Experiences of Obstetrician-Gynecologists Providing Pregnancy Care After Dobbs.

Importance: 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. Objective: 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. Exposure: An 1849 abortion law that suspended abortion care in Wisconsin between June 2022 and December 2023. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.