A new study of Wisconsin obstetrician-gynecologists (ob-gyns) finds that healthcare institutions’ lack of clear clinical and legal guidance after the U.S. Supreme Court’s Dobbs decision not only shaped patient care but also increased clinician stress and eroded their trust in health systems.
The study is among the first to deeply examine how healthcare institutions — not just laws — shape physician experiences and patient care under abortion restrictions. Findings reveal overlooked system-level factors and offer actionable steps to restore trust and ensure safe, timely, equitable reproductive healthcare in Wisconsin and beyond.
“Ignoring the role of institutions on the impact of abortion restrictions risks overlooking key levers to reduce harm — both to patients in need of abortion and the clinicians who care for them,” the study authors write.
Researchers interviewed 21 ob-gyns across academic, community, and religiously affiliated health systems between June 2022 and December 2023 to understand how institutional responses drove healthcare and clinician experiences under Wisconsin’s near-total abortion ban. The UW Collaborative for Reproductive Equity (CORE) study, led by Laura Jacques, associate professor of obstetrics and gynecology, appears in the journal SSM – Health Systems.
The study is among the first to deeply examine how healthcare institutions — not just laws — shape physician experiences and patient care under abortion restrictions.
Important background:
- After Dobbs (June 2022), all Wisconsin abortion clinics stopped offering services, and hospitals statewide modified miscarriage and obstetric care protocols while courts determined whether an 1849 state law, interpreted as banning abortion except to save the mother’s life, was enforceable. (The law was later rejected by the Wisconsin Supreme Court.)
- The post-Dobbs legal uncertainty created confusion for doctors who provide pregnancy-related care, because many treatments — such as managing miscarriages — can resemble abortion.
Key study findings:
- Most healthcare institutions failed to provide timely, actionable guidance after Dobbs, leaving doctors to navigate complex legal and ethical questions while trying to keep patients safe. Managing miscarriages and pregnancy complications became more stressful during already difficult moments.
- Vague or non-existent public statements by healthcare institutions following Dobbs also frustrated physicians, who felt hospitals should inform the public about the ruling’s impact on patient care.
- For doctors, the impact of institutional inaction post-Dobbs was personal. Many felt abandoned by their employers and described a breakdown of trust. Some saw institutions’ silence as a moral failure. Combined with pressures of the COVID-19 pandemic and an already strained reproductive healthcare system, these factors made a challenging job even harder.
In a previous paper (JAMA Network Open, March 2025), the CORE study authors detailed how legal ambiguity and a lack of institutional guidance after Dobbs led to delayed and fragmented care for pregnant patients and left physicians torn between their duty to patients and fear of criminal penalties.
In this latest publication, the authors closely examine how healthcare institutions actively shape the care that is delivered or denied under restrictive laws. The researchers note that institutional decisions — or indecision — carry real consequences for patients and providers.
Physicians in the study offered practical solutions to healthcare administrators and systems, including:
- Give clear, timely guidance and legal protection for evidence-based care within the bounds of law.
- Provide rapid legal interpretations and standardized workflows to reduce confusion and delays.
- Communicate openly with the public about how abortion laws affect care access and the alternatives available.
- Show visible support for patients and staff during periods of legal uncertainty.