Texas abortion ban disrupts care for women with medically complex pregnancies

Key takeaways:

• Counseling on pregnancy options for medically complex pregnancies was curtailed after Texas banned abortion.
• Patients unable to travel out of state had to continue pregnancies, which increased morbidity risk.

The ability of Texas health care professionals to provide evidence-based abortion care to women with medically complex pregnancies was disrupted after Texas Senate Bill 8 was implemented, researchers reported in Obstetrics & Gynecology.

Before September 2021, Texas law permitted abortions up to 22 weeks of gestation for any reason but prohibited Medicaid and private health insurance from covering abortion care unless medically indicated. Texas Senate Bill 8, which was implemented in September 2021, prohibited most abortions after the detection of embryonic cardiac activity.

“Studies on Senate Bill 8 have largely focused on trends in abortion volume and gestational duration. Provision of a prohibited abortion, or aiding or abetting a prohibited abortion, could result in civil litigation and penalties,” Whitney Arey, PhD, a postdoctoral fellow with the Texas Policy Evaluation Project at the University of Texas at Austin Population Research Center, and colleagues wrote. “In this qualitative study, we explore how Texas health care professionals cared for patients who were experiencing medically complex pregnancies before implementation of Senate Bill 8 and how implementation of the law changed their clinical practice.”

Arey and colleagues conducted 50 qualitative in-depth interviews with 21 maternal-fetal medicine specialists, 19 obstetrician-gynecologists, eight physicians whose primary practice is abortion care and two genetic counselors in Texas who cared for patients with life-limiting fetal diagnoses or who had existing or developed health conditions adversely impacting pregnancy. A first round of interviews (n = 25) was conducted from March to June 2021 before the implementation of Texas Senate Bill 8, and a second round (n = 25) was conducted from January to May 2022 after the implementation. Researchers then identified themes and changes in practice before and after Senate Bill 8.

All participants reported presenting their patients with information regarding health risks and outcomes of continuing their pregnancy during each policy period. After the implementation of Senate Bill 8, counseling on pregnancy options was curtailed, participants reported. In cases where a patient’s health and life would be compromised, the narrow criteria for abortions at hospitals limited care before Senate Bill 8, and these criteria became more stringent after Senate Bill 8, the researchers wrote.

Both abortion administrative approval processes and referrals delayed care and, therefore, endangered the health of patients, according to the researchers. This worsened when in-state options were eliminated after Senate Bill 8.

Health care participants also reported that patients with more limited resources who were unable to travel out of state had to continue their pregnancies, which increased their morbidity risk.

“State and hospital policies should allow health care professionals and patients to determine the best course of care that aligns with both clinical evidence and patient preferences and protects patient health,” the researchers wrote.