Texas Policy Evaluation Project and the Population Research Center, the Department of Women's Health, Dell Medical School, the Steve Hicks School of Social Work, and the Department of Sociology, University of Texas at Austin, Austin, the Pegasus Health Justice Center, Dallas, the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, and the Department of Obstetrics and Gynecology, University of Texas Rio Grande Valley, Edinburg, Texas.
Obstet Gynecol. 2023 May 1;141(5):995-1003. doi: 10.1097/AOG.0000000000005153. Epub 2023 Apr 5.
To evaluate how Texas health care professionals who care for patients experiencing medically complex pregnancies navigate abortion restrictions.
We conducted qualitative in-depth interviews with health care professionals across Texas who cared for patients with life-limiting fetal diagnoses or who had existing or developed health conditions that adversely affected pregnancy. We conducted the first round of interviews March-June 2021 and the second round of interviews January-May 2022 after the implementation of Texas Senate Bill 8 (SB8), which prohibited most abortions after detection of embryonic cardiac activity. We used inductive and deductive qualitative analysis to identify themes and changes in practice after the implementation of SB8.
We conducted a total of 50 interviews: 25 before implementation of SB8 and 25 after the law's implementation. We interviewed 21 maternal-fetal medicine specialists, 19 obstetrician-gynecologists, eight physicians whose primary practice is the provision of abortion care, and two genetic counselors. Participants reported presenting their patients with information about health risks and outcomes of continued pregnancy in each policy period; however, counseling on these options was curtailed after implementation of SB8. Even in cases in which a patient's health and, in some cases, life would be compromised, narrow criteria for abortions at hospitals limited care before implementation of SB8, and criteria often became more stringent after implementation of SB8. Administrative approval processes and referrals for abortion delayed care and endangered patients' health, which worsened after in-state options were eliminated after implementation of SB8. Participants noted that patients with more limited resources who were unable to travel out of state often had to continue pregnancies, further increasing their risk of morbidity.
Texas health care professionals' abilities to provide evidence-based abortion care to patients with medically complex pregnancies were constrained by institutional policies, and care options narrowed further after implementation of SB8. Abortion restrictions limit shared decision making, compromise patient care, and put pregnant people's health at risk.
评估德克萨斯州照顾经历复杂医疗妊娠的患者的医疗保健专业人员如何应对堕胎限制。
我们对德克萨斯州的医疗保健专业人员进行了定性深入访谈，这些专业人员照顾过患有危及生命的胎儿诊断的患者，或已经存在或出现影响妊娠的健康状况的患者。我们在 2021 年 3 月至 6 月进行了第一轮访谈，并在 2022 年 1 月至 5 月实施德克萨斯州参议院法案 8 （SB8）后进行了第二轮访谈，该法案禁止在胚胎心脏活动检测后进行大多数堕胎。我们使用归纳和演绎定性分析来确定实施 SB8 后实践中的主题和变化。
我们总共进行了 50 次访谈：在实施 SB8 之前进行了 25 次，在该法律实施后进行了 25 次。我们采访了 21 名母胎医学专家、19 名妇产科医生、8 名主要从事堕胎护理的医生和 2 名遗传咨询师。参与者报告说，在每个政策时期都向患者提供了有关继续妊娠的健康风险和结果的信息；然而，在实施 SB8 后，这些选择的咨询受到了限制。即使在患者的健康甚至在某些情况下生命受到威胁的情况下，医院对堕胎的严格标准也限制了实施 SB8 之前的护理，并且在实施 SB8 之后，标准通常变得更加严格。行政批准程序和堕胎转诊延迟了护理并危及患者的健康，这在实施 SB8 后州内选择被取消后变得更糟。参与者指出，无法前往州外的资源有限的患者通常不得不继续妊娠，这进一步增加了他们发病的风险。
德克萨斯州医疗保健专业人员为经历复杂医疗妊娠的患者提供基于证据的堕胎护理的能力受到机构政策的限制，并且在实施 SB8 后，护理选择进一步缩小。堕胎限制限制了共同决策，损害了患者护理，并使孕妇的健康处于危险之中。
