New Report: Abortion Bans Cause Serious Medical Harm

CHRISTIANE AMANPOUR, CHIEF INTERNATIONAL ANCHOR: Now, South Carolina’s governor has just signed a bill banning most abortions as early as six weeks into law. South Carolina is the latest state to tighten its grip on abortion access since Roe v. Wade was overturned last June. Now, a new study called “Care Post-Roe” has found that states blocking female reproductive rights are putting lives at risk. The co-authors of the report join Michel Martin to discuss how these bans are endangering women.

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MICHEL MARTIN, CONTRIBUTOR: Thanks, Christiane. Professor Kimport, Dr. Grossman, thank you both so much for joining us.

KATRINA KIMPORT, MEDICAL SOCIOLOGIST AND PROFESSOR, ADVANCING NEW STANDARDS IN REPRODUCTIVE HEALTH, UCSF: Thank you for having us.

DR. DANIEL GROSSMAN, DIRECTOR, ADVANCING NEW STANDARDS IN REPRODUCTIVE HEALTH, UCSF: Thank you.

MARTIN: So, Dr. Grossman, let me just start with you and ask, what was the intention behind this study? How did it get started? What were you thinking about and what did you want to know?

DR. GROSSMAN: Honestly, I was really concerned. As you know, these bans on abortion generally allow abortion in the cases when the pregnancy threatens the life of the pregnant person. But as a practicing physician for almost 30 years, what constitutes a life-threatening condition is just not always as clear as it might seem, it’s not black and white. You know, how severe does the condition need to be, how eminent does the threat need to be? And because these answers are so unclear, I was really concerned that my colleagues in states with these abortion bans were going to be forced to hesitate, to wait to provide the care that was medically necessary. And after the Dobbs decision and these laws started going to effect, we did see some reports from the media about cases where patients have pregnancy complications but they couldn’t get the care they need, even though the condition, apparently, threatened their life. And then, at the same time, we also started hearing reports that doctors were being told by their hospitals and their employers not to talk to reporters. They were essentially being muzzled. Their voices were being silenced. And so, that’s really why we started this project to give doctors and nurses and nurse midwives, nurse practitioners, pharmacists, anyone who cares for a patient, an opportunity to be able to share these stories about poor quality care anonymously if they wanted to.

MARTIN: So, Dr. Grossman, as a clinician, so you’re interested in like what’s going on in that clinical setting. Professor Kimport, you’re a sociologist. Tell me what you were interested in and discovering in this? Were you interested in sort of thinking about like what the patterns were?

KIMPORT: Absolutely. My interest has really long been in what a patient’s experience of navigating health career is and particularly, reproductive health care. And here, we have an instance where this is something that is not generally recognized, that there are heartbreakingly large number of ways that pregnancy can go wrong. In general, we think of pregnancy as a positive thing. Socially, people are excited about it. And we think of it as resulting in babies and family growth. But in actuality, there are a number of ways, a huge number of ways that can go wrong. And I was really interested in understanding what the
patient experience is, what they’re facing, what they’ve learn about, and what are the consequences of having a pregnancy in states that have banned abortion, and therefore, taking that tool out of the toolkit of the prenatal care providers, of maternal fetal specialists, of all the people who are supposed to take care of these patients, what happens to the patient then? And so, that’s why I joined the study, and what I was interested in.

MARTIN: So, you partnered with investigators at the University of Texas, Austin who started looking into the impact of a ban enacted in Texas in 2021 on abortions after six weeks. So, maybe, Dr. Grossman, you’ll start here. What were researchers seeing?

DR. GROSSMAN: My colleagues at the Texas Policy Evaluation Project were already talking to doctors back then and they were seeing that patients couldn’t always get the care that they needed, because it just wasn’t always clear when a situation was life-threatening enough to provide lifesaving care. And so, they started seeing some of these reports, essentially, Texas, because of this six-week ban, they really got a glimpse of what a post Dobbs world was going to look like for the rest of the country.

MARTIN: So, Professor Kimport, then the study expanded out. And so, tell me — or some of the other locations that you looked at, because I understand that the purpose here was to give people an opportunity to report without jeopardizing themselves professionally or legally, but it as broadly as you can, tell me, who are some of the people you heard from in the study?

