Sepsis, Delayed Chemo, a Canceled Liver Transplant: Study Shows Abortion Bans Cause Substandard Care

Doctors are denying patients emergency abortion care and, in some cases, other health care services because of their pregnancies—and their state's abortion bans. 

By Kylie Cheung  |  September 9, 2024 | 2:49pm
Photo: Getty Images AbortionPolitics Abortion
Sepsis, Delayed Chemo, a Canceled Liver Transplant: Study Shows Abortion Bans Cause Substandard Care

In one state where abortion is banned, a patient who was 19 to 20 weeks pregnant was sent home from the hospital, despite doctors determining that she was experiencing painless cervical dilation and protrusion of the amniotic sac through her cervix. The next day, she returned in severe pain and advanced labor. According to one physician familiar with the situation, multiple members of her health care team declined to be involved because of the state’s active abortion ban, fearing prosecution. “Anesthesiology colleagues refused to provide an epidural for pain,” the physician recounted. “They believed that providing an epidural could be considered [a crime] under the new law.”

They continued, “I will never forget this case because I overheard the primary provider say to a nurse that so much as offering a helping hand to a patient getting onto the gurney while in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion.’” The physician called this “a gross violation of common sense and the oath I took when I got into this profession to soothe my patients’ suffering.”

This testimony is one of 86 physician stories that the research organization ANSIRH (Advancing New Standards in Reproductive Health) of the University of California, San Francisco collected between September 2022 and August, from states with abortion bans. The new study, published Monday, details dozens of similarly horrific anecdotes and concludes that, since 2022, abortion bans have led to pregnant people receiving substandard, sometimes life-threatening medical care.

Dr. Daniel Grossman, the lead author of the study, told the Guardian that ANSIRH began collecting this research amid all the alarming stories in the immediate aftermath of Dobbs. “One question that we had was: were the changes that we were seeing initially related to the initial shock of the Dobbs decisions and the laws that then went into effect? Would clinical protocols kind of adjust and healthcare providers would figure out how to provide high-quality care? Would these poor-quality cases disappear?” But through their research, Grossman and his team found that “these cases are continuing to happen.”

In states with abortion bans, doctors are denying or delaying emergency care due to the ambiguity around the bans’ medical exceptions, particularly around what qualifies as “life threatening,” forcing many doctors to wait until patients are on the brink of death to act. Texas and Louisiana, for example, threaten doctors with life in prison and up to 15 years in prison, respectively, if they provide abortion care to a patient who’s condition is later deemed not life-threatening enough. Delayed care can lead to loss of fertility, chronic pelvic pain, or even heart attack and stroke related to uncontrolled hypertension—not to mention long-term impacts on mental health, ANSIRH researchers concluded.

In some cases, the complications stretch beyond reproductive care: Doctors canceled a liver transplant for a patient in a state that banned abortion because they discovered she was pregnant, even though she didn’t want to be. In a similar case, a woman who learned she was pregnant after being diagnosed with breast cancer was told she couldn’t start chemotherapy until she had an abortion—but abortion was banned in her state. At that point, she was six weeks pregnant; it took her seven additional weeks to obtain an abortion in a nearby state. 

In another case, a patient who suffered from anencephaly, a severe, fatal fetal anomaly, was forced to give birth; almost immediately after, she watched her newborn’s skin turn from pink to navy. “The scream and wailing she let out once she saw the baby was soul-crushing and enough to break everyone in the room,” a medical student told ANSIRH researchers. “The mother kept screaming ‘Why, God?’ in Spanish over and over, but this was not a problem up to the divine, but rather a completely man-made problem.”

Many of the narratives shared with ANSIRH involve medical emergencies like PPROM, which occurs when a patient’s water breaks prematurely and could potentially cause sepsis, a life-threatening infection. One patient, who was 16-18 weeks pregnant in an abortion-banned state, was sent home from the hospital, despite experiencing PPROM symptoms. Two days later, she was admitted to the emergency room with what a physician characterized as “severe sepsis.” Finally, her medical team performed a dilation and curettage (D&C) abortion to save her life; the patient “bled from everywhere,” the physician recounted, but survived. After the procedure, the physician said, “She asks me: could she or I go to jail for this? Or did this count as life-threatening yet?” Another patient suffering from PPROM had to drive four hours out of state to get emergency abortion care.

The study details numerous cases of pregnant patients in the middle of urgent medical emergencies forced to travel across state lines for time-sensitive care; in one such case, a physician wrote, “[The patient’s] condition worsened during the duration of transport time. The patient was separated from family and resources. Astronomic hospital costs. … This delay in care was a ‘near-miss’ and increased morbidity.” 

In addition to PPROM and other fetal conditions, other patients suffering a miscarriage weren’t immediately able to receive standard medication to stop the bleeding, resulting in life-threatening blood loss and hemorrhaging. Patients with ectopic pregnancies, which are nonviable and occur when a fertilized egg develops outside the uterine wall, had to travel out of state or chance receiving delayed care; some patients with ectopic pregnancies initially feared seeking any health care at all, believing they could be prosecuted.

The same study also details the experiences of people tied to the carceral system, like a woman on parole who sought and was denied permission to leave her state, where abortion is banned, for the procedure. The woman left her state anyway but had the procedure without sedation because she feared being drug tested. One 15-year-old in juvenile detention was forced to give birth because of her state’s abortion ban. ANSIRH researchers stressed that people of color, specifically Black and Latinx patients, were overrepresented in their research, building on a long history of patients from these communities receiving substandard, pregnancy-related care resulting in disproportionately high maternal mortality. 

“This study shows that abortion bans are fundamentally degrading medical care—not just in a single state or for a certain type of patient but for people with a range of health conditions living anywhere these bans are in place,” Dr. Kari White, a study co-author, said in a statement. “That a high proportion of patients described in the study narratives are Black and Latinx makes this even more concerning given the long-standing structural barriers to high quality care that these groups encounter in the U.S. medical system.”

In a statement, Grossman stressed that abortion bans are incompatible with a functional medical system: “Instead of policy band aids or exceptions that don’t work, we need to repeal abortion bans so that clinicians can do the job they were trained for and provide high quality health care to their patients.”

 
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