Four Years After Dobbs, Physicians Report That Pregnancy Care Has Been Reshaped
Study Finds Dobbs Has Affected Pregnancy Care Beyond Abortion
BOSTON — In 2022, the Supreme Court's Dobbs v. Jackson Women's Health Organization decision allowed states to ban or severely restrict abortion. Four years later, Beth Israel Deaconess Medical Center (BIDMC) researchers report that the effects of those laws are being felt throughout the health care system, forcing physicians to weigh legal risks, delay treatment and deviate from standard medical practices when caring for patients with other serious pregnancy-related conditions. The findings from the qualitative study are published in JAMA Network Open.
"In our study of physician-reported consequences of abortion bans across specialties, abortion bans were described as affecting care delivery far beyond what is traditionally categorized as abortion," said Sara Neill, MD, MPH, senior author of the study and an obstetrician-gynecologist at BIDMC. "Where decision-making was previously guided primarily by clinical judgment and patient values, care was increasingly shaped by legal risk."
As of January 2026, 13 states had total abortion bans and 41 imposed gestational limits, including seven that prohibited abortion at or before 18 weeks' gestation. To better understand how those restrictions impact physicians treating patients with abortion-adjacent conditions and pregnancy complications, Neill and colleagues conducted in-depth interviews with 40 physicians practicing emergency medicine, family medicine and obstetrics and gynecology in nine states with total abortion bans.
Across specialties, physicians reported that care decisions once guided primarily by clinical judgment and patient values have been increasingly shaped by concerns about legal liability.
Participating physicians — 30 women and 10 men — described delays in care for miscarriages, ectopic pregnancies and other serious pregnancy-related conditions, as clinicians sought additional testing, specialist consultation or approval from hospital attorneys or ethics committees before intervening. Some physicians reported having to wait until patients’ conditions worsened before treatment could be provided under state law, even when the appropriate course of care was already clear. Patients sometimes endured additional testing, repeated emergency department visits and prolonged uncertainty while clinicians determined whether legal thresholds for intervention had been met.
Physicians also reported growing mistrust among patients, some of whom delayed seeking care or withheld information for fear of being reported for seeking abortion-adjacent care. Taken together, the delays, extra consults and patient mistrust create another strain on an already-burdened health care system. Said one of the 18 OB-GYN interviewed via videoconference by Neill and colleagues: “Making somebody come back to the emergency room to repeat a [test] or making somebody have another ultrasound . . . it’s not always the best use of resources — especially in a place where we don’t have Medicaid expansion and not everybody has access to health insurance. We’re requiring patients to access resources that they don’t have access to.”
The findings build on a growing body of research describing delays in care, deviations from standard medical practice, clinician distress and moral injury in the post-Dobbs environment. While prior studies largely focused on abortion care itself, the current study illustrates how similar challenges can emerge in the care of patients with miscarriage, ectopic pregnancy and other serious pregnancy-related conditions. The findings also provide a window into how those delays unfold in practice as physicians navigate legal restrictions on care.
"Physicians expressed discomfort with the processes implemented to decide which patients were considered sick enough or which fetal anomalies were considered lethal enough to justify abortion under restrictive laws," writes corresponding author Sophia L. Landay, MD, an OBGYN resident physician at BIDMC. "What once served as a hypothetical values clarification exercise — deciding which patients are deserving of care — has become a real process overriding years of clinical judgment and expertise."
Co-authors included: Emily Newton-Hoe, MPH, MPA, of Harvard T.H. Chan School of Public Health; Subasri Narasimhan, PhD, MPH, of UCLA Center on Reproductive Health, Law, and Policy; Anitra Beasley, MD, MPH, of Baylor College of Medicine; Jessica Adkins, MD, of Massachusetts General Hospital. This study was supported by the William F. Milton Fund, an internal grant from Harvard University awarded to Sara Neill, MD, MPH.
The authors reported no conflicts of interest.
About Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center is a leading academic medical center, where extraordinary care is supported by high-quality education and research. BIDMC is a teaching affiliate of Harvard Medical School, and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.
Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.
