf.
  9. Roe v. Wade fast facts. CNN website. November 4, 2013. www.cnn.com/2013/11/04/us/roe-v-wade-fast-facts/.
  10. State policies in brief: an overview of abortion laws. Guttmacher Institute website. August 1, 2014. www.guttmacher.org/statecenter/spibs/spib_OAL.pdf.
  11. Supreme Court of the United States. Burwell, Secretary of Health and Human Services, et al. v. Hobby Lobby Stores, Inc., et al. Supreme Court website. Decided June 30, 2014. www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf.