Although the Dobbs v. Jackson Women’s Health Organization decision left us stunned, there has never been a more important time to act. Following the draft SCOTUS opinion leak, I came together with colleagues from different academic, clinical, and leadership backgrounds—we call ourselves the Kitchen Table Group because we have gathered in the evenings around our kitchen tables. We sought advice of colleagues from other institutions and considered how the impending Dobbs decision would affect our academic medical center. The following illustrates our initial steps:
- Local assessment. While abortion currently remains legal in Pennsylvania, the future of abortion rights in this state depends on the upcoming governor election. Dobbs changed the landscape in its surrounding states—the only abortion clinic in West Virginia closed and Ohio now has a six-week ban. We also assessed our hospital abortion policy and availability of local and statewide abortion providers.
- Identify short-term institutional consequences of Dobbs. We identified immediate needs including a) preparing emergency/urgent care services to provide compassionate care for patients presenting following self-managed abortion (understanding patients will fear legal consequences), b) preparing for increased demand for LARCs and sterilizations, and c) expecting that OB-GYN programs from banned states will need assistance with providing abortion training for their residents, an ACGME training requirement.
- Identify medium-term institutional consequences of Dobbs. It is possible that abortion will become illegal in Pennsylvania without exceptions (the position of one gubernatorial candidate). Preparedness strategies will include a) establishing procedures for out-of-state abortion for patients requiring hospital care, b) finding alternative locations for our OB-GYN residents to obtain ACGME-required abortion training, c) preparing for the anticipated surge in births that will strain our maternity and pediatric care services, and d) mitigating the impact on recruitment of students/trainees and faculty, etc.
- Assess the needs and values of institutional leadership. After sharing and gathering additional collective institutional knowledge, we estimated that our leadership was unlikely to support any sweeping decisions around abortion care that appear to be politically motivated. However, we were confident that our leaders were committed to the organization’s vision to be the most trusted academic healthcare institution in our region, including protecting the safety of our patients and the integrity of our educational programs.
- Request institutional recognition of our Post-Roe Task Force. Our leadership has deputized our Kitchen Table Group to be the institution’s Post-Roe Task Force that will focus on mitigating negative consequences of Dobbs. While we will grow the Task Force to include other key stakeholders, we will maintain the core Kitchen Table Group who can continue to meet frequently and work nimbly.
We brought a collective leadership model and approached the realities of Dobbs with a focus on harm reduction. While this tactic may appear muted, we have successfully built trust with our institutional leadership around issues where there is common ground and received institutional support as a formal part of the solution. This will ultimately allow us to have greater impact on institutional preparedness for a Post-Roe era.