Primary Submission Category: Policy
Moral distress among obstetrician-gynecologists in states with restrictive abortion laws: Preliminary findings from the Study of OB-GYNs in Post-Roe America
Authors: Erika Sabbath Mara Buchbinder Kavita Arora Samantha McKetchnie
Presenting Author: Erika Sabbath*
Background: In June 2022, the U.S. Supreme Court issued the Dobbs v. Jackson decision, eliminating the federal right to an abortion and allowing states to ban abortion outright. Bans have had wide-ranging impacts on many aspects of reproductive health care, putting obstetrician-gynecologists (OB-GYNs) in positions of having to choose between appropriate clinical care for patients and their own legal jeopardy. Such situations are likely to create moral distress: a situation in which a healthcare provider knows the right course of clinical action, but is barred from taking that action by external constraints. The purpose of study is to characterize experiences of moral distress among OB-GYNs in states with the most restrictive abortion laws post-Dobbs, and to describe the impacts of this moral distress on OB-GYNs’s health and wellbeing.
Methods: The Study of OB-GYNs in Post-Roe America (SOPRA) is a qualitative study consisting of semi-structured interviews with 54 OB-GYNs from 13 of the 14 states that had banned abortion as of March 2023. Data were collected from March through August 2023.
Findings: Fifty of 54 OB-GYNs described situations in which they knew the right course of clinical action, but were barred from taking it due to state laws. Morally distressing situations fell into four categories: needing to wait longer than necessary to provide lifesaving care; restrictions on counseling patients about options for a given pregnancy or directly discussing abortion; inability to provide needed care or direct referral; and conflicts with colleagues due to different levels of risk tolerance with respect to abortion bans. These morally distressing situations impacted participants both professionally (e.g. desire to leave one’s state) and personally (e.g. sleep difficulties, mental health).
Conclusions: Findings reveal deep and widespread impacts of the laws on OB-GYNs, with implications for physician wellbeing and care availability in large parts of the United States.