(160) Psychiatry and Reproductive Care in a Post-Roe World

Background/Significance: On June 24, 2022, the U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization ruling ‎overturned the landmark 1973 Roe v. Wade decision that granted women the right to abortion. In states with so-called ‎‎"trigger laws", reproductive care was immediately impacted. A prompt response by the medical community to preserve the ‎core ethical principles of patient care became imperative. Psychiatrists will inevitably find themselves sitting across from ‎patients whose mental health is affected by their reproductive options. Consult psychiatrists are particularly well positioned ‎to leverage their expertise and relationships with medical teams to care for these patients and support their reproductive ‎care needs. We therefore conducted a Quality Improvement (QI) project to enhance psychiatrists' knowledge and comfort ‎in practicing reproductive psychiatry in the wake of the Supreme Court ruling.‎

Methods: Psychiatry residents, fellows, and teaching attendings completed a 12-item survey assessing comfort with clinical ‎scenarios integrating mental and reproductive healthcare. This was followed by an educational series of five lectures ‎delivered by an interdisciplinary panel of speakers (physicians, thanatologist, attorney, genetic counselor, and social ‎worker). The series addressed 1) counseling about and prescribing contraceptives, 2) local abortion laws, and educating ‎patients about their reproductive choices, 3) local and national resources available to those seeking abortion, 4) ‎community and government assistance programs for socioeconomically disadvantaged families, and 5) supporting patients ‎experiencing grief or mental illness due to obstetric complications, unwanted pregnancies, or fetal demise. The educational ‎series was concluded by another survey re-assessing comfort with the same clinical scenarios.‎

Results: Fifty-one physicians completed the baseline survey. On average, providers trended towards "slightly ‎uncomfortable" with the evaluated clinical scenarios, suggesting knowledge gaps. Data analysis examining the utility of the ‎educational series is pending completion of the follow-up survey (scheduled to end April 7, 2023). We hypothesize that data ‎will demonstrate improvement in provider comfort in managing psychiatric patients with reproductive care-related needs.‎

Discussion: In many U.S. states, patient's reproductive choices were significantly restricted following the Supreme Court ‎ruling. As patients face challenges in accessing reproductive care, consult psychiatrists may be uniquely positioned to assist ‎some of the most vulnerable patients but hindered by limited knowledge and confidence in navigating these clinical ‎scenarios. Our project aimed to help psychiatrists gain proficiency in addressing reproductive health-related matters as part ‎of psychiatric care, as these two often intersect in practice. Baseline assessments revealed knowledge deficits across ‎multiple reproductive care domains in physicians at all levels of training. Education targeting the intersection of mental and ‎reproductive healthcare may be an effective strategy to increase psychiatrists' knowledge and comfort with handling these ‎challenging clinical scenarios.‎

Conclusion/Implications: Psychiatrists should be equipped to serve patients whose mental health may be impacted by the ‎reproductive choices available to them. Enriching the education of psychiatric trainees and attendings through targeted ‎lectures may be one way to accomplish this goal.‎

References: ‎
‎1. Thomas E. Dobbs, State Health Officer of the Mississippi Department of Health, et al. v. Jackson Women's Health ‎Organization, et al., No. 19-1392, 597 U.S. Available at: https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf.‎