University of Minnesota researchers: Doctors have 'professional obligation' to protect abortion access

Rachel Hardeman and Asha Hassan, two smiling Black women.
Dr. Rachel Hardeman and Asha Hassan are authors of a new report in the New England Journal of Medicine, "Abortion Access as a Racial Justice Issue."
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A new journal article from University of Minnesota researchers argues doctors have an obligation to expand and protect abortion access.

Published Wednesday in the New England Journal of Medicine, the report frames abortion as a racial justice issue – calling Dobbs v. Jackson, which rolled back Roe v. Wade in June, a “direct assault on racial equity in health care.”

Host Cathy Wurzer talked with two authors of the report, from the University of Minnesota’s School of Public Health. Rachel Hardeman is a Professor of Health and Racial Equity and Asha Hassan is a doctoral student. (Katy Backes Kozhimannil, a Distinguished McKnight University Professor at the University of Minnesota, also co-authored the article.)

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Audio transcript

[MUSIC PLAYING] CATHY WURZER: There's a new article from two University of Minnesota researchers that argues medical doctors have an obligation to expand and protect abortion access. Published yesterday in the New England Journal of Medicine, the report frames abortion as a racial justice issue. It calls Dobbs v. Jackson, the decision that reversed Roe v. Wade in June of this year, a, quote, direct assault on racial equity in health care. Two of the authors of the report are from the University of Minnesota's School of Public Health.

They're on the line right now. Dr. Rachel Hardeman is a professor of health and racial equity. And Asha Hassan is a doctoral student. Welcome to you both.

RACHEL HARDEMAN: Thanks so much for having us.

ASHA HASSAN: Thank you for having us.

CATHY WURZER: Absolutely. Dr. Hardeman, we can start with you. Why were you compelled to write this piece?

RACHEL HARDEMAN: We were compelled to write this piece for a variety of reasons. First and foremost, we begin from the premise of reproductive justice. And that is the fact that health care is a human right and abortion care is part of health care, and thus a human right.

And the fact that that has been revoked for so many people, and particularly people from communities that are racialized and disadvantaged across our country, is incredibly important and incredibly heartbreaking. We wanted to make it clear to our colleagues, to those doing the work of providing abortion care, of supporting those who need those services that this is a racial justice issue, first and foremost, and also that we each have a role to play in supporting our colleagues and ensuring that people get the care that they need.

CATHY WURZER: Asha, what motivated you to be a part of this effort?

ASHA HASSAN: Yeah. So I think one thing to really emphasize here is that while abortion bans and restrictions are dangerous and unjust for all people, we know that the burdens fall hardest for Black and Indigenous and racialized people. We see this in the maternal mortality outcomes that are projected, including up to a 38% increase in maternal mortality for Black pregnant people, given severity of different restrictions. And it hasn't really been framed very strongly within this construct of racial justice, so we felt that we needed to speak on that specific issue.

CATHY WURZER: The report gives a sobering history of policies that encouraged reproduction during slavery to a shift after the civil war toward eugenics and sterilization laws. We know about racial inequities in access to health care. You write that there are serious racial and ethnic disparities in reproductive health too.

So let's dive a little deeper into that. Asha, could you do that for us?

ASHA HASSAN: Absolutely. So abortion bans are part of a long-standing history of undermining the bodily autonomy of people, but especially Black and Indigenous people. In the United States, we see this in boarding schools and forced sterilization, other atrocities including forced medical experimentation on enslaved people. And this specific example of the Dobbs decision and other abortion restrictions over time really works to limit the fertility determination that individual communities have.

And we know that given that this has a disproportionate impact on the outcomes of Black and Indigenous folks, that this is especially harmful to those communities.

CATHY WURZER: Dr. Hardeman, we've done a lot of reports on figures that show-- and Asha did talk about this-- Black and Indigenous people are two to four times as likely as white people to die during pregnancy or in childbirth. And you write that abortion, which is now criminalized in many US communities, is safer than pregnancy and delivery, especially for Black and Indigenous people. So are you saying in many cases in BIPOC communities that abortion is taking the place of contraception?

RACHEL HARDEMAN: That's a really complicated question to answer. I think what we have to understand and what we have to be clear about-- and there's data from Mississippi that really outlined this, I think, very starkly-- is that a Black person is 118 times more likely to die from carrying a pregnancy to term than from having a legal abortion. And so it's a both-ender.

We need to ensure that people have reproductive health care services, a full spectrum of them. So whether that is contraception, whether that is preconception care because what we know also is that preconception care can help someone planfully and healthfully become pregnant and bring a healthy child into the world. But I think the bottom line here is that when we eliminate choice from the lives of people who have not had much choice to begin with-- we outlined that deep history and offered some examples of where that choice has been taken away-- we are going to exacerbate inequities across the board.

CATHY WURZER: I want to hear more about your view that doctors have an obligation to protect abortion. And obviously, in Minnesota abortion is still legal, but in neighboring states like North Dakota, providing an abortion is punishable by law. What do you suggest doctors do, Dr. Hardeman?

RACHEL HARDEMAN: So I think it's important to be clear, again, that abortion is health care. It's a form of health care just like any other form of health care. And so taking that ability from clinicians away to be able to provide that piece of health care is problematic. As clinicians think about this issue and think about their role in improving health outcomes, they have to understand that providing abortion care themselves, supporting colleagues who do so are incredibly important.

Advocating for safe and dignified and humane reproductive health care services across the board is incredibly important as well. We believe that clinicians and each of us have a professional obligation to support policies, to support policymakers, to support our leaders who are doing the work of ensuring that reproductive health care services are offered and are equitably offered in our communities.

CATHY WURZER: Asha, do you want to weigh in on this as well?

ASHA HASSAN: Absolutely. So I think you have south Dakota as an example and some of our neighboring states where abortion restrictions are way more severe than they are here in Minnesota. Part of the issue with some of those states, South Dakota specifically, is that it has been a hostile environment for abortion access for a very long time, even before the Dobbs decision. We can have legislation in place or different rulings that are going to support abortion access, but part of that really requires community members, including those within the health care community and within institutions, to do their part to support colleagues that are abortion providers, to support abortion-seeking patients. It is a team effort in order to support these patients.

CATHY WURZER: Now this came out--

RACHEL HARDEMAN: And--

CATHY WURZER: Yes, go ahead, Dr. Hardeman.

RACHEL HARDEMAN: I would also add that in states where we're seeing abortion being criminalized, it's the role of clinician colleagues there to protect one another to be able to do the work that needs to be done to keep patients and keep people safe.

CATHY WURZER: And what do you do about doctors who might personally be opposed to abortion?

RACHEL HARDEMAN: Wow, that's a tough question. I think that we have to think, again, from this lens that this is a health care issue. Everyone deserves the right to health care.

It is a right. And so we have to be thinking about moving forward in that vein and in that lens to really ensure that people get what they need.

CATHY WURZER: I wish I had more time with you both. I really appreciate your time, though, today. Thank you so much.

RACHEL HARDEMAN: Thank you for having us.

ASHA HASSAN: Thank you.

CATHY WURZER: Dr. Rachel Hardeman is a professor of health and racial equity at the University of Minnesota. Asha Hassan is a doctoral student there. And you can read their perspective piece in the New England Journal of Medicine just published last night.

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