AAP Voices Blog

Medical consensus holds that comprehensive reproductive health care is a basic human right. However, we now face a worsening reality in which many pediatricians across the U.S. cannot offer the full spectrum of this care to their patients.

Prior to the overturning of Roe vs. Wade, many states had already implemented restrictive laws such as six-week bans, mandatory waiting periods, and legal protection of provider conscientious objection. Until universal access to comprehensive reproductive health care is guaranteed for all, pediatricians must mitigate the harms of restrictive anti-choice laws. We must conscientiously extend services to those most affected, ensure access to our patients’ contraceptive method of choice, offer universal proactive emergency contraception, navigate rapidly changing state laws, and advocate for protective reproductive health care legislation.

Abortion restriction deepens health and income disparities for those underserved

Black, Hispanic and American Indian or Alaska Native individuals are more likely to die in pregnancy and childbirth than White women. LBGTQ individuals and persons with disabilities experience increased barriers to reproductive health care. Individuals who live in poverty or in rural locations face steeper financial barriers when long-distance travel, time off work, and time away from family is necessary to obtain abortion. Research has shown that those who seek and do not receive abortion services experience greater economic hardship and higher rates of poverty after carrying an undesired pregnancy to term. New restrictions on abortion access will deepen income disparities and further entrench the most vulnerable in poverty. We as pediatricians know that the effects of childhood poverty can lead to lifelong negative health outcomes.

Pediatricians must ensure contraception access

Counseling on and provision of contraception is an essential standard of pediatric care. In states where abortion access is greatly restricted, prevention of unintended pregnancy is vital. Pediatricians must ensure that patients have access to both non-emergency and emergency contraception. Youth are more likely to achieve their reproductive goals when they have emergency contraception on hand. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists advocate for the advanced prescription of emergency contraception in order to decrease barriers to access. A prescription can also ensure that emergency contraception is free of charge as out of pocket costs range from $11-$50 for a single dose.

Access is not universal. Some states currently restrict access to contraception. Providers in these states can refuse to prescribe or dispense contraception. Health care institutions have similar legal protections. Therefore, pediatricians must be familiar with state laws and institutional policies to navigate barriers to access.

Know the options for emergency contraception. Most pediatricians are familiar with non-emergency contraception, but knowledge gaps are common with emergency contraception. There are currently two forms of oral emergency contraception available to patients: levonorgestrel (for instance, Plan B) and ulipristal (Ella). Levonorgestrel can be purchased without a prescription in generic and brand name forms, whereas ulipristal requires a prescription. Access to these medications is not universal and is subject to restriction or protection by state laws.

Ensure confidentiality. The AAP advocates for confidential reproductive health care for all adolescents. However, there is great variation in the state laws regarding privacy and parental notification. Pediatricians must be familiar with their state's laws regarding age requirements, the definition for a minor, and the types of reproductive care that can be kept confidential. In order to ensure confidential communication with patients, pediatricians should be educated on the privacy concerns regarding parental access to electronic medical records and cellular phones.

Consider the cost. With the enactment of the Affordable Care Act, access to contraception, including emergency contraception, is covered by most health insurance plans. However, recent Supreme Court rulings now permit religious exemptions for contraception coverage by private insurance plans. Therefore, pediatricians need to consider the possibility of insurance coverage gaps and potential out-of-pocket costs. Financial resources are available if needed.

Know when to refer. If pediatricians refuse to provide contraception or options counseling to pregnant patients of all available options either due to conscientious objection or knowledge base, they must ensure timely referral to a provider who can offer needed services.

Evolving state laws restrict and now eliminate access to abortion care

As pediatricians, it has always been incumbent upon us to counsel patients on the full range of options available after diagnosing a pregnancy. Now the landscape is exponentially more complicated. The Guttmacher Institute’s interactive map tracks these changes in real time. There is also a legislative state tracker which shows information about bills which are currently in the process of legislation at the state level. Consulting these resources regularly may help inform pediatricians in this complicated new landscape.

Time is of the essence. If your state bans abortion by a certain gestational age, it is important to facilitate timely connection with a clinician who provides full spectrum reproductive health care, including abortion. Some states have laws which require a waiting period and/or multiple appointments before abortion is permissible.

Again, consider the cost. Some states have enacted laws which do not allow any insurance program to pay for abortion services. Therefore, it is critical to connect individuals with private abortion funds, that subsidize the cost of services and travel. Federally funded Title X family planning services are also a critical resource for individuals whose insurance will not cover reproductive care or are uninsured. However, some states restrict Title X funding.

Travel may be needed. For states that have enacted complete abortion bans or have laws that disqualify many individuals from receiving needed services, out of state travel may be necessary. Pediatricians should be prepared to share resources on where patients can find abortion services out of state, if needed.

Pediatricians must advocate for legislative protection reproductive services

The AAP has already put forth a robust catalog of policy statements on comprehensive reproductive health care, which has informed clinical practice and advocacy efforts. To amplify these policy statements in the post-Roe landscape, pediatricians join advocacy efforts with colleagues obstetricians/gynecologists and family medicine physicians in order to advocate for state laws which protect comprehensive reproductive services including abortion. State AAP chapters often already have advocacy efforts in place which allow pediatricians to more easily participate in the legislative process. Integration of core AAP policy statements into state advocacy initiatives is crucial in this post-Roe world. Pediatricians may consider advocating for inclusion of reproductive health protection in their state chapter’s advocacy agenda or joining such initiatives.

“We face an immediate, unprecedented crisis in this post-Roe world and pediatricians have a crucial role to play. Our patients will look to us for guidance and support, and it is incumbent upon us to meet their needs.”

A pediatricians’ critical role in a post-Roe reality

We face an immediate, unprecedented crisis in this post-Roe world and pediatricians have a crucial role to play. Our patients will look to us for guidance and support, and it is incumbent upon us to meet their needs. This involves our own acclimation to cataclysmic change in reproductive rights, our readiness to provide essential health care, and to exceed the limits of care we traditionally provide. In the future, some pediatricians may even consider training in medical abortions in order to meet patient needs.

As pediatricians, we must play an active role in ensuring that all individuals have access to safe, comprehensive reproductive health care, including abortions.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.