The Impacts of Dobbs v. Jackson on Relationships between Patients and OB-GYNs in States with Restrictive Abortion Laws

Background and Purpose: The 2022 Dobbs v. Jackson U.S. Supreme Court decision, which overturned Roe v. Wade, eliminated the federal right to abortion and resulted in many states passing legislature to restrict or ban abortion access. Additionally, “aiding and abetting” clauses added to abortion legislation in some states have limited OB-GYNs’ ability to counsel patients on treatment options or refer for abortion care. In states with the strictest abortion laws, OB-GYNs are now forced to choose between following the law and providing evidence-based clinical care for patients, placing a wedge between the provider and the patient. The purpose of this analysis was to characterize the impacts of the Dobbs decision on relationships between OB-GYNs and their patients in states with abortion bans.

Methods: A collaborative research team comprised of social workers, a public health scholar, an OB-GYN, and a medical anthropologist engaged in qualitative data collection and analysis. A total of 54 qualitative, semi-structured interviews were conducted from March-August 2023 via videoconference with OB-GYNs practicing in 13 of the 14 states that had abortion bans in place at the start of data collection. Participants were asked about their experiences practicing under their states’ abortion bans, including changes to their clinical practice due to the bans, as well as the overall effects of the bans on pregnant individuals. Interviews were transcribed and then coded using Dedoose software and a qualitative descriptive approach. For the present analysis, we focused on codes pertaining to patient impacts and patient-provider relationships and trust.

Results: OB-GYNs described impacts on both trust and patient-physician communication resulting from state-level abortion bans. They noted that the lack of clarity in legislative language, as well as “aiding and abetting” laws enacted in some states, has resulted in hesitancy on the part of both patients and providers to engage in open and honest communication about patients’ feelings about their pregnancies in general, and abortion in particular. Among the barriers to uninhibited dialogue was a sense of being monitored, with several participants describing feeling as if legislators were physically present in the room during reproductive counseling conversations with their patients. This belief was fueled by a fear that the content of their patient counseling could violate the current anti-abortion legislation and could lead to criminal charges. OB-GYNs in the sample also discussed that, in instances when they did provide abortion-related care or reproductive counseling, patients were aware of the legal risk assumed by the provider. Patients expressed both gratitude for the care received, as well as fear and guilt at the possibility that treating their medical condition could result in their OB-GYN facing criminal charges.

Conclusions and Implications: Findings of this analysis indicate that the Dobbs decision, and the resultant state-level abortion bans, may have pervasive impacts on the relationships between patients and their OB-GYN providers, limiting OB-GYNs’ ability to engage in effective, patient-centered care.