Wisconsin obstetrician-gynecologists (ob-gyns) faced significant challenges and limited support in facilitating abortion care after the Dobbs decision, a new study reports. Unclear or absent guidance from healthcare institutions for abortion referrals contributed to poor patient experiences, exceptional physician burdens, and adverse clinical care.
The June 2022 U.S. Supreme Court Dobbs ruling overturned the federal right to abortion and upended access in Wisconsin. All abortion clinics in the state stopped offering services for more than 15 months while courts determined whether an 1849 state law interpreted as banning abortion was enforceable (the Wisconsin Supreme Court later rejected the 1849 law). For well over a year, Wisconsin physicians were barred from providing abortion care themselves or referring patients to Wisconsin’s freestanding abortion clinics.
UW Collaborative for Reproductive Equity researchers interviewed 21 ob-gyns across Wisconsin and found that the threat of the 1849 law increased barriers to providing pregnancy care and facilitating abortion for Wisconsinites due to a lack of clear institutional guidance or reliable referral systems.
As a result, doctors leaned on informal and unconventional means to help patients find care. Wisconsinites seeking abortion, especially those requiring hospital-based care, faced substantial burdens and were largely forced to seek care out of state.
The study, led by UW ob-gyn and assistant professor Abigail Cutler, suggests that access to abortion care depends not only on state laws but also on the systems that health care institutions create to connect patients with care. The study authors conclude that hospitals and health systems, especially in states where abortion is banned or restricted, should establish clear referral pathways, formal partnerships with outside providers, and patient navigation services.
View the full study here and read more highlights below.
Legal fog: Physicians reported widespread confusion about what was permitted under the state’s 1849 abortion law and limited guidance from hospitals and health systems on how to help their patients access care. Although state law allowed exceptions for a life-threatening emergency, urgent or emergent clinical situations created confusion and uncertainty.
Digging deeper: Unclear guidance left physicians without systems to help patients access care, and abortion referral practices varied widely. Some physicians could provide patients with contact information for out-of-state clinics, while others were restricted by institutional policies prohibiting contact with abortion providers on patients’ behalf.
Why it matters: Unclear institutional guidance plus weak or nonexistent referral pathways left ob-gyns to create informal systems, negatively impacting patient care and burdening physicians. Lack of timely access to abortion care is strongly associated with poor maternal, fetal, and neonatal health outcomes.
The big picture: With abortion services severely restricted post-Dobbs, Wisconsin’s healthcare systems struggled to support timely access, forcing many patients to seek services out of state. Patients often faced long travel distances, additional costs for transportation, lodging, childcare, and time off work, and the burden of navigating unfamiliar health systems.
Physician effects: Doctors described difficulty finding appropriate care options, particularly for patients with pregnancy complications or fetal conditions that require timely abortion care. Many also described frustration over losing continuity of care.
Novel solutions: Some ob-gyns developed patient handouts, relied on personal contacts at out-of-state clinics, or spent significant personal time coordinating care. A few used their own resources to help patients overcome logistical barriers. These efforts helped some patients access care but placed substantial additional burdens on clinicians.
The bottom line: This study elevates the role of healthcare systems in abortion referrals and referral breakdowns. Findings suggest that health care institutions should establish clear referral processes and support systems to ensure timely access to care and reduce physician burdens.
Practical implications: Stronger referral systems and dedicated hospital and health system staff such as care coordinators, nurses, or patient navigators could improve patient experiences, reduce delays in care, and support better health outcomes.
Related:
- Study: Post-Dobbs, Wisconsin ob-gyns described professional distress and poor care for pregnant patients
- The impact of the Dobbsdecision on the ob-gyn workforce in Wisconsin
- Impacts of abortion restrictions on pregnant people, their partners, families, and communities
- The impact of Wisconsin abortion laws: What’s the evidence?