Methotrexate prescriptions are suddenly being denied to people who have long benefited from its use. The medication is commonly prescribed to treat rheumatic and autoimmune diseases, severe psoriasis, various cancers, lupus, and more. It is also a known abortifacient. Therefore, since the U.S. Supreme Court’s Dobbs v. Jackson ruling which overturned Roe v. Wade, many patients—whether they want to be pregnant or not—are being denied this life-saving and life-improving medication in an effort to ensure that future hypothetical pregnancies become forced births. An 8-year-old in Texas was initially refused the drug by a pharmacist, who wrote a note to the child’s doctor saying, “Females of possible child-bearing potential have to have diagnosis on hard copy with state abortion laws.” Denying methotrexate to patients who need it will ultimately cause many preventable harms and even deaths.
This is a demonstration of how the denial of reproductive rights has an impact beyond reproductive care. Restrictive abortion laws reach far beyond abortion, impact more than just pregnant people, and lead to the targeting of other human rights. There will be far-reaching consequences in the wake of legal rulings that target abortion, and they will impact the overall health of anyone with a uterus, or assumed to have a uterus, of anyone considered to have “possible child-bearing potential”—even if they are as young as 8 years old.
One of the biggest concerns following the toppling of Roe is how PCOS patients will be affected. Polycystic ovary syndrome (PCOS) is one of the most commonly occurring endocrinopathies as well as one of the most common causes of uterine infertility, affecting up to 26.7% of cis girls and women of reproductive age. Beyond that, it also impacts an undetermined number of trans and nonbinary individuals. It is characterized by an overproduction of androgens, which interfere with the development of eggs and their release from the ovaries, causing irregular periods and many other distressing symptoms.
“Birth control pills, or oral contraceptive pills (OCPs), are one of the first lines of treatment for PCOS,” said Dr. Cannon, an OB-GYN practicing in Florida who requested not to use their first name. “OCPs work through multiple mechanisms of action, including suppressing the brain’s secretion of a particular hormone called luteinizing hormone (LH), suppressing ovarian secretions of androgens, and increasing the circulating proteins that bind particular hormones. OCPs also decrease risk of endometrial hyperplasia and carcinoma, secondary to chronic ovulation.”
PCOS can be a very painful condition due to the growth of cysts on one or both ovaries. As they grow, these cysts create pressure and discomfort by pushing on the uterus, fallopian tubes, and other organs. Cysts can lead to ovarian torsion, where the ovary becomes twisted. Cysts can also rupture and sometimes require emergency surgery. Both of these are extremely painful. Birth control helps to lower the risk of ovarian cysts and curtail other PCOS symptoms. Without birth control, often in congruence with other treatments, PCOS patients are at high risk for developing other health issues. Moreover, birth control is used to manage other health conditions, such as endometriosis, dysmenorrhea, anemia, and Premenstrual dysphoric disorder (PMDD).
Though it is a leading cause of infertility, it is still possible to become pregnant with PCOS. However, not everyone who is fertile is capable of safely carrying a pregnancy fully to term. PCOS is associated with an increase in ectopic pregnancy and early pregnancy loss. In the case of an ectopic pregnancy—where a fertilized egg implants outside of the uterus, usually in one of the fallopian tubes—evacuating the fertilized egg is a life-saving procedure, and the typical treatment happens to be a dose of methotrexate. If left unaddressed, ectopic pregnancies often result in hemorrhaging and death.
“Though abortion restriction bills contain carve-outs for lifesaving care to the mother—which technically includes ectopic pregnancies,” writes Julia Ries for Healthline, “the vague language regarding what is and isn’t legal could confuse healthcare professionals and cause them to delay care out of fear of being prosecuted, according to experts.” In Ohio, an abortion clinic “received calls from two women with ectopic pregnancies … [whose] doctors wouldn’t treat them.”
Moreover, there are now laws in place that allow doctors to refuse non-emergency treatments if they do not align with their personal beliefs. Though the removal of an ectopic pregnancy is not classified as abortion, as the fertilized egg is outside of the uterus and will never be viable, conservative and misinformed physicians may still understand it as an abortion due to their personal beliefs. This will only result in increased barriers to proper, ethical, timely, and life-saving reproductive care, even in cases of miscarriage and non-viable pregnancy.
