LEGAL UNCERTAINTY AND THE CHILLING EFFECT OF ABORTION BANS ON CLINICAL CARE

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2025-10-13 DOI:10.1016/j.contraception.2025.111088

S Neill, S Landay, E Newton-Hoe, A Beasley, S Narasimhan, J Adkins Murphy, C Spera

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引用次数: 0

Abstract

Objectives

We aimed to identify how physicians understand and adapt to abortion bans in their day-to-day clinical work.

Methods

Physicians in emergency medicine, family medicine, or obstetrics and gynecology practicing in states with abortion bans were recruited via professional networks. We conducted virtual semi-structured interviews, including items on understanding of abortion bans and subsequent changes in clinical practice. Multiple coders with diverse reflexivity (physician and non-physician team members) analyzed interviews using thematic analysis via inductive and deductive coding.

Results

Some 30 physicians were interviewed across nine states. Four key themes emerged: (1) Physicians lacked clarity on abortion laws, leading to confusion and avoiding clinical interventions for pregnant patients. (2) There was not consistent institutional or legal guidance; physicians with greater understanding of the laws pursued independent education or were affiliated with advocacy groups. (3) Physicians deferred to specialists (Ob-Gyn, MFM) to interpret and apply abortion bans in clinical practice. (4) Physicians interpreted abortion bans through a medical malpractice lens, anchoring their legal understanding in concepts of liability and risk avoidance, contributing to feelings of stress, defensive practice, and burnout.

Conclusions

Abortion bans exert a chilling effect on the care of pregnant patients across specialties. This effect is driven by legal ambiguity, lack of guidance, and physicians’ understanding of abortion bans through the lens of malpractice. Deferring clinical care and interpretation of abortion bans to Ob-Gyn or MFM specialists adds strain to the already burdened reproductive health workforce. These factors contribute to highly conservative interpretations of abortion bans, limiting a broad range of pregnancy care.

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法律的不确定性和堕胎禁令对临床护理的寒蝉效应

目的：了解医生在日常临床工作中如何理解和适应堕胎禁令。方法通过专业网络招募在禁止堕胎州执业的急诊医学、家庭医学或妇产科医生。我们进行了虚拟的半结构化访谈，包括对堕胎禁令的理解和临床实践的后续变化。具有不同反身性的多名编码员（医生和非医生团队成员）通过归纳和演绎编码使用主题分析来分析访谈。结果来自9个州的约30名医生接受了采访。出现了四个关键主题：(1)医生对堕胎法不清楚，导致对怀孕患者的混淆和避免临床干预。(2)没有一致的体制或法律指导；对法律有更多了解的医生追求独立教育或隶属于倡导团体。(3)医生在临床实践中服从于专家（妇产科、MFM）对堕胎禁令的解释和应用。(4)医生通过医疗事故的角度来解释堕胎禁令，将他们的法律理解固定在责任和风险规避的概念上，从而导致压力感、防御性做法和倦怠。结论堕胎禁令对各专科孕妇的护理产生了寒蝉效应。这种影响是由法律的模糊性、缺乏指导和医生通过医疗事故的镜头对堕胎禁令的理解驱动的。将临床护理和堕胎禁令的解释推迟给妇产科或MFM专家，给本已负担沉重的生殖健康工作人员增加了压力。这些因素导致了对堕胎禁令的高度保守的解释，限制了广泛的怀孕护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.