Open Letter to UPMC Regarding Abortion Care


We are clinicians, scientists, professors, staff, trainees, and students across UPMC and the University of Pittsburgh who are profoundly concerned about the Dobbs v. Jackson Women’s Health SCOTUS decision to overturn Roe v. Wade and eliminate federal protection for abortion care. This decision directly threatens the health, safety, security, and wellbeing of the people who seek care at UPMC hospitals and health centers, its employees, and people across the nation, especially those from socially and economically marginalized communities.

Western Pennsylvania has a critical role to play in the emergent public health crisis. Because of its location abutting states that have already banned or severely restricted abortion access (i.e. Ohio and West Virginia), our region has already become a major surge area for abortion care.  Our ability to absorb this demand will impact the reproductive and overall health of people in our region and beyond. We are eager for UPMC to join other major healthcare institutions in affirming a commitment to provide abortion care as part of evidence-based comprehensive reproductive health care (1-2). Every day that goes by with our silence, we as a health system are in danger of complicity with forces that politicize this health care issue at the expense of our patients and their families.

While abortion is currently legal in Pennsylvania, there are efforts to amend the state constitution to ban abortion outright (3). Such a move would have substantial health and economic impacts on UPMC patients, employees, and hospital operations.  Robust data from the Turnaway Study have shown that the inability to obtain a desired abortion leads to significant adverse physical, psychological, and economic consequences (4-13). The U.S. has the highest pregnancy-related mortality rates among high-resource nations, with Black pregnant people dying at 3-4 times the rate of white pregnant people (14-15).  A new study by researchers at the University of Colorado predicts that abortion bans will not only worsen the maternal mortality crisis but will further widen the already unconscionable racial disparity (16). The health and social impacts on adolescents who need confidential care will also be devastating. Given UPMC’s stated commitment to health equity and addressing health disparities including maternal morbidity and mortality, it is critical that we work collaboratively and with alacrity to address this public health emergency.

It is hard to overstate the impossible situation that providers and hospitals will be in if/when a state bans abortion with limited health exceptions. In states that have banned abortion, doctors are already struggling to answer questions such as: can you treat an ectopic pregnancy before it ruptures or must you wait until the pregnant person is hemorrhaging? If a family discards fertilized embryos during IVF, is that considered abortion? If a patient is suffering from preterm premature rupture of membranes (PPROM), but the fetus still has a faint heartbeat, can you offer abortion care or must you wait for the patient’s health to deteriorate? If a pregnant person is diagnosed with cancer and requires immediate treatment that could be harmful to the pregnancy, is that sufficient justification to offer abortion? Waiting too long may lead to the patient’s death or an EMTALA lawsuit against the hospital. Offering abortion too soon may lead to criminal prosecution against the provider. These situations will undoubtedly occur and be an absolute nightmare for patients, providers, and hospitals alike.

Moreover, impacts go beyond abortion- or pregnancy-related care to touch on every aspect of clinical care, including medicolegal decisions for surgical procedures, diagnostic imaging, chemotherapy, contraception, and provision of teratogenic medications to treat serious chronic medical and psychiatric illness (17-18). Reports are already circulating about people with rheumatic disease being unable to get prescriptions for methotrexate both because of its abortifacient properties and liability concerns related to prescribing a teratogenic medication without the option of abortion for fetal anomalies (19).


Given the profound and far-reaching impact of harmful state and federal abortion policies on the health and wellbeing of the people we serve, we call on UPMC to condemn legislative interference in patient-provider health decision making by:

● Issuing a public statement that abortion care is a vital component of comprehensive reproductive healthcare and is available at UPMC hospitals.
● Leveraging UPMC’s voice and power as a major employer and healthcare system to oppose the proposed Pennsylvania constitutional amendment banning abortion.
● Convening a multidisciplinary panel of providers, family planning experts, ethicists, lawyers, scholars, patients, and administrators to develop operational strategies and clinical decision protocols for the current situation, and in the event of laws criminalizing abortion in PA.
● Absent a court order to the contrary, committing to no cooperation with law enforcement when prosecuting patients, abortion providers, those who help abortion patients, or employees at UPMC, in line with the federal government's interpretation of HIPAA (20) and the recently issued statewide executive order (21).

We have the opportunity for leadership and meaningful action in the wake of the Dobbs v. Jackson Women’s Health decision. As one of the nation’s top healthcare systems, our response to this public health crisis will be a model for the next generation of healthcare leaders. We look forward to UPMC embodying our mission and values of high-quality patient care, transformational health systems, and unwavering commitment to health equity and care for the underserved and disadvantaged.

