The Association Between Abortion Restrictions and Patient-Centered Miscarriage Care: A Cross-Sectional Study of U.S. Obstetrics and Gynecology Residency Programs [ID: 1377546]

Abstract

INTRODUCTION: Miscarriage is common, and treatment modalities overlap with those used for induced abortion. In places where abortion is heavily regulated, clinicians managing miscarriages may cautiously rely on the strictest criteria to differentiate early pregnancy loss from potentially viable pregnancy and may not offer certain treatments commonly associated with abortion. METHODS: From November 2021 to January 2022, we conducted a cross-sectional study of all 296 U.S. obstetrics and gynecology residency programs, surveying each about their institution’s miscarriage practices. We compared miscarriage care by program characteristics, institutional abortion restrictions, and state legislative policies. RESULTS: Of 149 programs who responded (50.3% response rate), 74 (49.7%) reported strict reliance on conservative imaging criteria before offering any intervention for suspected early pregnancy loss, despite patient-centered society recommendations, while the remaining 75 (50.3%) reported incorporation of imaging guidelines with other factors. After controlling for other factors, institutional abortion restrictions were the only independent predictor of strict reliance on imaging guidelines (odds ratio 12.3, 95% CI 3.2–47.9). Mifepristone was used less at programs in states with hostile abortion legislation (32% versus 75%, P<.001) or with institutional abortion restrictions (25% versus 86%, P<.001). Similarly, office-based aspiration was lower in hostile states (48% versus 68%, P=.014) and with institutional abortion restrictions (40% versus 81%, P<.001). CONCLUSION: Academic institutions with restricted access to induced abortion are less likely to holistically incorporate clinical evidence and patient priorities in determining when to intervene for miscarriage and are less likely to offer the full range of treatment options. With abortion bans proliferating nationwide, evidence-based education and patient-centered care for miscarriage may also be imperiled.