Disclosures: Arey does not report material financial information. Please consult the study for relevant financial information from all other authors.
Key take away:
- Counseling about pregnancy options for medically complex pregnancies has been curtailed after Texas banned abortions.
- Patients unable to travel out of state had to continue pregnancies, which increased the risk of morbidity.
The ability of Texas health care providers to provide evidence-based abortion care to women with medically complex pregnancies has been disrupted after the implementation of Texas Senate Bill 8, researchers reported in Obstetrics and Gynecology.
Prior to September 2021, Texas law allowed abortions up to 22 weeks of gestation for any reason, but barred Medicaid and private health insurance from covering abortion care unless medically indicated doctor. Texas Senate Bill 8, which was implemented in September 2021, banned most abortions after detection of embryonic heart activity.
“Studies on Senate Bill 8 have focused largely on trends in abortion volume and length of gestation. Providing a prohibited abortion, or aiding or abetting a prohibited abortion, could result in civil litigation and penalties,” Whitney AreyPh.D, a postdoctoral fellow with the Texas Policy Evaluation Project at the University of Texas at the Austin Population Research Center, and colleagues wrote. “In this qualitative study, we explore how health care providers in Texas cared for patients experiencing medically complex pregnancies prior to the implementation of Senate Bill 8 and how the implementation of the law changed their clinical practice “.
Arey and colleagues conducted 50 in-depth qualitative interviews with 21 maternal-fetal medicine specialists, 19 obstetrician-gynecologists, eight physicians whose primary practice is abortion care, and two genetic counselors in Texas who cared for patients with fetal diagnoses. limiting or who had existing or developed health conditions that negatively impact pregnancy. A first round of interviews (n = 25) was conducted from March to June 2021 prior to implementation of Texas Senate Bill 8, and a second round (n = 25) was conducted from January to May 2022 after implementation. The researchers then identified the themes and changes in practice before and after Senate Bill 8.
All participants reported that they presented their patients with information about the health risks and outcomes of continuing pregnancy during each policy period. After Senate Bill 8 was implemented, counseling about pregnancy options was reduced, participants reported. In cases where a patient’s health and life would be compromised, narrow criteria for hospital abortions limited care before Senate Bill 8, and these criteria have become more stringent since Senate Bill 8, the researchers wrote.
Both administrative abortion approval processes and referrals delayed treatment and, therefore, endangered patients’ health, according to the researchers. The situation worsened when in-state options were eliminated after Senate Bill 8.
Health care participants also reported that more resource-constrained patients who were unable to travel out of state had to continue with their pregnancies, which increased their risk of morbidity.
“State and hospital policies should enable health care providers and patients to determine the best course of care that aligns with both clinical evidence and patient preference and protects patient health,” the researchers wrote.
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