Miller Kristen A, Wagner Chelsea A, Montgomery Samantha, Rietzler Jennifer, Saich Madison, Allred Amanda, Hein Cara, Howell Julie, Cook Israel, Pori Bella, Williamson Rachel, Morgan Kelly
Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Billion to One, Menlo Park, California, USA.
J Genet Couns. 2025 Aug;34(4):e70082. doi: 10.1002/jgc4.70082.
The 2022 Dobbs v. Jackson Women's Health Organization ruling, which returned abortion regulation to individual states, has created a fragmented and rapidly changing legal landscape in the United States. These legislative changes have profound implications for healthcare professionals, including genetic counselors (GCs), whose roles encompass providing comprehensive, client-centered reproductive counseling and facilitating access to abortion care. This study conducted a legislative scan of post-Dobbs abortion laws from 2023 to 2024 to assess how specific provisions intersect with the established genetic counseling practice competencies. Using a framework rooted in the genetic counseling scope of practice, state-level abortion laws were categorized into four domains: gestational age limits, fetal condition-specific laws, public funding or insurance coverage, and abortion care coordination. Legislative provisions were classified as restrictive, protective, or intermediate. A Restrictiveness Score (RS) and Protectiveness Score (PS) were calculated to quantify the impact of these laws on GCs' ability to deliver care. Of the 192 legislative provisions identified, 111 (58%) were classified as restrictive; overall, gestational age laws (n = 65, 34%) and insurance coverage/public funding provisions (n = 65, 34%) were the most prevalent. States with high RS values often overlapped with geographic areas of limited access to genetic counseling services. Furthermore, 18 states included "reason bans" targeting fetal conditions, including sex, anomalies, and genetic conditions, directly challenging GCs' ability to provide comprehensive counseling. This study underscores the need for ongoing monitoring of abortion legislation and proactive policy advocacy to protect reproductive health services and genetic counseling practice. By providing a detailed framework for legislative scans, this work offers a replicable model to track evolving legal landscapes and their implications for healthcare delivery.
2022年的多布斯诉杰克逊妇女健康组织案裁决将堕胎监管权交回各州，这在美国造成了一个分散且迅速变化的法律格局。这些立法变化对医疗保健专业人员，包括遗传咨询师（GCs）产生了深远影响，他们的职责包括提供全面的、以客户为中心的生殖咨询，并协助获得堕胎护理。本研究对2023年至2024年多布斯案后的堕胎法律进行了立法审查，以评估具体条款如何与既定的遗传咨询实践能力相交。使用基于遗传咨询实践范围的框架，州级堕胎法律被分为四个领域：孕周限制、特定胎儿状况法律、公共资金或保险覆盖范围，以及堕胎护理协调。立法条款被分类为限制性、保护性或中间性。计算了限制分数（RS）和保护分数（PS），以量化这些法律对遗传咨询师提供护理能力的影响。在确定的192条立法条款中，111条（58%）被归类为限制性；总体而言，孕周法律（n = 65，34%）和保险覆盖范围/公共资金条款（n = 65，34%）最为普遍。RS值高的州往往与获得遗传咨询服务机会有限的地理区域重叠。此外，18个州纳入了针对胎儿状况的“理由禁令”，包括性别、异常和遗传状况，这直接挑战了遗传咨询师提供全面咨询的能力。本研究强调了持续监测堕胎立法和积极进行政策倡导以保护生殖健康服务和遗传咨询实践的必要性。通过为立法审查提供详细框架，这项工作提供了一个可复制的模型，以跟踪不断演变的法律格局及其对医疗服务提供的影响。
