THE IMPACT OF DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION ON FACILITATING ABORTION CARE IN A RESTRICTED STATE

Objectives

Prior to Dobbs, the provision of abortion care and patient need for “referral” differed widely across health systems in Wisconsin. Following Dobbs, Wisconsin physicians faced an 1849 state law widely interpreted to criminalize abortion except in life-saving emergencies. We documented how the post-Dobbs legal landscape shaped how obstetrician-gynecologists (Ob-Gyns) facilitated abortion care for pregnant patients.

Methods

Following Dobbs, we recruited 21 Ob-Gyns from rural and urban areas with varying hospital affiliations, scopes of practice, and individual demographics to participate in virtual interviews between September and December 2023. Interviews explored experiences providing pregnancy care under the threat of a statewide abortion ban. Investigators coded and analyzed qualitative data using a combined inductive-deductive approach.

Results

Participants described difficulties in facilitating patient-centered abortion care following Dobbs. Referral practices ranged from direct referrals within or between health systems to less formal or absent processes. The degree of institutional support for care facilitation varied widely. Participants cited a lack of robust referral systems as contributing to delayed and discontinuous patient care. The absence of institutional support exacerbated barriers for patients and overburdened physicians.

Conclusions

Following Dobbs, a criminal abortion ban increased the need for and barriers to facilitating abortion care for Wisconsinites. Healthcare systems played a significant role in compounding those challenges. In abortion-restricted settings, institutions should actively build and support referral pathways for their patients in need of abortion, within and beyond state borders.