In 2022, the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision allowed states to enact laws that ban or severely restrict abortion. Four years later, a study led by Harvard Medical School researchers at Beth Israel Deaconess Medical Center shows 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 serious pregnancy-related conditions.
The findings, published June 22 in JAMA Network Open, describe physician-reported consequences of abortion bans across multiple medical specialties.
“Abortion bans were described as affecting care delivery far beyond what is traditionally categorized as abortion,” said senior author Sara Neill, HMS assistant professor of obstetrics, gynecology, and reproductive biology at Beth Israel Deaconess. “Where decision-making was previously guided primarily by clinical judgment and patient values, care [since the 2022 decision has been] increasingly shaped by legal risk.”
More requirements, less patient trust
As of January 2026, 13 states had total abortion bans and seven 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 of the states with total abortion bans.
Across specialties, physicians reported that care decisions 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.
“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,” said one of the OB-GYNs interviewed by Neill and colleagues.
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, the study suggests.
Consequences beyond abortion
The findings add to 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,” said corresponding author Sophia Landay, HMS clinical fellow in obstetrics, gynecology, and reproductive biology at Beth Isreal Deaconess. “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.”
Adapted from a Beth Israel Deaconess news release.
Authorship, funding, disclosures
Additional authors of this work include Emily Newton-Hoe, Subasri Narasimhan, Anitra Beasley, and Jessica Adkins.
This study was supported by the William F. Milton Fund, an internal grant from Harvard University.
