An updated report presents findings from the Care Post-Roe Study, and shows how health care providers have been unable to provide the standard of care in states with abortion bans since the Supreme Court struck down Roe v. Wade over two years ago, leading to harm and negative health outcomes for patients in the United States.
More than two years after the fall of Roe, researchers at ANSIRH have released a new report detailing how health care providers are still unable to provide standard medical care in states with abortion bans, leading to more delays, denials of care, and worsened health outcomes.
Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision documents a wide range of harm occurring among pregnant people in states with abortion bans, including increased morbidity, and complications that could result in serious impairment and risk of death. The report notes that longer-term effects could include loss of fertility, chronic pelvic pain due to infection or surgery, or heart attack and stroke related to uncontrolled hypertension, as well as effects on mental health. This has impacted both patients and providers and has deepened the existing inequities in the health care system for people of color. years to come.
Stories From Real Patients and Providers
The report provides a view over time into how patients have been impacted since the fall of Roe through 86 narratives submitted by their providers, from September 2022 to August 2024. The report also includes quotes highlighting the types of complications that providers observed.
These stories paint a stark picture of a post-Roe clinical landscape, detailing harm not only to patients, but also to health care providers who are now being forced to follow medically unnecessary laws that negatively impact their patients’ health.
One physician described their management of a patient at 20-22 weeks in a state with an abortion ban:
“Patient presented with [preterm prelabor rupture of membranes] (PPROM), was admitted. Due to laws, we can only provide expectant management until fetal demise or immediate threat to patient life. Despite her desire for a termination, we were forced to manage expectantly until she developed an intraamniotic infection, which progressed to sepsis requiring IV antibiotics for multiple days.”
The narratives also provide insight on the cost and logistical issues that patients encountered, including cases where patients would have been covered by their insurance in their home state but had to cover these costs out of pocket when they traveled to another state. The logistical challenges were particularly acute for those who had to arrange care for their children, get time off work, or pay for travel to a distant state.
A reporting physician wrote:
“If [the patient] had seen [a] provider in [her home state] when bleeding started…, she would have had the ectopic diagnosed about 6 weeks earlier, potentially eligible for [methotrexate] and therefore potentially avoided surgery, and even if [she] needed surgery [it] would have been at home with her family and support. Instead [she] had to… recover alone in a hotel room in a random state she had never been to before.”
The Impact of Abortion Restrictions on Medicine
It's clear that abortion bans and tying providers’ hands impacts every aspect of care. The report underscores the emotional and professional impacts on the health care workforce. Providers expressed moral distress at being forced to follow medically unsound practices, where they knew how to correctly manage a patient, but institutional or governmental policies prevented them from doing so. Some felt this distress so acutely that they were considering relocating to a state where abortion remained legal.
“In the two years since the fall of Roe, medical care for pregnant people has become dangerously warped as providers remain hamstrung in states with abortion bans. This research shows that every pregnant person in these states is at risk of being denied the care they need,” said Dr. Daniel Grossman, ANSIRH Director and lead report author. “Instead of policy band aids and exceptions that don’t work, we need abortion bans repealed so that clinicians can do the job they were trained for – to provide high quality health care to their patients.”
Key takeaways from the Care Post-Roe report suggest that abortion bans have fundamentally altered how pregnancy-related care—and even other medical care for people with the capacity for pregnancy—is delivered. As a consequence, patients’ health and wellbeing are being compromised. Given that reproductive harms disproportionately affect people of color in the US, it is also notable that patients described as Black or Latina/Latinx/Hispanic, as well as those who primarily speak Spanish, account for about half of all cases in our analysis.
To learn more, read Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision and our press release. Health care providers can submit a narrative about a case through this brief survey.