References:
1. Wheeler, T. (2022, June 28). Cleveland Clinic Statement on Women's Health. Cleveland Clinic Newsroom, from https://newsroom.clevelandclinic.org/2022/06/28/cleveland-clinic-statement-on-womens-health/ 
2. Access to abortion care: U-M Public Affairs. U. (n.d.), from https://publicaffairs.vpcomm.umich.edu/access-to-abortion-care/ 
3. Center, L. D. P. (n.d.). Bill Information - senate Bill 956; Regular session 2021-2022. The official website for the Pennsylvania General Assembly, from https://www.legis.state.pa.us/cfdocs/billInfo/billInfo.cfmsYear=2021&sInd=0&body=S&type=B&bn=0956 
4. Foster DG, Ralph LJ, Biggs MA, Gerdts C, Roberts SCM, Glymour MA. Socioeconomic outcomes of women who receive and women who are denied wanted abortions. March 2018. American Journal of Public Health, 108(3):407-413.
5. Roberts SCM, Biggs MA, Chibber KS, Gould H, Rocca CH, Foster DG. Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion. September 2014. BMC Medicine, 12:144.
6. Upadhyay UD, Biggs MA, Foster DG. The effect of abortion on having and achieving aspirational one-year plans. November 2015. BMC Women’s Health, 15:102.
7. Foster DG, Biggs MA, Raifman S, Gipson JD, Kimport K, Rocca CH. Comparison of health, development, maternal bonding, and poverty among children born after denial of abortion vs after pregnancies subsequent to an abortion. September 2018. JAMA Pediatrics, 172(11):1053-1060.
8. Gerdts C, Dobkin L, Foster DG, Schwarz EB. Side effects, physical health consequences, and mortality associated with abortion and birth after an unwanted pregnancy. November 2015. Women’s Health Issues, 26(1):55-59.
9. Ralph LJ, Schwarz EB, Grossman D, Foster DG. Self-reported physical health of women who did and did not terminate pregnancy after seeking abortion services: A cohort study. August 2019. Annals of Internal Medicine, 171(4):238-247.
10. Biggs, M. A., Upadhyay, U. D., McCulloch, C. E., & Foster, D. G. (2017). Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA Psychiatry, 74(2), 169. https://doi.org/10.1001/jamapsychiatry.2016.3478
11. Foster, D. G. (2020). The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—Or Being Denied—An Abortion. Scribner.
12. Miller S, Wherry LR, Foster DG. The Economic consequences of being denied an abortion. January 2020. The National Bureau of Economic Research, NBER Working Paper No. 26662.
13. Upadhyay UD, Angel Aztlan-James E, Rocca CH, Foster DG. Intended pregnancy after receiving vs being denied a wanted abortion. September 2018. Contraception, 99(1):42-47.
14. Petersen  EE, Davis  NL, Goodman  D,  et al.  Racial/ethnic disparities in pregnancy-related deaths—United States, 2007-2016.   MMWR Morb Mortal Wkly Rep. 2019;68(35):762-765
15. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L; United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016 Jan 30;387(10017):462-74. doi: 10.1016/S0140-6736(15)00838-7. Epub 2015 Nov 13. PMID: 26584737; PMCID: PMC5515236.
16. Stevenson, A. J. (2021). The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant. Demography, 58(6), 2019–2028. https://doi.org/10.1215/00703370-9585908
17. Harris, L. H. (2022). Navigating Loss of Abortion Services—A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade. New England Journal of Medicine, 386(22), 2061–2064. https://doi.org/10.1056/NEJMp2206246
18. Arey, W., Lerma, K., Beasley, A., Harper, L., Moayedi, G., & White, K. (2022). A Preview of the Dangerous Future of Abortion Bans—Texas Senate Bill 8. New England Journal of Medicine, 0(0), null. https://doi.org/10.1056/NEJMp2207423
19. Methotrexate barrier for arthritis patients: Arthritis foundation. Methotrexate Barrier for Arthritis Patients | Arthritis Foundation. (n.d.). Retrieved July 6, 2022, from https://www.arthritis.org/about-us/news-and-updates/new-barrier-to-methotrexate-for-arthritis-patients 
20.   (OCR), O. for C. R. (2022, June 29). HIPAA privacy rule and disclosures of information relating to Reproductive Health Care. HHS.gov, from https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/phi-reproductive-health/index.html 
21.    Gov. Wolf signs executive order ensuring access and protections to reproductive health care services to health care providers and out​-of​-state residents . Governor Tom Wolf. (2022, July 12, from https://www.governor.pa.gov/newsroom/gov-wolf-signs-executive-order-ensuring-access-and-protections-to-reproductive-health-care-services-to-health-care-providers-and-out-of-state-residents/ 

 

This letter was signed by 1826 individuals across UPMC and the University of Pittsburgh.