Dobbs v. Jackson Decision: It’s Time to Get Uncomfortable

The recently announced decision of the Supreme Court in the Dobbs v. Jackson case has left health care providers, researchers, and administrators struggling to defend reproductive health care against legal restrictions. Although some hospital-based providers may not consider reproductive health care as part of their “wheelhouse,” anyone who cares for adolescents and young adults must see this as a call to action. Reproductive health screening is often missed in the primary care setting,¹  which has led to recommendations to provide this care wherever adolescents and young adults present for care.²  Because adolescents are under the legal age of majority and typically have less experience, education, and resources to help them access reproductive health care when needed, these new abortion laws will create disproportionate burdens on the adolescent population. For low-income youth and adolescent and young adults of color, this will likely worsen the disparities that already exist with regard to access to reproductive health care.³  Adolescents have the highest rates of unintended pregnancy,⁴  and these pregnancies are more likely to end in abortion than adult pregnancies.^5,6  Adolescents younger than age 20 make up 12% of individuals who have abortions in the United States; minors who are 17 years or younger account for about 4% of all abortions in the United States.⁷ 

Adolescent pregnancy rates may be partially attributed to the greater barriers adolescents face in obtaining confidential care and effective contraception. Although 71% of adolescent women report having penile vaginal sex by age 19 in the United States,⁸  < 50% have ever received instruction on where to get birth control before they had sex for the first time.⁹  Even if they have the appropriate education and knowledge, logistical challenges such as transportation and finances may pose additional barriers for adolescents.

As health care providers for adolescents and young adults, these restrictions to reproductive health care will impact our patients. Additionally, this Supreme Court decision likely will further increase health care disparities. To mitigate these potential effects, we need a broader strategy to increase access to reproductive health care for adolescents and young adults. We need to maximize prevention of unwanted pregnancy to the utmost of our ability. Here are some specific steps that each of us can take:

1. ASK the questions: Providers from all disciplines can help identify those at risk for becoming pregnant by simply asking the questions. Although the questions can be straightforward and relatively quick to ask, it may take practice to feel comfortable with phrasing and word choice. Get comfortable being uncomfortable. Ensure that every adolescent and young adult has some dedicated time alone to have a confidential conversation in a private space. Despite both patients and providers being open to addressing reproductive health in the inpatient setting,^10,11  the social history is commonly deferred, as other tasks take priority.¹²  Now is the time to prioritize the reproductive health conversation and ask the questions.

2. EDUCATE ourselves about reproductive health: Similar to the expanded role many have taken on in the management of anxiety, depression, or attention deficit hyperactivity disorder, addressing reproductive health has never been so incredibly critical to the welfare of our patients. Learn about the basics of contraceptive methods. Consider training in long-acting reversible contraceptive methods like implants and intrauterine devices, which are highly effective, safe, and considered first-line treatment in the adolescent and young adult population.¹³  The Colorado Family Planning Initiative focused on increasing access to long-acting reversible contraceptives decreased unintended pregnancy rates by 40% in teens aged 15 to 19.¹⁴ 

   Effective contraception counseling should be now, more than ever, an expectation rather than an exception for providers. However, if a provider is unable or unwilling to manage contraception, they should identify trusted and accessible resources within their community to provide this care in a timely manner.¹⁵  Stay up-to-date on legislation in your state and be knowledgeable about resources in your area.

3. ADVOCATE at the institutional level: Pediatric health care institutions have a unique opportunity to provide reproductive health care to the most at-risk youth (often because of underlying medical conditions), whether they are being seen in urgent care, the emergency department, or an inpatient service. Reproductive health care is an integral and holistic part of any and all encounters in these settings. Hospitals must ensure access to confidential care, all contraceptive methods (including emergency contraception and long-acting reversible contraceptives), as well as procedural space and necessary equipment.

4. TRAIN the next generation of providers to be facile in the management of reproductive health: Encourage rotations through Gynecology, Adolescent Medicine, and Family Planning clinics as integral parts of resident education so that the rising workforce has the skills necessary to provide reproductive health care to our adolescent and young adult patients.

The steps mentioned above can be taken by providers across the country right now. Nearly all major national medical associations that care for adolescents and young adults, including the American Academy of Pediatrics,¹⁵  Society for Adolescent Health and Medicine, the North American Society for Pediatric and Adolescent Gynecology,¹⁶  and American College of Obstetricians and Gynecologists,¹⁷  have spoken out to remind us of this obligation. Although provision of abortion care may be out of scope for many providers, we encourage you to become familiar with trusted resources, whether within your community or accessible beyond state lines, for patients needing this service. Regardless of your specialty or experience, now is the time to recognize your critical role in improving the reproductive health of your patients.