New study sheds light on how abortion restrictions impact ob-gyns' ability to practice medicine and put patients' lives at risk
When Roe v. Wade was overturned in June 2022, many people were aware that it would impact reproductive care for women across the country. A year and a half later, at least 14 states have banned abortion except in narrow circumstances, and doctors who are found to be in violation of those laws face serious consequences, including felony charges, loss of their medical licenses, fines and even prison sentences.
While many stories have surfaced of women impacted by strict reproductive health laws, there has been less research on how these changes impact doctors and their ability to provide proper care for their patients — until now.
A disturbing new investigation breaks down just how much the overturning of Roe v. Wade, which once guaranteed the right to an abortion for women across the country, has impacted medical care in the U.S.
The investigation, published Wednesday in JAMA Network Open, uses remote interviews with 54 ob-gyns practicing in 13 states that banned abortion as of March 2023. The researchers found that the overturning of Roe v. Wade has caused “profound public health consequences” that have impacted abortion rates, as well as care for obstetric emergencies, the management of miscarriage and the treatment of serious illnesses during pregnancy. “Early evidence suggests that abortion bans have lowered the standard of care and worsened patient health, amplifying socioeconomic, racial, ethnic and geographic disparities in pregnancy outcomes,” the researchers wrote.
Overall, the researchers found that abortion no longer being a legal right in the U.S. led to the following major issues for health care providers and their patients:
Delayed care
Many of the study participants said they needed to delay medically necessary abortion care until their patients were at risk of death or permanent disability or until the fetus's heart stopped beating spontaneously.
“The way our legal teams interpreted it, until they became septic or started hemorrhaging, we couldn’t proceed,” one doctor said. “[It] puts women in a very challenging, risky position. Is a 5% risk of death enough? Does it take 20%? Does it take 50%? What is enough legally? And the legal people seem to have a different definition that also just feels horrible, to say until you’re at a greater than likely chance of dying, you can’t make a decision.”
No referrals
Many states with abortion bans have aiding and abetting clauses. That keeps some health care providers from providing referrals for where to go to obtain an abortion or even discussing abortion as an option. “[The hospital] even warned us, if you feel like you have a patient who may be pro-choice … you shouldn’t contribute to that conversation because you don’t know if you’re being recorded,” one doctor said. “They could use that against you.”
Others talked about how stressful it was to be unable to help their patients. One shared the story of a refugee patient who was “incredibly emotionally distraught” after learning that her baby had major fetal anomalies. “Just think, the psychological trauma that she was having to go through already,” one doctor said. “And then the idea of having to carry and continue this pregnancy to term. ... I just wanted to be able to do something or anything for her, and not being able to was really, really, really, really hard. And this was a noncompatible with life pregnancy — why couldn’t I help her?”
Moral distress
Over 90% of participants said they found themselves in situations where they or their colleagues couldn't follow medical standards due to legal constraints. Doctors used words like “muzzled,” “handcuffed” and “straitjacketed.” One shared, “That word ‘moral injury’ is getting thrown around a lot now, but that’s what really this is. … I know what the right thing is to do for my patients, but I am carrying this legal worry and worried about what could happen to my family at the same time. And that’s a terrible thing to feel.”
Fears about violating the law
Most participants said they worried about practicing medicine post-Roe v. Wade. “I feel like there’s a politician in the room with me with patients … just waiting to send me to jail, to make an example out of me if I say the wrong thing,” one ob-gyn shared. Another said: “It used to be that any day you were going to work, you could get sued. And now, any day you go to work, you could get sued or you could be charged with a felony. And that additional anxiety just weighs on me.”
Wanting to leave
Six of the study participants moved their practices to states with strong abortion protections. Overall, 60% said they considered leaving their state, but personal ties made it tough. “I am married to a man who has shared custody of three children. … But I absolutely hate working here. …I feel trapped here by my family situation,” one shared.
Others said they decided to stay to try to help women rather than abandon them. “I’ve thought so many times about leaving, but I’m only one of three people, really, in this state who can take care of a patient who is possibly dying from their pregnancy. And that makes me want to stay,” one said.
Mental health issues
Seventy percent of study participants said they had symptoms of anxiety and depression as a result of Roe v. Wade being overturned and the abortion restrictions that followed in many states. “When [Roe] was overturned, there was just a cloud that came over, and it has not left,” a doctor said. Another doctor, who used to be in the Army, said the fallout of the legal change to abortion has been more stressful than practicing medicine in a war zone. “When I was in the Army, I deployed to Iraq. … I left a 15-month-old baby at home with my husband. I practiced medicine in a war zone … but it’s never felt like this,” they said. “My life was actually at risk in that scenario. I had to wear a flak vest and be armed when I was providing care … but I didn’t feel this way. I never had to see a counselor. I never had any treatment for mental health in all of those years.”
Overall, the study's authors said the findings suggest that state abortion bans “have created an occupational health crisis for ob-gyns intertwined with a maternal health crisis for their patients.” They added, “These abortion bans may have implications for future availability of reproductive health care in much of the country.”
Doctors agree that the situation is dire
Women's health expert Dr. Jennifer Wider tells Yahoo Life that the study findings are “not surprising at all.” She continues, “Women's health care has become a nationwide public health crisis.”
Women’s health expert Dr. Jessica Shepherd, an ob-gyn in Texas, which bans abortion, agrees. “Ob-gyns have seen a complete shift with the relationship with their patients and also the depth of counseling they can do with their patients in a doctor-patient relationship,” she tells Yahoo Life. “This directly obstructs the ability for patients to make informed decisions and to get the care they need and deserve.”
Shepherd says that the health care system has “failed women” since the overturning of Roe v. Wade and put women's lives in jeopardy. “In states such as Texas, there have been many women who have had to leave the state in order to get the adequate care they need for them in their time of need,” she says.
She also flags the “significant health inequities for women” in states with abortion bans or restrictions. Wider expects that things will only get worse if the laws don't change. “Access to health care is under attack, maternal mortality is on the rise, and many women will seek unsafe, unregulated abortions as a result,” she says.
