Cutler Abigail S, Hale Corinne M, Bennett Eliza, Jacques Laura, Higgins Jenny
Department of Obstetrics and Gynecology, University of Wisconsin-Madison.
Department of Anthropology, University of Wisconsin-Madison.
JAMA Netw Open. 2025 Mar 3;8(3):e252498. doi: 10.1001/jamanetworkopen.2025.2498.
Following the Dobbs v Jackson Women's Health Organization (Dobbs) decision in June 2022, which overturned the federal right to abortion, Wisconsin physicians faced the threat of an 1849 state law widely interpreted to criminalize provision of abortion except in life-saving emergencies. Physicians and their institutions were left to interpret whether and how they could treat and/or refer certain pregnant patients.
To document how the post-Dobbs legal landscape shaped Wisconsin obstetrician-gynecologists' (OB-GYNs') ability to provide health care to patients facing pregnancy-related risks and complications, with particular attention to the mediating role of health care institutions.
DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, 21 OB-GYNs were recruited between June 2022 and December 2023 from rural and urban areas with varying hospital affiliations, scopes of practice, and individual demographics to participate in semistructured, remote interviews.
An 1849 abortion law that suspended abortion care in Wisconsin between June 2022 and December 2023.
Physicians' perceptions of (1) how the legal landscape shaped management of pregnancy and related complications, and (2) how institutional-level factors contributed to physicians' experiences caring for pregnant patients following Dobbs.
This study included 21 OB-GYNs (mean [SD] age, 43 [5.88] years; 16 [76.2%] female; 5 [23.8%] non-White and 16 [76.2%] White) who practiced obstetrics in Wisconsin. OB-GYNs described how the threat of criminalization following Dobbs was detrimental to physicians' ability to provide pregnancy care. Absence of legal clarity surrounding the 1849 law led to confusion and wide variations in institutional comfort and clinical practice, which resulted in substandard, delayed, and fragmented patient care. Overwhelmingly, the threat of criminalization after Dobbs exacerbated barriers for physicians providing comprehensive pregnancy care and patients seeking it.
In this qualitative study of OB-GYNs practicing in an abortion-restrictive state, threat of criminalization in post-Dobbs Wisconsin resulted in uncertainty and confusion for OB-GYNs and worse care for pregnant patients. The absence of clear guidance and support from institutional and health care system leadership emerged as a particularly salient missed opportunity. These experiences, which contribute to a critical evidence base on the harms of abortion restrictions, are relevant to states facing similar bans that criminalize or restrict health care.
2022年6月，“多布斯诉杰克逊妇女健康组织案”（Dobbs案）的判决推翻了联邦堕胎权，威斯康星州的医生面临着一项1849年州法律的威胁，该法律被广泛解释为将堕胎行为定为犯罪，除非是在挽救生命的紧急情况下。医生及其所在机构只能自行解读他们是否以及如何治疗和/或转诊某些怀孕患者。
记录多布斯案后的法律环境如何影响威斯康星州妇产科医生为面临与怀孕相关风险和并发症的患者提供医疗服务的能力，特别关注医疗机构的调解作用。
设计、背景和参与者：在这项定性研究中，2022年6月至2023年12月期间，从农村和城市地区招募了21名妇产科医生，他们隶属于不同的医院，业务范围和个人人口统计学特征各异，参与半结构化的远程访谈。
一项1849年的堕胎法，该法在2022年6月至2023年12月期间暂停了威斯康星州的堕胎护理。
医生对（1）法律环境如何影响怀孕及相关并发症的管理，以及（2）机构层面的因素如何影响多布斯案后医生照顾怀孕患者的经历的看法。
本研究纳入了21名在威斯康星州从事产科工作的妇产科医生（平均[标准差]年龄为43[5.88]岁；16名[76.2%]为女性；5名[23.8%]为非白人，16名[76.2%]为白人）。妇产科医生描述了多布斯案后定罪威胁如何损害医生提供怀孕护理的能力。围绕1849年法律缺乏法律明确性导致了机构舒适度和临床实践的混乱及巨大差异，从而导致患者护理不达标、延迟和碎片化。绝大多数情况下，多布斯案后的定罪威胁加剧了医生提供全面怀孕护理以及患者寻求此类护理的障碍。
在这项对在堕胎限制州执业的妇产科医生的定性研究中，多布斯案后威斯康星州的定罪威胁给妇产科医生带来了不确定性和困惑，并导致对怀孕患者护理质量下降。机构和医疗系统领导层缺乏明确的指导和支持是一个特别突出的错失机会。这些经历为堕胎限制危害的关键证据库做出了贡献，与面临将医疗保健定为犯罪或加以限制的类似禁令的州相关。
