The American College of Rheumatology (ACR) is deeply concerned about the U.S. Supreme Court’s Dobbs v. Jackson ruling because it negatively impacts the practice of rheumatology. Furthermore, we oppose any legislation or regulation that will limit access to comprehensive reproductive healthcare and interfere with patient-physician shared-decision making.
Pregnancy can worsen rheumatic diseases, such as systemic lupus, and may be life threatening, and several medications necessary to treat severe inflammatory disorders can cause birth defects. Therefore, it is medically necessary for many patients to delay pregnancy until an optimal time, and in some cases, it is advisable to terminate pregnancy to avoid life-threatening worsening of severe chronic inflammatory diseases. Planning for a medically safe pregnancy often requires contraception or the use of assisted reproductive technology.
Limiting patient access to medically necessary reproductive health services such as abortion, contraception, and assisted reproductive technology places sound medical practice and the health of patients at risk. State restrictions that intrude on the practice of medicine and interfere with the patient-physician relationship leave millions with limited access to reproductive healthcare services.
For those living in certain states, access to comprehensive reproductive care will be limited to those with sufficient resources, circumstances, and/or financial means to travel to receive medically-necessary reproductive health services —exacerbating health inequities by placing the heaviest burden on patients from Black, Latinx, Indigenous, low-income, rural, and other historically disadvantaged communities that already face numerous structural and systemic barriers to accessing healthcare.
Additionally, the U.S. Supreme Court decision has led to a lack of clarity about how patients in some states can access critical treatments such as methotrexate, a necessary medication that is commonly used to treat many rheumatic diseases, due to its alternate use as a medication to terminate pregnancy – though in much higher doses.
Rheumatology health professionals and patients should not face legal consequences for utilizing medically necessary care. People with rheumatic disease must be able to access reproductive healthcare that is appropriate, and healthcare professionals must be allowed to provide evidence-based care that is in the best interest of their patients.
