Hospital-based abortions are often the only option for women, especially those with complex medical needs. Obstetrics and gynecology residency programs are required to provide access to abortion training, but graduates frequently report that hospital policies interfere with that training. When it comes to teaching hospitals, facility-level abortion restrictions can affect both patient care and clinician instruction.
In response to a national survey of 169 OB-GYN teaching hospitals, the majority (57%) of residency training program directors reported that their facility had some sort of written or unwritten policy that restricted abortion provision beyond what their state law allowed. Such policies were more common at hospitals in the South and the Midwest. It was more common for policies to restrict abortions sought for reasons other than maternal or fetal health, rape, or incest, also known as “non-medically indicated” or “elective” abortions. A quarter of all sites prohibited non-medically indicated abortions altogether, and many restricted care for such procedures to a gestational duration under state law requirements. A quarter of institutions restricted both medically indicated and non-medically indicated abortions beyond state law.
Policies were created by those with institutional power, including hospital leadership and obstetrics and gynecology department chairs, and were perceived to be motivated by personal beliefs and a desire to avoid controversy. It is likely that patients presenting to U.S. teaching hospitals with policies that restrict abortion access beyond state law are unaware of those restrictions.
These findings are especially relevant during the COVID-19 crisis, when elected officials and hospitals have targeted abortion as a “nonessential” procedure. Abortion is essential in any circumstance, given that both health risks and difficulty accessing care increase with delay. Still, the restrictions imposed during the pandemic will only exacerbate the kinds of restrictions we found in place at hospital training facilities, further depriving people of their right to decide if and when to have a child.
This study, “Abortion Policies in U.S. Teaching Hospitals: Formal and Informal Parameters Beyond the Law,” is available in Obstetrics & Gynecology.