Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD 21287, United States.
Am J Emerg Med. 2023 Jul;69:160-166. doi: 10.1016/j.ajem.2023.04.022. Epub 2023 Apr 20.
Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
个体经历亲密伴侣暴力（IPV）和/或人口贩运（HT），由于立法将堕胎定罪和/或限制堕胎，会增加遭受严重健康后果的风险，预计随着最高法院 Dobbs v. Jackson 一案的裁决，这种风险会增加。这些风险进一步因种族、社会经济和其他边缘化人口属性而有所区分。由于施虐者控制了获得交通和资金的途径，由于担心寻求医疗保健会遭到报复，以及其他障碍，IPV 和 HT 会对维护身心健康造成障碍。个体经历 IPV 或 HT 往往缺乏生殖自主权，因为他们的施虐者会对他们进行生殖强制。在 Dobbs 裁决之后，如果这些弱势群体的患者在医学上需要或希望堕胎，他们的生殖自主权将进一步受到限制，获得堕胎的障碍也将增加。这可能会导致更多的患者因不安全或无人监督的自行管理堕胎而出现并发症，前往急诊部门就诊，也会导致更多的患者因害怕法律后果而不愿报告自己进行了非法堕胎。这对于经历 IPV 和 HT 的个体尤其相关，因为他们由于面临众多障碍，可能更倾向于使用这些方法来堕胎。急诊医学临床医生在为这些患者提供护理方面至关重要，因为他们经常到急诊部门就诊。必须采取多管齐下的方法来更好地支持这些患者，包括提高对 IPV、HT 或无人监督堕胎并发症的怀疑指数，改进组织结构，为员工提供专门培训，改进筛查方法，反思隐含偏见，并为谨慎记录和法律考虑提出建议。
