Miscarriage Care Compromised by Abortion Restrictions

Author: University at Buffalo
Published: 2023/02/10 - Updated: 2025/10/18
Publication Details: Peer-Reviewed, Findings
Category Topic: Pregnancy Information - Academic Publications

Page Content: Synopsis - Introduction - Main - Insights, Updates

Synopsis: This peer-reviewed research examined how restrictive abortion policies affect the quality of miscarriage care across U.S. states, finding that physicians in states with restrictive abortion laws were significantly less likely to offer evidence-based treatments like mifepristone and office uterine aspiration compared to their counterparts in states with supportive policies. The study surveyed over 350 obstetrician-gynecologists from academic medical centers nationwide and found that 40.8% of physicians in restrictive states offered mifepristone alone versus 67.5% in supportive states, and only 33.2% versus 51.3% offered both mifepristone and office aspiration respectively. Because miscarriage management uses the same medical protocols as abortion care, restrictive policies create a chilling effect that compromises optimal treatment for the roughly one in four people who will experience spontaneous pregnancy loss in their lifetime—a finding particularly relevant for people with disabilities who may face additional barriers to accessing reproductive healthcare - Disabled World (DW).

Introduction

Comparison of Early Pregnancy Loss Management Between States With Restrictive and Supportive Abortion Policies - Women s Health Issues.

A study led by a University at Buffalo physician has found that people experiencing a miscarriage in states with restrictive abortion policies may be less likely to receive optimal care than those with supportive abortion policies.

Main Content

Published online in November in Women's Health Issues, the research was conducted before the Supreme Court's decision last June to overturn Roe v. Wade.

The study was led by Elana Tal, MD, while a fellow at Washington University School of Medicine in St. Louis; she is now an assistant clinical professor in the Department of Obstetrics and Gynecology in the Jacobs School of Medicine and Biomedical Sciences at UB. Tal had concerns about how restrictive abortion policies affect care for people experiencing spontaneous pregnancy loss.

Less Ideal Care

"I had a hunch that is restricting abortion means less ideal care for people experiencing miscarriage," said Tal, who focuses on complex family planning at UB and is a physician with UBMD Obstetrics & Gynecology.

"Too often, when we talk about abortion, the conversation becomes about the morality of ending a pregnancy and not about how restricting abortion affects reproductive health in general," she said. "We know abortion restrictions correlate with higher maternal mortality rates, so it follows that other aspects of health care would be affected, especially miscarriage care, which closely mirrors abortion care. I wanted to find out if that was true."

Spontaneous pregnancy loss, i.e., miscarriage, in the first trimester occurs in about 10% of all clinically recognized pregnancies, and 25% of all people capable of becoming pregnant will experience a miscarriage in their lifetime.

This study is among the first to explore how miscarriages are managed in light of evidence-based, patient-centered guidelines issued in recent years by the American College of Obstetricians and Gynecologists (ACOG). Those guidelines, and the research they were based on, found that optimal care for managing early pregnancy loss includes uterine aspiration in the physician's office and prescribing both mifepristone and misoprostol, which block hormones that are necessary for pregnancy and help clear the uterus.

Because these methods are also used to terminate a pregnancy, Tal and her co-authors wanted to see if access to these methods is compromised for those experiencing a miscarriage.

Physicians Less Likely to Offer Mifepristone

The researchers found that in states with restrictive abortion policies, physicians managing early pregnancy loss were less likely than physicians in supportive states (40.8% vs. 67.5%) to offer mifepristone alone and less likely to offer both mifepristone and office uterine aspiration (33.2% vs. 51.3%). They also found that there was no significant difference in the proportion offering uterine aspiration between physicians in restrictive states and those in supportive states.

In addition, physicians in restrictive states were less likely to report having received abortion training (67.3% vs. 89.6%) and less likely to report perceived institutional support for abortion care (49% vs. 85%).

"Our study is consistent with the notion that general pregnancy care suffers where abortion is restricted," said Tal. "That would apply to routine early miscarriage, more complicated miscarriage like second-trimester fetal demise, and abortion for life-threatening situations."

"Clinicians should be aware of the potential deficiencies in their ability to provide miscarriage care if they train or practice in states with restrictive laws," she said.

In addition to surveying the impact of a state's policies on access to reproductive care, the survey was also aimed at determining how a physician's perception of their institution's support for abortion care, or lack of it, might influence access to reproductive care generally.

The survey was sent to more than 1,500 members of ACOG. Respondents were deemed eligible to respond if they were attending physicians with an academic medical center who provided obstetric and gynecologic care and had provided early pregnancy loss care in the past year.

Eligible responses were received from 350 physicians from every region in the U.S., representing half of the academic medical centers.

Tal noted that the end of Roe v. Wade is expected to impact care access for those experiencing a miscarriage more strongly.

"At the time of our study, access to abortion was constitutionally protected, and we still saw disparities in the management of miscarriage, a prevalent reproductive health issue," she said. "We would expect the disparities we outlined in our study to get worse since the overturning of Roe v. Wade."

She concluded:

"We should recognize that people experiencing miscarriage are at risk of collateral damage from abortion restrictions. We must actively work to destigmatize abortions, be outspoken in support of abortion care, and promote universal access to excellent miscarriage care."

Co-authors are Rachel Paul, Megan Dorsey, and Tessa Madden, MD, all of Washington University in St. Louis School of Medicine. The Society funded the research for Family Planning Research Fund.

Insights, Analysis, and Developments

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by University at Buffalo and published on 2023/02/10, this content may have been edited for style, clarity, or brevity.