U.S. state abortion bans are disrupting medical care across many fields of medicine and resulting in substandard, discriminatory health care, according to a Physicians for Human Rights (PHR) research brief published today. PHR calls on federal and state policymakers to defend and strengthen national and state protections for abortion access and urge the U.S. Food and Drug Administration (FDA) to refrain from further restrictions on the medications mifepristone and misoprostol, associated with reproductive health care, given rigorous evidence of their safety.
Cascading Harms: How Abortion Bans Lead to Discriminatory Care Across Medical Specialties is based on 33 in-depth interviews with physicians across 20 states from fields including oncology, neurology, hematology, dermatology, cardiology, pulmonology, and obstetrics and gynecology. The study reveals that abortion bans have had a widespread chilling effect on health care as clinicians are forced to weigh legal risks, often deviating from standards of care or waiting until patients become severely ill to intervene.
“Doctors waiting for ‘irreversible damage’ before offering care. Patients given less effective medicines instead of the best available treatments. Health systems offering substandard and discriminatory care to pregnant patients. The consequences of state abortion bans are not only manifesting in harms to reproductive health care, but across many other medical specialties. From cancer care to pulmonology and beyond, the harms of abortion bans are cascading across the health system,” said Michele Heisler, MD, MPA, medical director at PHR and professor of internal medicine and public health at the University of Michigan. “Our research shows that abortion bans are undermining fundamental principles of medicine and patient autonomy – leading to discrimination in care to women, girls, and pregnant patients.”
Research brief findings include:
- Delays in emergency care: Doctors describe patients being bounced between facilities, arriving septic or with irreversible organ damage.
- Breakdown of standards of care: Physicians are prescribing less effective drugs out of fear of legal repercussions, disproportionately harming women, low-income patients, and marginalized communities, resulting in discriminatory care.
- Barriers to essential medications: Pharmacies have denied mifepristone, misoprostol, and methotrexate even for non-abortion use, jeopardizing cancer, autoimmune, and critical care treatment.
- Some physicians avoid prescribing teratogenic medications to reproductive-age patients due to fear that patients might become pregnant and be unable to access abortion care.
- Physician scattering and burnout: Specialists are leaving ban states due to fear of the confusing exceptions and severe criminal and civil penalties in state-level abortion bans, worsening “maternity care deserts” and creating gaps in cancer and cardiac care.
Twenty-eight states have introduced legislation banning or curtailing access to abortion care following the U.S. Supreme Court ruling overturning the constitutional right to abortion in Dobbs v. Jackson in June 2022. This legislation often includes criminal or civil penalties on health care providers who provide abortion care. As restrictive laws and telemedicine lead to more patients utilizing medication abortion, states such as Louisiana have sought to restrict access by reclassifying mifepristone and misoprostol as controlled substances, and other states have also put forward similar legislation. Several states with abortion bans have sought to prosecute clinicians across state lines who prescribe abortion medication via telehealth.
Under the Trump administration, federal efforts to further restrict the use of mifepristone and misoprostol are also underway, while fears continue that the administration could use the Comstock Act to prosecute the mailing of mifepristone, misoprostol, and potentially other instruments used in reproductive health care nationally.
PHR’s research brief highlights testimony from clinicians across the country that highlights how abortion bans have impeded medical care far beyond reproductive health, including:
- “What we are doing is sitting and waiting almost for irreversible damage to occur before we do something and offer them [abortion care].” – An OB-GYN
- “We had critical care docs who told us that critically ill women showed up in my intensive care unit (ICU) who had these congenital heart problems or other conditions that had made pregnancy really unsafe for them. They hadn’t been able to access abortion. And now they’re critically ill in my ICU and I’m trying to just keep them alive.” – A pulmonologist
- There are definitely situations that I’ve seen on more than one occasion where a patient [who came here for abortion care] was told in her home state that her pregnancy did not pose enough of a threat to her life, regardless of her cancer diagnosis and regardless of needing to delay the appropriate treatment for cancer.” – An OB-GYN, discussing cancer care for patients
- “What we see is patients who are put on these really inadequate, inappropriate therapies because people are afraid of the possible pregnancy, which raises the question of abortion that physicians in abortion ban states do not want to deal with.” – A neurologist
Findings from the brief will be discussed at an online launch event today at 12:00 U.S. Eastern Time (RSVP here), featuring co-authors, physicians affected by the bans, and POLITICO’s Alice Miranda Ollstein.
PHR calls for the U.S. government and Congress, state governments, and health care institutions and professionals to defend national protections for abortion access and refrain from further restrictions on the medications mifepristone and misoprostol given rigorous evidence of their safety.
“Clinicians have an ethical obligation to stand against policies that interfere with their duty of care and deny patients the right to comprehensive medical care. The widespread harms of abortion bans highlighted in this research show the need for physicians across specialties to speak out. Clinician advocacy can push back against anti-scientific policies and help ensure that additional rollbacks, such as restrictions on mifepristone and misoprostol, do not go into effect,” said Dr. Heisler.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.