A Preview of the Dangerous Future of Abortion Bans -- Texas Senate Bill 8

Source: NE Journal of Medicine



We interviewed 25 clinicians from across Texas about how SB8 has affected their practice in general obstetrics and gynecology, maternal and fetal medicine (MFM), or genetic counseling. We concurrently interviewed 20 Texans who had medically complex pregnancies and sought care either in Texas or out of state after September 1, 2021. Although aimed at clinicians who provide abortion care, SB8 has had a chilling effect on a broad range of health care professionals, adversely affecting patient care and endangering people’s lives.

Some Texas clinicians still provide abortion counseling and referrals, believing that the law does not limit their free speech, while also noting that such freedom depends on a clinician’s willingness to assume possible legal risk. On the basis of legal guidance, other Texas clinicians believe they are not even allowed to counsel patients regarding the availability of abortion in cases of increased maternal risks or poor fetal prognosis, although before SB8 they would have done so. Many clinicians have also been advised that they cannot provide information about out-of-state abortion facilities or directly contact out-of-state clinicians to transfer patient information. These fears have disrupted continuity of care and left patients to find services on their own.



Clinicians we interviewed recounted a variety of circumstances in which a patient could have received hospital-based abortion care before SB8 but was now denied that care. Patients with a life-limiting fetal diagnosis, such as anencephaly or bilateral renal agenesis, are only being counseled to continue their pregnancy and offered neonatal comfort care options after delivery. All hospitals where our respondents practiced have prohibited multifetal reduction, even though in some cases (e.g., complications of monochorionic twins) failure to perform the procedure could result in the loss of both twins.

Patients with pregnancy complications or preexisting medical conditions that may be exacerbated by pregnancy are being forced to delay an abortion until their conditions become life-threatening and qualify as medical emergencies, or until fetal cardiac activity is no longer detectable. An MFM specialist reported that their hospital no longer offers treatment for ectopic pregnancies implanted in cesarean scars, despite strong recommendations from the Society for Maternal–Fetal Medicine that these life-threatening pregnancies be definitively managed with surgical or medical treatment.4 Some clinicians believe that patients with rupture of membranes before fetal viability are eligible for a medical exemption under SB8, while others believe these patients cannot receive an abortion so long as there is fetal cardiac activity. In multiple cases, the treating clinicians — believing, on the basis of their own or their hospital’s interpretation of the law, that they could not provide early intervention — sent patients home, only to see them return with signs of sepsis. An obstetrician–gynecologist recalled only one patient who was able to obtain an abortion at their hospital under SB8’s maternal health exemption, because her severe cardiac condition had progressed to the point that she was admitted to the intensive care unit. As an MFM specialist summarized, “People have to be on death’s door to qualify for maternal exemptions to SB8.”



Read more: https://www.nejm.org/doi/full/10.1056/NEJMp2207423