Doctors who practice medicine in states with abortion bans have described in a new study how three of their pregnant patients died, but probably could have been saved had they been able to receive abortion care.
The doctors, who treat lung, respiratory and other critical illnesses, never raised abortion, including the option of traveling out of state for the procedure, out of fear of legal repercussions, according to interviews with the doctors in the study, which was published in Chest, a medical journal. No other information about the patients who died was published.
The study, led by the researcher Katrina Hauschildt at the Johns Hopkins School of Medicine, sought to understand how abortion bans put in place after the supreme court’s 2022 decision to overturn Roe v Wade affected specialist doctors outside the field of obstetrics and gynecology, where most research has been focused.
“While these downstream consequences [on pulmonary and critical care physicians] have been hypothesized, little systematic empirical data exists on the impact of these policies on patients with pulmonary and/or critical illness and their physicians,” the study said.
The research, based on interviews with more than two dozen pulmonary and critical care physicians, who work in 15 states with abortion bans, described “repeated experiences of restricted and delayed treatment” of their patients, impacts to training, concerns about ways abortion bans had “disparate impacts across social groups”, and their own moral distress at navigating abortion laws. In one case, treatment for an ectopic pregnancy, which is by definition nonviable, was delayed, resulting in “hemorrhagic shock”, a doctor reported.
“This study clearly demonstrates the immediate and wide-spread harm that abortion bans are having on pregnant people. Even in states with ‘exceptions’ to the abortion ban, doctors’ hands are tied until it is too late and severe outcomes, including preventable death are happening,” said Dr Caitlin Bernard, an Indiana-based obstetrician-gynecologist and reproductive and abortion rights activist.
Bernard added: “While some cases are deemed newsworthy, these daily injuries and death are not even counted, much less made public. Nobody will ever know how many women have been harmed or died because of abortion bans preventing appropriate medical care.”
The interviews took place between October 2022 and July 2024 and included physicians practicing in Georgia, Idaho, Indiana, Kentucky, Louisiana, Missouri, Mississippi, Oklahoma, Tennessee and Texas, among other states with strict abortion restrictions. (Missouri has since restored some abortion access following a ballot initiative held in November 2024.)
In one case, a doctor who was interviewed described how a patient with a congenital heart defect, who began having symptoms of health issues at 18 weeks, first presented at a local hospital. The doctor said: “Abortion at that point probably would have prevented [life-threatening disease] progression,” but was never discussed with her. She was then transferred to critical care physicians to “try to get her to the 22-week mark” so that she could have a viable fetus.
Her condition rapidly deteriorated and she began to have respiratory failure, the doctor said. “We got her to 22 [weeks] … they performed a C-section and took the fetus. The baby survived, but I think she left the [intensive care] unit on a ventilator … and I just remember [her husband] saying: ‘I’m not sure this is what she would have wanted.’”
Four of the 29 doctors who were interviewed said they did not believe they were allowed to discuss abortion at all with their patients. Of those, two who were interviewed said a total of three of their patients had died.
One of those doctors – who had two pregnant patients die – said one patient had been a mother from a large family with several children already, whose disease had “in theory” been well-controlled during pregnancy. But she did not survive delivery.
“You know, you felt a little bit like your hands were tied because you’d want to counsel termination – not carrying the pregnancy forward, but with the restriction placed in the state, you’re not really sure if that counseling could be a reason that you get in trouble with the legal system, or your license is put under question, because there are rules in other states where that does happen,” the doctor said.
In another case involving a pregnant patient whose treatment was delayed, a doctor described how the patient had an ectopic pregnancy but doctors were unsure of “whether it had fully ruptured”.
“She spent about 12 hours in the emergency department with it not being clear whether anyone could perform surgery or not, and then developed hemorrhagic shock and went to surgery and had an OK outcome,” the doctor said, “but had an obvious delay in care that was almost certainly a result of the [abortion restriction] and the uncertainty around what is an imminent threat in the life of the mother.”
The doctor added that the patient received blood products she probably would not have needed if the delay had been avoided.
Some delays in care occurred because more people have become involved in care decisions as the legality of medical decisions are determined, the study found. In one case, delays occurred because pharmacies required a discussion with a physician before pulmonary medication that could result in miscarriage was dispensed.
“[Previously] … there would be no involvement of other people. So it definitely invokes a delay in care. One hundred per cent, like at least two or three hours is delayed, because we have to involve these extra people to make sure that we do [decide and document] correctly, and we guess we just hope that two or three hours is OK,” one doctor said.
The physicians also pointed to inequities in patient populations. “We have a huge group that are very poor, very uneducated, maybe not native speakers, and don’t have those abilities [to get out of state abortion care]. So for that group, there are no options,” one doctor said.
Physicians reported feeling unsure of whether they would be supported by their medical institutions if they faced legal scrutiny for helping patients obtain pregnancy terminations. The research found that most felt they would be supported by colleagues, but were unsure about their institutions, which sometimes receive funding from the state.
Do you have a tip? Please contact Stephanie.Kirchgaessner@theguardian.com or on Signal at 646-886-8761.
