Hospitals Adapt to Abortion Bans

Hospitals in abortion ban states have quickly developed standards to protect clinicians from legal risks when providing abortions in cases where the health or life of the mother is at risk. According to a qualitative study, six primary strategies are being used to support evidence-based reproductive care amid the legal constraints in states with abortion bans.

Strategies for Supporting Reproductive Care

The study, reported by Deepshikha Ashana, MD, of Duke University School of Medicine, identified the following strategies: providing criminal defense resources for physicians, implementing employment, safety, and healthcare protections for employees, explicitly aligning institutional definitions of abortion with the fullest extent of care permitted under state law, formalizing decision-making support for maternal indication exemptions, building intrastate hospital alliances to standardize interpretation of state laws banning abortion, and engaging in legislative advocacy and strategic litigation to maximize reproductive care.

Implementation and Impact

These policies have helped with employee retention and recruitment as well as improving the reproductive care offered by the hospitals. Some of the policies cost little, while others, like providing criminal defense resources, require financial investment. The study found that hospitals in nine high birth-volume hospitals in abortion-restrictive states have implemented these strategies to support clinicians and staff.

Challenges and Limitations

The study notes that abortion laws already restrict reproductive care to a great degree, and it is very important for hospitals to set institutional standards about what is and isn't allowable, so physicians can have clarity and deliver timely, evidence-based patient care. However, the study also notes that the policies described may not be representative of smaller hospitals, and worry about risk or retaliation might have prevented people from sharing the full range of policies at their hospitals. The researchers used semi-structured interviews with 34 participants, including physicians, hospital administrators, legal counsels, and bioethicists, to gather information about the strategies being used.

The study's findings suggest that hospital practices and policies can protect clinicians and staff while supporting the fullest extent of legally permissible, evidence-based reproductive care. According to Ashana, national organizations like the American College of Obstetricians and Gynecologists can help hospitals develop institutional abortion policies. The study's authors emphasize the importance of proactive assessment of organizational values in developing patient- and employee-centered policies.