Reproductive Health

Reproductive health care: Navigating the Dobbs decision

Pharmacists play a crucial role in patients’ access to reproductive health services.

On June 24, 2022, the U.S. Supreme Court’s ruling on Dobbs v Jackson Women's Health Organization overturned Roe v Wade. This decision has implications on the complete span of reproductive health services, as it leaves abortion regulation to individual states and creates a new landscape for health care providers to navigate.

The consequences of this decision have widespread impact on patients, communities, pharmacists, and all other health care professionals involved in caring for patients. APhA is working to support pharmacists through the complexities that the Dobbs decision brings to light.

Listening sessions for APhA members

Existing APhA policy covers many important topics; however, it does not explicitly contemplate the complexities and sensitivities that the Dobbs decision brings to light.

APhA held two listening sessions in August 2022 to gather members’ feedback on this subject. Members were encouraged to register for one or both of these sessions to share their perspectives, concerns, and insights to inform the direction of APhA policy. Feedback received during these listening sessions provide critical background information for deliberation of these issues at the next seating of the APhA House of Delegates in 2023. Top Takeaways heard from APhA members during these sessions can be found below.

APhA Listening Session Top Takeaways

APhA statements

In response to concerns raised, APhA issued these statements:

AMA, APhA, ASHP, NCPA Statement on State Laws Impacting Patient Access to Medically Necessary Medications (September 9, 2022)
APhA issues statement in response to Supreme Court’s Dobbs v Jackson decision (July 25, 2022)
New Federal Guidance confuses an already complicated landscape for pharmacists (July 13, 2022)

Key terminology

When discussing reproductive health services, pharmacists can reduce confusion and educate their communities by understanding and using clinically accurate language. Several key terms are listed below.

Abortion: ending a pregnancy with medication or a medical procedure.
Abortifacient: an agent (such as a medication) that induces abortion.
Teratogenic: of, relating to, or causing fetal developmental malformations. Medications that are teratogenic are distinct from abortifacients.
Contraceptive: a device or medication serving to prevent pregnancy. Medications that are contraceptives are distinct from abortifacients.
Emergency contraceptive: a therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An emergency contraceptive is not an abortifacient, as it does not end a pregnancy. To learn more, reference The American College of Obstetricians and Gynecologists (ACOG)’s practice bulletin on emergency contraception.

Reference ACOG’s guide to language and abortion for more information about using language on this topic that is medically appropriate and unbiased.

Navigating federal and state laws

The state and federal legal impact of the Dobbs decision on pharmacy practice is evolving and complex.

Recently, the Office of Civil Rights (OCR) issued guidance for retail pharmacies that sets forth their obligations under federal civil rights laws, which conflicts with some state laws and raises concerns for our nation's pharmacies and pharmacists. The policy outlined seeks to protect “the rights of women and pregnant people in their ability to access care that is free from discrimination,” including their ability to access reproductive health care—such as prescription medications from their pharmacy—free from discrimination." In essence, OCR states that failure to provide medications for reproductive health is discriminatory against pregnant women. However, there is no guidance or clarity for pharmacists who practice in states that prohibit the dispensation of specific mediations for reproductive health.

APhA issued a statement expressing concerns that the guidance causes confusion, impedes pharmacists’ use of professional judgment, and has unintended consequences that could compromise patients’ safety. APhA is working with HHS/OCR to provide clarity for pharmacists regarding the guidance and conflicts between state and federal laws. APhA will keep pharmacists informed as information is available.

The following resources may be useful for navigating the legal landscape:

The Kaiser Family Foundation

More information

Official APhA policy is developed by the APhA House of Delegates, which is comprised of delegates from state pharmacy associations, APhA membership academies, affiliated organizations, recognized pharmacy organizations, and ex-officio groups. The House of Delegates meet during the APhA Annual Meeting & Exposition to debate and adopt policy proposals developed throughout the year. Access the APhA House of Delegates 2021 policy manual to reference existing policy.
Learn more about hormonal contraceptive options and how to prescribe, furnish, and/or dispense thesm according to state law through APhA’s hormonal contraceptive training.
ReproductiveRights.gov
Oath of a Pharmacist
Code of Ethics for Pharmacists
Conscience Protections for Health Care Providers
Pharmacist Conscience Clause