State bans on abortion force doctors to provide substandard care – new study
More than two years after the U.S. Supreme Court overturned Roe v. Wade, state abortion bans are forcing doctors to provide poor-quality medical care, new research published Monday finds.
The study describes how One woman’s waters broke prematurely in her pregnancy and she ended up in intensive care with severe sepsis because she could not have an abortion to end her doomed pregnancy. Her story is one of dozens collected by the research group Advancing New Standards in Reproductive Health, based at the University of California, San Francisco.
Another woman had her liver transplant canceled when doctors discovered she was pregnant, even though the pregnancy was unwanted. Yet another was forced to deliver a baby with anencephaly, a serious and fatal fetal abnormality. By the time the baby was delivered to its mother, the baby’s skin had changed from pink to navy blue.
“The scream and the crying she let out when she saw the baby was heartbreaking and enough to break anyone in the room,” a medical student told researchers. “The mother kept screaming ‘Why, God?’ in Spanish, but this was not a problem of the gods, but rather a completely man-made problem.”
Advancing New Standards in Reproductive Health began collecting physician stories about their post-Roe experiences in August 2022, shortly after Roe was overturned in the Supreme Court case Dobbs v Jackson Women’s Health Organization. The group a preliminary report published of their findings in May 2023; they collected a total of 86 stories.
“One question we had was, were the changes that we initially saw related to the initial shock of the Dobbs decisions and the laws that were put in place at that time? Would clinical protocols change and would providers figure out how to provide high-quality care? Would these poor-quality cases go away?” said Dr. Daniel Grossman, the study’s lead author. “These cases continue to happen.”
Since Roe was struck down, more than a dozen states have banned abortions outright. Every state with a ban on the books technically allows abortions in medical emergencies, but the exact details of what constitutes an “emergency” can vary from state to state. Doctors across the country have said that exceptions to abortion bans are so vague and confusingly worded that they are practically unenforceable.
Ideally, when doctors sense that a patient is headed for a medical emergency, they act as quickly as possible. Abortion bans, doctors have said, force them to wait until patients are on the brink of death to act.
Some patients experienced massive, life-threatening blood loss after miscarriage care was delayed, according to the report Advancing New Standards in Reproductive Health. A doctor in a state with an abortion ban told investigators that hospital staff refused to help a woman in severe pain during a miscarriage.
“I will never forget this case because I heard the head nurse tell a nurse that offering a helping hand to a patient lying on a gurney in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion.’ It is better not to touch the patient who is having a miscarriage at all,” the doctor said. “A gross violation of common sense and the oath I took when I entered this profession to alleviate the suffering of my patients.”
“Some clinicians were eager to move to a state where abortion was still legal, even though they were not primarily abortion providers,” Grossman said.
Most of the patients described in the report were between 18 and 35 years old and had experienced complications during the second trimester of pregnancy, ectopic pregnancies (which are not viable), fetal abnormalities or miscarriages. The researchers noted that Black and Hispanic patients were disproportionately represented; research has long shown that they are more likely to experience substandard care.
Patients who were connected to the carceral system in some way also experienced barriers to care. In one case, a 15-year-old in juvenile detention had a baby because she could not get an abortion in her state. In another case, a woman on probation in a state with an abortion ban asked for permission to leave for an abortion and was denied. She left the state anyway for the procedure, but refused sedation because she feared a drug test.
There has been little quantitative research on how abortion bans affect medical care, Grossman said, although one study found a link between Texas’ six-week abortion ban — which was in effect for about 10 months before Dobbs implemented a near-total ban — and an increase in infant mortality.
Grossman says reports from physicians on Advancing New Standards in Reproductive Health are still coming in, although the number of submissions has declined.
“I think part of the reason the number of requests has gone down is that clinicians have gotten used to it,” he said. “This has become the new norm now and it’s not as shocking. They’re also just burned out and frustrated because they can’t provide the care that they’re trained to provide.”