Abortion Bans' Impact on OB/GYNs and Their Medical Practice
In a Journal of the American Medical Association study titled “US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans", they found significant and alarming clinical and personal impacts in states with abortion bans.
The objective of the study was to find the “perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health, and turnover intention among US OB-GYNs practicing in states with functional bans on abortion”. Participants in this study were 54 OB-GYNs from 13 states with abortion bans.
Below are excerpts from study with much of the detailed content missing. We invite you to read the entire study.
Clinical Impacts
Delayed Care
Many participants described needing to delay medically necessary care until patients were at risk of death or permanent impairment, or the fetal heart stopped spontaneously. Clinically inappropriate delays, and their consequences occurred during middle-of-the-night emergencies when calls to legal teams for clearance to proceed went unanswered.
Counseling Restrictions
Due to aiding and abetting clauses, some participants were informed by their institution that they could not provide referrals for abortions or discuss abortion as an option. Many described such limits on counseling as the laws’ most damaging parts, calling these restrictions an affront to their medical expertise and to patient autonomy.
Inability to Provide Care
In the absence of counseling restrictions, participants could accurately describe care options, but these options were functionally unavailable to many patients,: “[It’s] incredibly frustrating because it’s care and services that I am capable of providing to people and that are not unsafe or hard.” This was especially true for participants with a high proportion of low-income, Medicaid-insured patients who could not afford to travel out of state.
Many shared the difficulty of being unable to care for their patients “on probably the worst day of their life.” Those unable to provide care for unstable or high-risk patients at their own institutions described spending hours orchestrating hospital or inter-state transfer, cutting into time with other patients or their own families. Even after extensive time spent arranging handoffs, they feared poor outcomes.
Personal Impacts
Moral Distress
Ninety three percent reported situations in which they or their colleagues could not follow clinical standards due to legal constraints. When describing their moral distress over such encounters, participants used words like muzzled, handcuffed, and straitjacketed.
Perceived Consequences of Violating State Law
Most participants (87%) reported worries about practicing in an uncertain legal climate. Fears centered on potential for criminal prosecution, loss of medical license, loss of income, or incarceration. A few retained private criminal defense attorneys at their own expense, fearing inadequate representation by their institution.
Leaving the State
Six participants (11%) had moved their practices to states with stronger abortion protections. In contrast, some felt galvanized to stay. One explained, “I’ve thought so many times about leaving but I’m only 1 of 3 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.” As colleagues moved away, those who remained described shouldering increased burdens of clinical care and declining morale as colleagues moved away.
Mental Health
Most participants (38 [70%]) reported symptoms of anxiety and depression as a direct consequence of Dobbs v Jackson. Although men accounted for 19% of the overall sample (10 participants), they represented 38% of participants (6 of 16) reporting no mental health impacts.
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