Restrictions on abortion affect the care people receive if they miscarry, a new study suggests.
The same medications and procedures that cause abortion are used to treat miscarriages. The 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organizationwhich ended constitutional protection of abortiontriggered bans in 14 states. Compared to states that did not ban abortion, states that banned abortion were associated with reduced miscarriage medication management, researchers report in the May 18 report. Journal of the American Medical Association. In cases where medication management was continued, states that banned medications were linked to less use of the most efficient protocol.
“Miscarriage is the most common complication of pregnancy, and the results of this analysis demonstrate how vulnerable patients are to system ruptures,” says obstetrician and gynecologist Courtney Schreiber of the Perelman School of Medicine at the University of Pennsylvania, who was not involved in the new research. People who experience miscarriage “experience additional psychological and physical harm from policies that restrict access to abortion care, even though these restrictions should not apply to this population.”
Around 15 to 20 percent of known pregnancies end in miscarriageoften due to genetic abnormalities or without apparent cause. Early miscarriages affect approximately 1 million women each year in the United States. A miscarriage puts a person at risk of complications, including infections, and mental health problems such as depression and post-traumatic stress disorder.
Bleeding, cramping or pain early in pregnancy could indicate a miscarriage, “and you want to contact your clinician immediately,” says study co-author Maria Rodriguez, an obstetrician and gynecologist at Oregon Health & Science University School of Medicine in Portland.
If a person is otherwise healthy, they have a choice on how to proceed. Some people want to give the body time to shed the pregnancy tissue, which is called expectant management. Others, after learning the pregnancy is over, want medication or surgery to finish the expulsion of tissue as quickly as possible, Rodriguez says. “We go by what patients prefer.”
In terms of medication management, the most effective protocol is to use both mifepristone, which blocks progesterone, a hormone that promotes pregnancy development, and misoprostol, which induces contractions. Use both the drug leads to complete expulsion pregnancy tissue more often than misoprostol alone.
In January 2023, the U.S. Food and Drug Administration removed the in-person dispensing requirement for mifepristone and allowed the drug to be mailed and made available in pharmacies. But the agency has maintained other restrictions that may make it difficult to acquire and supply the drug, even though mifepristone is safe and effective. Clinicians providing obstetric and gynecological care states with abortion restrictions are less likely to offer mifepristone in the treatment of miscarriages, according to research.
The new study, which used data from a commercial insurance database, included nearly 124,000 people ages 15 to 45 who had a first-trimester miscarriage. The research team analyzed the treatment of miscarriages before Dobbs decision, from January 2018 to May 2022, and after the decision, from July 2022 to September 2024. Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia, which ban abortion at or before six weeks, have about 54,000 people who have had a false layer. The others were comparison states without abortion bans: Alaska, California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Michigan, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Rhode Island, and Washington.
There was an association between states with bans and a 2.8 percentage point increase in expected management as well as a 2.2 percentage point decrease in medication management, compared to states without bans. “There is no general increase in the number of women requesting a future pregnancy,” says Rodriquez. “This is limited to states where abortion is prohibited.” So someone wanting to manage their medications in states that ban abortion may not have that option, she says. “It puts a person in a difficult situation.”
There was also a 13.8 percentage point increase in protocols using only misoprostol for people living in banned states who were receiving the drugs, instead of following the more effective approach of using both drugs.
“The results of this study are important in that they document differences in clinical practice regarding miscarriage care,” says obstetrician and gynecologist Daniel Grossman, director of Advancing New Standards in Reproductive Health at the University of California, San Francisco, who was not involved in the new research. “Together with anecdotal reports of patients facing evidence-based barriers to miscarriage care in states banning abortion, this study highlights the far-reaching impact of these laws on pregnant women. »
The fact is, Rodriguez says, “you can’t compartmentalize just one aspect of pregnancy care” because all of it is inextricably linked.
“Women’s health, in particular, is subject to excessive legislation,” she says. With laws written by people who are not doctors, midwives, nurses, or any medical expertise, it’s “basically practicing medicine without a license, and when that happens, it’s going to harm people.”