KIMPORT: Exactly. So, we structured it to be fully anonymous to allow people to submit cases, even when their maybe hospital system was discouraging them from speaking about it and even when they were concerned that maybe they potentially would be at risk of legal or criminalization. What we heard from, is we heard from doctors and nurses in states that have abortion bans about cases of patients who they took care of where they weren’t able to offer the standard of care. And then, we also heard from physicians who were in states that were receiving these patients, right? So, when the patients weren’t able to get standard medical care, many times, they would then travel to a state that didn’t have an abortion ban in order to receive what they could have received before the Dobbs decision in their own hospital, from their own providers. In our study, thankfully, we didn’t get any reports of deaths. That miraculously, all of the patient cases that we heard about resulted in the patient ultimately getting the care they needed. But I think the question is sort of, what — at what cost? And what we see in these examples is they had to travel, they had to experience the both physical extension of repercussions of the delay in receiving standard medical care and they had to then be away from family and friends. And for some, they had to then fear that what they were doing was illegal, right? So, we have instances of people doing all of these things that they need as basic medical care under an umbrella of fear that what they’re doing could result in them needing to go to jail, being fined, and potentially in long- term, physical repercussions.

MARTIN: So, Professor Kimport, it’s my understanding that you got submissions from about 50 providers across 14 states. Is that about right?

KIMPORT: Correct.

MARTIN: But I take it you still feel that the findings are important to highlight. You know, why is that? For people who would argue or could question that that’s just — it’s not a huge number, given how many practitioners there are and given how many pregnancies there are, what would you say?

KIMPORT: I think the simplest way of answering that question to say that we believe this is the tip of the iceberg, right? So, these are the cases where somebody observed that a patient did not receive standard medical care, knew enough about our study to then be able to report it, and took the time to complete that form. We can only imagine that there are other cases and, you know, it’s hard at this point to estimate what that number would be, but there are going to be plenty of cases where somebody either didn’t know about the study or didn’t have the time to be able to report it. So, fundamentally, what these cases represent — and remember, they happened immediately after these legal changes went into effect. And what we are looking at is just a six-month snapshot.

MARTIN: So, Dr. Grossman, walk me through some of the reports that stood out to you.

DR. GROSSMAN: Sure. You know, there were many different scenarios. No two of them were exactly alike. But there were some broad themes, I would say, that, you know, allows us to kind of group the cases. Some of them were cases where there was a medical complication and pregnancy where it became necessary to terminate the pregnancy. An example is a case of a person who was pregnant at about 16 weeks, whose bag of water breaks, and because this puts a woman at a very high risk of infection or heavy bleeding, and it’s also very unlikely that she’ll be able to continue the pregnancy to a point where the baby could survive outside of her, the standard of care is to at least offer the woman the option of having a termination. But that wasn’t the case in these scenarios and many of them came back and had serious infections. And some of them came very close to dying. That second category, were cases where there was a medical complication with the fetus. So, these were women who were pregnant with a fetus that had malformations or anomalies that were generally incompatible with life. So, before Dobbs, patients had the option of having an abortion in these scenarios, but that was no longer possible now. And so, women were faced with the very difficult decision to either, you know, travel to another state to obtain an abortion care and all the logistical complexities and financial costs associated with that, or continue the pregnancy, carrying a baby that they knew was impossible for the baby to survive, that it was likely the baby would have a very short and painful life. And then, the third category would be patients who were having a miscarriage. So, there is one case of a woman who was prescribed medication for by her doctor, and she couldn’t get it at a pharmacy because the pharmacist was concerned that it was being used to induce an abortion. There were another couple of patients who have symptoms and were concerned that they were having a miscarriage and they lived in a state with an abortion ban, but they were so scared to even go to a hospital or see a doctor because they were worried that they might be accused of possibly having done something on their own to end the pregnancy that instead, they traveled hundreds of miles to try to get care in another state.

MARTIN: So, Professor Kimport, I was interested in the fact that many of these physicians were going out of their way to coordinate with colleagues could potential — some of them hundreds of miles away. I was wondering whether that affected their ability to care for people with “more routine medical concerns.” Like I’m just mindful of the fact that the maternal mortality rate in the United States is very high for a country as affluent as it is. And in fact, it ranks among one of the highest for a country as wealthy as the United States is and particularly among certain groups. I mean, black women, for example, have a higher far higher rate of maternal mortality than other groups do, and I just wondered if that was part of this discussion.

KIMPORT: You’re absolutely right. I mean, the United States has a crisis of maternal mortality, and it is particularly devastating for black and brown women. And it’s worth noting, this is across the United States, but there’s also specifics of states with even higher maternal mortality rates. So, these are women who were dying in childbirth or within a short period of time after giving birth. And it’s even more devastating in many of the states that have enacted these abortion bans, right? So, these abortion bans are layered on top of a maternal mortality crisis. The people who rode in and shared their cases in our study describes going to extreme lengths, spending a huge amount of time and resources, and it is — it absolutely follows that that meant that they are taking away time and their effort toward other patients. The other piece that’s important to underscore about the effort that these physicians were taking on behalf of their patients to ensure they could get the standard of care is that many of them were relying on their personal social networks. They were contacting their colleagues and friends in other states that didn’t have abortion bans. And so, what that means from a patient perspective is that your care and your ability to have standard medical care may actually depend on the social networks of your physician, right? This is something that, suddenly now, whether or not you are able to have standard of care depends on who your physician is friends with.

