8. “I feel like we are walking on eggshells”: Experiences of Pediatric Residents Providing Care for Pregnant Adolescents in Texas Post-Dobbs

Abstract

Background

In the year following the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization to remove federal protection for abortions, new and unprecedented laws were passed related to pregnancy in Texas and elsewhere. Pediatric residents are often the first point of contact for pregnant adolescents. Examining the impact of these laws on pediatric residents is crucial to understanding gaps and promoting quality patient care in this new political landscape.

Methods

Pediatric residents were randomly selected from a Texas pediatric residency program and invited for a virtual, semi-structured, one-to-one interview with a trained study investigator between August and October 2024. Interviews explored residents' experience providing healthcare to pregnant patients and knowledge of current laws governing these interactions in Texas. All interviews were recorded, transcribed, and independently conducted using an inductive coding approach by two investigators. Themes were generated using iterative thematic analysis.

Results

Participants (n=11) included 4 third-year pediatric residents and 7 second-year pediatric residents. Inductive coding generated 34 codes consolidated into 8 themes. Data showed fear of discussing abortion was universal among residents with concerns around rules for notifying patients’ parents, and legal ramifications of documentation. Residents also discussed the emotional and moral burden of being limited in the care they can provide and awareness of the unequal impact of restrictive laws on low-income patients. Misconceptions of laws related to reproductive health care were pervasive among residents who were often informed by more senior physicians or non-academic online resources, with most residents assuming stricter versions of current policies. Overall, residents were enthusiastic about learning to care for pregnant patients and desired more clarification in their training.

Conclusions

Study findings show high levels of fear discussing abortion and common misconceptions about abortion policy among pediatric residents caring for pregnant adolescents in Texas. Given radical shifts in the U.S. policy environment, new pregnancy-focused training materials are necessary to ensure trainees feel confident caring for this patient population. Increased resident training is especially important in restrictive legal environments like Texas to prevent trainees from “over-implementing” state abortion policies and placing additional restrictions on patients' access to reproductive health services.