The IAPM New York 2024 declaration on professional responsibility and abortion

Introduction

The International Academy of Perinatal Medicine (IAPM) has taken a significant and definitive stance on the topic of professional responsibility and abortion, declaring it a fundamental reproductive right. This declaration was unanimously approved at the IAPMs annual meeting on June 28, 2024 in New York City (Table 1). Advocating for access to safe and legal abortion services is based on the professional responsibility model, which respects autonomy and beneficence-based obligations to the pregnant patient and beneficence-based obligations to the fetal patient.

Legal foundation of abortion

The IAPM’s declaration aligns with international human rights frameworks that advocate for reproductive rights as fundamental human rights. The World Health Organization (WHO) and other international bodies have long recognized that access to safe and legal abortion is crucial for safeguarding women’s health and rights [1]. The legal and ethical foundation of the IAPM’s stance is built on the premise that denying access to abortion services infringes upon an individual’s right to autonomy and self-determination.

Public health implications

The public health implications of restricted access to abortion services are profound. Legal restrictions on abortion do not reduce the incidence of abortion; rather, they drive women to seek unsafe procedures, often with devastating consequences. Unsafe abortions have been shown to be a leading cause of maternal mortality and morbidity globally [2], [3], [4], [5], [6], [7]. The IAPM’s support for the legalization of abortion is a call to prioritize women’s health and well-being. Ensuring access to safe and legal abortion services can significantly reduce the rates of maternal mortality and improve overall public health outcomes [2, 3, 5, 6].

Fetal viability and beyond

Neonatal viability involves the development of critical fetal systems, particularly the lungs, necessary for independent breathing post-birth. Viability is a complex assessment based on gestational age, fetal weight, and available medical interventions. Viability is generally defined as the point where a fetus can survive outside the womb, usually around 22–24 weeks gestation, though different regions may have different abilities to support the neonate [8, 9]. The IAPM supports the legalization of abortion up to viability and acknowledges that post-viability abortions may be necessary in cases of maternal health risks or severe fetal anomalies, emphasizing a compassionate, context-sensitive approach to reproductive healthcare.

Legal context of abortions

Since the overturning of Roe vs. Wade in 2022 [10], many US states have enacted laws significantly restricting abortion rights. These new regulations vary widely, creating a complex legal landscape [11, 12]. In some states, access to abortion has been severely limited by strict gestational limits, mandatory waiting periods, and requirements for multiple in-person visits. Other states have banned specific procedures or criminalized abortion services. This patchwork of laws has increasingly constrained access to abortion, making it highly dependent on geographic location and highlighting the ongoing debate over reproductive rights in the United States.

Globally, abortion laws typically limit post-viability abortions, defined as after 22–24 weeks to cases where the mother’s health or life is at risk or in instances of severe fetal malformations [12, 13]. This approach is seen in most European nations and Australia, balancing the rights of the pregnant individual with fetal viability. In contrast, the legal landscape in the US and Canada varies, with some US states (such as New York, California, Colorado, New Mexico) allowing post-viability abortions without restrictions. These US states represent a divergence from the global norm and professional medical ethics. By allowing post-viability abortions without a specific indication, a political vulnerability is created.

Conclusions

The International Academy of Perinatal Medicine.s New York Declaration on Professional Responsibility and Abortion underscores the importance of reproductive freedom [14], [15], [16], [17], [18], [19], [20], [21], [22]. By advocating for the legalization of abortion up to fetal viability and beyond in specific circumstances, the IAPM emphasizes the need to protect individual health and rights and to respect beneficence and autonomy-based obligations to the pregnant patient and beneficence-based obligations to the fetal patient. This stance aligns with professional ethics and international human rights standards, highlighting the interconnectedness of gender equality, public health, and social justice. It reaffirms the crucial role of healthcare professionals in ensuring access to safe, legal abortion services, thereby promoting comprehensive and compassionate reproductive healthcare globally.