Rheum in the Court, Law in the Clinic: Health Policy in Global Rheumatology

SAN DIEGO—At the ACR Convergence 2023 panel, Actions with Impact: Health Policy and Global Rheumatology during the annual Global Summit, four experts covered a range of policy issues relevant to rheumatologists and their patients around the world.

Dr. Edens

The first half of the session was dedicated to reproductive rights. Coughi Edens, MD, FAAP, and Maria del Carmen Zamora-Medina, MD, discussed abortion legislation in the U.S. and Mexico, respectively.

Abortion Access: What Rheumatologists Need to Know

Both Dr. Edens and Dr. Zamora-Medina emphasized the importance of abortion access as a public health issue with unique ramifications for patients with rheumatic diseases.

According to Dr. Zamora-Medina, patients with rheumatic diseases obtain abortions at the same rate as the general population, but may have additional reasons to terminate. Even in cases of desired pregnancy, patients may be too medically unstable to safely continue a pregnancy to term, may have high-risk organ involvement or may require treatments likely to cause fetal abnormalities. Rheumatic disease flares may cause rheumatologists to advise patients to terminate pregnancies to avoid serious medical complications, including death.

In states where abortion is criminalized, doctors may delay or withhold treatment with teratogens to avoid the risk of pregnancy termination. As a result, patients with rheumatic disease who can become pregnant, even if they aren’t planning to, have a harder time obtaining prescriptions for such drugs as methotrexate, negatively affecting their treatment.

Dr. Edens explains that, globally, abortion laws are trending more progressive over time; the U.S. is a notable exception. In June 2022, the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization ruled the Constitution does not confer a right to abortion and returned abortion regulation to state legislatures.

Fifteen states now have a total ban on abortion, forcing many people to travel out of their state for an abortion. According to Dr. Edens, 45% of patients in the U.S. cannot access a surgical abortion without driving over 90 minutes.¹ The cost of such a trip is prohibitive for low-income and rural patients.

Dr. Zamora-Medina

As Dr. Zamora-Medina said, “In this context, women’s ability to dictate the course of their lives and the terms of their reproductive citizenship have depended entirely on where they live and whether they have the economic and social capital to navigate the legal, geographical and bureaucratic barriers.”