Beyond ectopic pregnancy, people with PCOS are three times as likely to miscarry during the early months of pregnancy and have a 50% increased risk of stillbirth. As such, PCOS patients are more likely to be impacted by the increased criminalization of miscarriage and stillbirth. Since 2006, long before the overturning of Roe, at least 1,300 people in the U.S. have been either arrested or charged with a crime following pregnancy loss. According to Bloomberg, there exists “a movement to use state laws on child endangerment, feticide, or murder to arrest women whose pregnancies ended prematurely, reproductive rights lawyers say, and it may be a harbinger of what’s to come.”
Black, Indigenous, and people of color (BIPOC), especially Black people, are the most likely to experience these pregnancy losses, often due to racial bias in medicine. Miscarriage rates are more than 40% higher for Black people, and they are more than twice as likely to experience stillbirths than white patients. With the increasing carceral response to miscarriage and stillbirth, not only are Black people more likely to experience pregnancy loss, but they are also more likely to be criminalized and prosecuted. In more conservative states that pass the most draconian laws, it will be BIPOC who are disproportionately impacted by restrictive laws against privacy, bodily autonomy, and reproductive rights.
But even for people living with PCOS who will never become pregnant, there are still significant concerns, particularly when it comes to birth control access. Following the SCOTUS decision on abortion rights, Justice Clarence Thomas declared that “In future cases, we should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell … [W]e have a duty to ‘correct the error’ established in those precedents.”
The 1965 Griswold v. Connecticut ruling protected the right of married people’s privacy amidst state restrictions on contraception. It was followed in 1972 by Eisenstadt v. Baird, an expansion that extended contraceptive access and privacy rights to unmarried people. Both Roe and Griswold had right to privacy elements, as did Eisenstadt, Lawrence, and Obergefell—with Lawrence and Obergefell being decisions about privacy rights regarding non-heterosexual sexual activity and non-heterosexual marriage, respectively. The targeting of them all, and the right to privacy inherent to them, is key in the fascist attempt to create a reality where U.S. citizens have no real sexual or reproductive autonomy and the only sexual activities considered legal and right are within the bounds of cisheteropatriarchy. Many are rightfully worried that Griswold and access to birth control will be the next to fall, and the others will drop like dominos.
“If Griswold v. Connecticut were to be overturned, this would drastically impact the way we as gynecologists are able to manage patient care and safety,” says Dr. Cannon. “Withholding oral contraceptive pills—that have been studied first-line treatments in conditions such as PCOS, endometriosis, abnormal uterine bleeding, and pelvic pain—is unethical and clinically dangerous.”
It is a very real possibility that birth control will become more difficult or even impossible to obtain for many people if Griswold is overturned in the future, but birth control is already under attack in several states. As Michelle Trupiano tells Pew Trusts, “There are many at the political extreme who equate birth control with abortion … The attack on the full range of reproductive health care is going to continue.” Policymakers on the right are continually vying for reproductive control through various means without any concern for how restrictions will impact the overall health of people in the U.S., especially anyone with a uterus.
Reproductive health care for people society deems as women is haunted by a history of deeply embedded misogyny and racism in medicine. “White supremacy and misogyny have been the foundation in the inherent disregard for BIPOC and folks [assigned female] in the U.S. As an obstetrician and gynecologist, it is well known in our field that the ‘Founding Fathers’ performed egregious, non-consensual experimental surgeries without anesthesia on enslaved Black women,” laments Dr. Cannon. “To this day, multiple surgical instruments are named after these men, and their actions have really only been called into question in recent years.”
The overturning of Roe v. Wade, as well as the potential reversal of Griswold v. Connecticut, creates even more health barriers for PCOS patients within a medical institution that already does not provide adequate enough reproductive care, with BIPOC suffering the worst outcomes. The fall of Roe will have long-lasting and far-reaching consequences for anyone with a uterus.