Confusion, Cruelty and Fear: Delivering Reproductive Care to Women After Texas’ Abortion Ban

A  by Manatt Health interviews physicians across the state of Texas grappling with the state’s abortion ban in the wake of the Dobbs ruling. Interviewees include OB/GYNs, emergency medicine (EM) physicians, and family medicine (FM) physicians trained in obstetrics and documenting their stories and common themes emerging across multiple physicians. 

The new study revealed five cross cutting themes:

1. Legal Standards Have Replaced Medical Guidelines. In evaluating whether or how to terminate a pregnancy, physicians now apply legal standards; clinical standards and medical judgment are secondary at best. Decision-making, including during emergent situations where time is critical, is slowed down as physicians consult leadership teams and legal counsel in cases that otherwise would have been managed quickly and compassionately. 
2. The Doctor-Patient Relationship Has Been Impaired. The trust between patient and doctor is eroding. OB/GYNs, EMs, and FMs report that they are no longer able to practice evidence-based medicine or speak openly to their patients.
3. “It’s Just Plain Cruel.” Doctors repeatedly described it as “cruel” to require a woman to carry to term and deliver, against her will, a fetus that clearly could never survive outside the womb. In these cases, the pregnant women bear all the risks of pregnancy and the grief over the lost baby and must endure a delivery that may be physically and emotionally traumatic.
4. Erosion of Expertise. With increasingly limited opportunity for trainees to manage medically necessary abortions, doctors are not learning how to manage pregnancy terminations, putting all women at risk.  Given Texas’ standing as a major educator and training site for future physicians, this threatens other states as well, with trainees beginning practice without the requisite skills to manage miscarriages or abortions.
5. Fear Dominates. Fear and confusion manifests in the different approaches doctors and hospitals take in interpreting Texas law.  Some doctors believe they are permitted to tell women that abortion is an option outside of Texas and others believe if they say even that much they will be prosecuted for aiding and abetting an abortion. 

This study builds on a , sponsored by nine independent and non-profit foundations in Texas, on the state’s abortion ban and the implications for access to reproductive health care.

Click to read the full report, interviews and findings.