Docs in Abortion Ban States Find Workarounds to Deliver Care

Two years ago, the Dobbs v. Jackson Women’s Health Organization decision overturned Roe v. Wade, upending federal abortion protections and making abortion access and training a patchwork. Despite new challenges, ob/gyns practicing in states with abortion restrictions said they’ve figured out workarounds to get patients the care they need, according to a MedPage Today survey.

Among 50 ob/gyns who practice in abortion-ban states, 60% said they’ve come up with other ways to help patients access the full spectrum of reproductive care, even as they face abortion restrictions.

Daniel Grossman, MD, of the University of California San Francisco, said even within states with abortion bans, some facilities have taken the lead in terms of caring for patients with conditions that put them at risk for serious complications, including preterm premature rupture of membranes, bleeding in the second trimester, and preterm labor.

“In some of these states there are a few facilities that have stepped up and … set up policies to provide care in these situations with fewer barriers,” Grossman told MedPage Today. “Now, about 2 years in, people have figured out where those places are, and they can … funnel patients to those places.”

Grossman cautioned, however, that “even if they figured out workarounds, it’s still challenging, and it’s different from how it used to be. You still either have to jump through hoops at your own institution, or more commonly, send people to another institution.”

Jumping through hoops could include facing an abortion panel at your own facility, which was the case for 30% of respondents. When they did face a panel, only 8% said they always got the care they needed, 10% got it three-quarters of the time, 2% only got it a quarter of the time, and 12% said they were always denied.

About a third of respondents (32%) said they had to turn away a patient seeking an abortion at some point.

These barriers to care may be showing up in outcomes, as 42% of respondents reported that delays in delivering care have put a pregnant patient’s life or health at risk. Indeed, 50% said care has gotten worse since bans went into effect. While 44% said care has stayed the same, only three respondents said care has gotten better.

Additionally, 40% said that patients expressed more interest in contraception, though 58% said interest in birth control has remained about the same; only one person said they saw less interest in contraception post-Roe. And 54% said interest in self-managed abortion has increased since bans took effect.

Last year, doctors told MedPage Today they were feeling the impacts of the Dobbs decision “every single day” in their practice. Despite these restrictions, only one in five ob/gyns surveyed said they’ve seriously considered leaving their state because of an abortion ban.

David Hackney, MD, a maternal-fetal medicine specialist in Ohio, noted that most ob/gyns can remain distant from abortion — and that a surprising number don’t care.

“For a lot of general ob/gyns, if some terrible complication arises, they can still refer, so they don’t actually have to know the laws or follow [the issue],” Hackney told MedPage Today.

Nearly half (48%) of the survey respondents said they did not get any legal guidance on the issue from their hospital or employer.

In Ohio, where Hackney practices, there was an abortion ban for 12 weeks before it was put on hold by a judge. Ohio voters passed a constitutional amendment last year enshrining abortion access in the state, but while the ban was in place, Hackney said there was wide variation in medical malpractice coverage, with some companies saying they wouldn’t cover criminal charges at all.

“I know a number of people have had a criminal lawyer on retainer because if it’s not covered — if the hospital doesn’t want to get its hands involved in anything criminal, and criminal isn’t covered by your medical malpractice — you certainly need to make some plans,” Hackney said.

Nonetheless, most respondents (68%) said they felt supported by the hospital where they worked.

As for the future of the ob/gyn workforce, 24% of respondents said the abortion ban had an impact on the residency training program at their hospital.

“We did see that last year applications dropped across the board, but more significantly in states with bans,” Grossman said. “Still, all residency spots were filled because it’s a competitive specialty, but I think it’s definitely something that trainees are thinking about.”

Indeed, recent research found that access to abortion training was an important consideration for prospective ob/gyn residents.

The MedPage Today survey was sent to healthcare professionals who handle reproductive care in 18 states that either have total abortion bans or gestational limits between 6 and 12 weeks from the last menstrual period. Most of the 50 respondents were general ob/gyns, with a handful of maternal-fetal medicine specialists and reproductive endocrinologists, as well as one gynecologic oncologist and one certified nurse midwife. Half of respondents worked in private practice, 14 in hospital systems, five in academic medical centers, and seven in other environments.