Supporters of legal abortion are fighting back in medical journals as well as at the ballot box and on social media. The consistent theme is that America is being divided into two regions, one supporting abortion rights and one hostile to abortion. The losers are women who have special medical or psychological needs.

Writing in the New England Journal of Medicine, two physicians from the University of Colorado Cancer Center say that their patients’s options have shrunk. Abortion after  a breast cancer diagnosis “is an extremely difficult choice and one that women do not make lightly,” Dr Nicole Christian says. “Denying women this essential reproductive health care only makes what is already an excruciating time that much harder.”

“When the Dobbs ruling came out, I had a lot of thoughts about how it impacted me personally as a woman in America,” she says. “Then I thought about how lucky I am that I take care of patients in Colorado, where the state legislature has protected reproductive health choices. But as a regional health care center, we see patients from states with much more restrictive options. I have patients from Oklahoma, Nebraska, occasionally Texas, and their options are a lot more limited now.”

And in STAT, two scholars in law, bioethics and genetics argue that pre-natal genetic testing could effectively be criminalized by state anti-abortion legislation.

Sonia M. Suter, of George Washington University, and Laura Hercher,  of  Sarah Lawrence College, point out that genetic tests and genetic counselling have become routine in recent decades. After Dobbs, however, doctors might be reluctant to offer these services, lest they motivate women to abort a child with a genetic defect.

But what is now routine prenatal care may no longer be universally available in a post-Dobbs world. 

Instead, there likely will be different tracks of prenatal care, depending on where people live. In some states, people will have access to the full spectrum of medically recommended care: carrier screening, prenatal testing, and anatomy scans at 20 weeks. In-vitro fertilization and preimplantation genetic testing will also remain legal in these states. In other states, abortion restrictions may severely limit access to such care, if not prohibit some or all of it.

Whether people in states that restrict abortion can find ways around those limitations will depend on their resources. Those who can pay for it may be able to travel to abortion-friendly states to access this care. Those who can’t pay won’t have access. So the nature of prenatal care available to individuals will depend on two factors: where they live and their resources.