MARTIN: Dr. Grossman, did the clinicians talk at all about the toll on themselves? Like did they talk about wanting to leave medicine, for example? Did any of them talk about fear of criminal prosecution? Did they ever talk about the toll on themselves in the course of the study?

DR. GROSSMAN: They did. You know, these laws are — it’s very scary. There’s a risk that they could go to jail. And in some of these narratives, they talk about that fear, and at the same time, the moral distress that they were experiencing because they felt like their hands were tied, that they had been trained for so long to provide high quality medical care, and now, they were unable to do that. And they had to watch their patients essentially suffer or figure out a way to get them care in another state.

KIMPORT: One of the things that we saw too, while not that many reported that they are intending to leave medicine altogether, there were several who said that they are planning to relocate. So, they were planning to move to a state that wouldn’t tie their hands. And then, there were others who were committed to their community and their patients and had no intention to leave but said that they would discourage a future resident physician or a nurse from moving to the area and starting a practice. So, I think we are going to see — maybe not immediately, but down the line, we’re going to start to see a shift in the workforce, and that’s
going to have even more consequences for patient care.

MARTIN: And here’s where I have to ask both of you a question that clearly there are medical providers who do think and — or pharmacists, other providers who do agree that abortion should be illegal and — or at least, illegal in many cases. And so, I’m going to ask each of you, did any of your respondents take that view?

DR. GROSSMAN: No.

MARTIN: No?

DR. GROSSMAN: No one took that view. I mean, you know, we were specifically asking doctors and nurses to tell us about the cases where the care was different from the standard, and really, in all of the submissions, they talked about how they had to — the care was different. It was worst quality and this is a serious problem. And, you know, they were all very critical of the laws.

MARTIN: There are clearly significant numbers of people in the country, including some medical practitioners who do believe that abortion is wrong, it should not be permitted. And so, I’m going to ask you that there are those who would say that you found what you are looking for, how do you respond to that?

KIMPORT: I think that a lot of these findings illustrate is the disconnect between how we think in a public setting and often in — among politicians and legislation how we think and define abortion is and then, what it actually means in a medical setting, and the disconnect between this idea of law and on the ground medical care. And so, this idea in law and often in our public discussion about abortion is that there is some sort of black and white setting, right, that we can say this is an abortion and this is not. And what we get into in actual medical care is a lot more gray and it becomes a lot more difficult to draw a really firm line. And what we see, in this study, is that over and over again, when people try to draw a line through the law, what ended up happening is that patients got sicker, patients were denied the care that they needed, that their physicians, their doctors and nurses knew was the best care. There really is no bright line where you can just segment off abortion and say that this is never necessary or isn’t a part of reproductive health care. And instead, what we find is that abortion and the procedures related to abortion are fundamentally important tools in keeping patients safe. And doing things like ensuring their future fertility, ensuring that they have a reduced risk of complications and reduced risk of mortality.

DR. GROSSMAN: I certainly recognize that people have different belief systems and may feel differently about abortion bans, and these laws restricting abortion. But I just want people to know that these laws are having an additional effect. They’re causing real harm to the very pregnant women that I think we all care about and want to protect. And it just feels really important to me now to share this information about the harms that we are seeing so that people are aware of this as they’re having discussion and thinking about what kinds of laws and policies they want in their state. You know, clinicians, like myself, we just want to provide the best high- quality care that we can to patients, and that’s no longer possible in some of these states. And I really want people to hear about this, to learn about this and be as concerned as I am.

MARTIN: And, Professor Kimport, a final thought from you, what is it that you hope that people will take away from this study, other studies like it, and this conversation?

KIMPORT: I hope that it helps the conversation recognize the way that these abortion bans are really creating dangerous situations for pregnant patients. And that it means that they are being denied standard medical care, and I think that was never a way that people talked about abortion bans or understood what their effects could be, but it’s what we are seeing and it needs to be part of the conversation.

MARTIN: Professor Katrina Kimport, Dr. Daniel Grossman, thank you both so much for talking to us about this.

KIMPORT: Thank you so much for having me.

DR. GROSSMAN: Thank you very much.

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