Healthcare providers caring for pregnant patients in the months after the US Supreme Court’s decision to strike down Roe v Wade have been unable to provide standard medical care in states where abortion is effectively outlawed, leading to delays and worsening and dangerous health outcomes for patients, according to an expansive new report.
In the wake of the Supreme Court’s ruling last year, individual reports from patients and providers have shed some light on the wide range of harm facing pregnant women in states where access to abortion care is restricted or outright banned.
But a first-of-its-kind report from the University of California San Francisco captures examples from across the country, documenting 50 cases in more than a dozen states that enacted abortion bans within the last 10 months, painting a “stark picture of how the fall of Roe is impacting healthcare in states that restrict abortion,” according to the report’s author Dr Daniel Grossman.
“Banning abortion and tying providers’ hands impacts every aspect of care and will do so for years to come,” he said in a statement accompanying the report. “Pregnant people deserve better than regressive policies that put their health and lives at risk.”
The report collected anonymised narratives from providers who observed complications facing their patients.
The most common scenario involved preterm pre-labor rupture of membranes (PPRM), in which the amniotic membrane surrounding the fetus breaks. In several of the cases, patients developed a severe infection, including cases that put patients in hospital intensive care units. Patients in many cases were instead sent home and told to return to a hospital when labor started or when they experienced signs of an infection.
In one case, a patient returned to a hospital’s intensive care unit two days after her water broke at roughly 16 to 18 weeks of pregnancy in a state where abortion is banned.
“The anesthesiologist cries on the phone when discussing the case with me,” the physician wrote, according to the report. “If the patient needs to be intubated, no one thinks she will make it out of the [operating room].”
The report notes that “miraculously” the patient survived. Following the termination of the pregnancy, the patient asked the doctor whether any of them broke the law.
“She asks me: could she or I go to jail for this?” the doctor said, according to the report. “Or did this count as life-threatening yet?”
Providers also described other cases where patients showed evidence of inevitable pregnancy loss, but their care teams had their “hands tied” under state laws.
Health providers also submitted stories of patients experiencing ectopic pregnancies. Delays to treat one patient resulted in a ruptured ectopic pregnancy that required surgery to remove her fallopian tube. Another patient was denied an abortion for a Caesarean scar ectopic pregnancy, a life-threatening condition where a pregnancy implants in the scar of a prior Caesarean section.
Other physicians reported the inability to treat patients with fetal anomalies and patients who faced delays receiving treatment for miscarriages.
“Unfortunately, this report confirms that our fears about abortion bans are valid,” said Dr Chloe Zera, a maternal-fetal medicine specialist and associate professor at Harvard Medical School.
“As someone who cares for patients who have high-risk pregnancies, I need to be able to provide care consistent with evidence-based guidelines,” she said in a statement accompanying the report. “This research underscores the completely preventable harm that is now happening to our patients because of barriers to abortion care.”
The report also outlines the moral dilemmas facing physicians operating in states or treating patients from states that have outlawed the potentially life-saving care they previously provided.
Some physicians said they were considering quitting or relocating, or noted the immense coordination required between health providers in multiple states to treat patients, and outlined the ways in which restrictive state laws have complicated other care unrelated to abortion.
In one case, a physician refused to remove an intrauterine device for a patient who was between 10 and 12 weeks pregnant, despite the partially expelled IUD posing a risk for infection or miscarriage.
“The doctor did not feel comfortable” removing the IUD, one physician wrote, according to the report. “The context provided was concern over the recent changes in law that create [the] possibility for felony charges for providers causing abortion in our state shortly after the Roe decision was overturned.”
During a “heated exchange” among health providers, “the doctor [said] the patient had... been examined by the nurse practitioner, who was unable to visualize the IUD, and that ‘even if I could see it and it was easily removable, I wouldn’t remove it because of the law,’” according to the physician’s description in the report.
“Abortion bans that block providers from offering standard medical care have the greatest impact in states like Texas that have some of the poorest indicators of maternal health,” according to Dr Kari White, lead investigator of the Texas Policy Evaluation Project at The University of Texas at Austin.
“Pregnant people should be able to rely on their healthcare provider to provide the best possible care, regardless of where they live,” she said in a statement accompanying the report.
More than a dozen states, mostly in the South, have effectively outlawed or severely restricted access to abortion care after the Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization last June.