JAMA Netw Open. 2026 Jun 1;9(6):e2619644. doi: 10.1001/jamanetworkopen.2026.19644.
ABSTRACT
IMPORTANCE: Following the Dobbs v Jackson Women’s Health Organization decision, states with abortion bans have experienced increased maternal morbidity and mortality. However, the associations of these restrictions with abortion-adjacent care-medical care directly affected by or overlapping with abortion, such as management of early pregnancy loss (EPL), ectopic pregnancy, and other pregnancy complications-are not well described.
OBJECTIVE: To examine how state-level abortion bans are associated with abortion-adjacent clinical care among physicians from different medical specialties.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was conducted between May 13, 2024, and May 23, 2025, using purposive and snowball sampling. Participants included physicians from emergency medicine, family medicine, and obstetrics and gynecology specialties practicing in 9 states with total abortion bans. Semistructured interviews were conducted via videoconference and analyzed using an inductive thematic approach with dual independent coding.
EXPOSURE: Medical practice in a state with an abortion ban.
MAIN OUTCOMES AND MEASURES: Participant-reported experiences with clinical decision-making, care delivery, counseling practices, and professional responsibilities in the context of abortion bans.
RESULTS: A total of 40 physicians (18 in obstetrics and gynecology, 8 in family medicine, and 14 in emergency medicine) across 9 states participated, 30 (75.0%) of whom were female. Mean (SD) length of time in practice was 7.9 (6.1) years. Six major themes emerged: (1) delays in care and deviations from standard practice for EPL, ectopic pregnancy, molar pregnancy, preterm prelabor rupture of membranes, and maternal comorbidities; (2) ambiguity and fear among physicians; (3) loss of patient autonomy and shared decision-making; (4) erosion of trust in the patient-physician relationship; (5) placement of physicians into new gatekeeping roles; and (6) increased health care system burdens. Physicians described requiring additional confirmatory testing, seeking institutional approval even for emergent life-saving interventions, and being forced to determine which patients were sick enough to receive medically indicated care.
CONCLUSIONS AND RELEVANCE: In this qualitative study of the consequences of abortion bans across multiple medical specialties, abortion bans were associated with disrupted clinical care far beyond what is traditionally categorized as abortion, with treatment delays that endanger patients, undermined patient autonomy and physician-patient trust, and with new gatekeeping roles for physicians. These restrictions shifted medical decision-making from clinical judgment and patient values toward legal risk mitigation, with potential long-term consequences including exacerbation of health care inequities and compromised ability to provide safe and effective care for pregnant patients.
PMID:42329649 | DOI:10.1001/jamanetworkopen.2026.19644
