Abortion bans make ‘evidence-based medicine’ impossible in some cases, new report says

Original article by Melody Schreiber

Maternal fetal specialists should see abortion care as a “core component” of their practice in states where laws restrict abortion, according to a new special statement from the Society for Maternal-Fetal Medicine (SMFM).

Some 41 states ban abortion at some point in pregnancy, and these legal restrictions make it difficult or impossible for clinicians to practice “standard-of-care, evidence-based medicine”, the report, released on Tuesday, says.

The Dobbs decision made it even more challenging for patients to access abortion care in the US, as more restrictions went into effect in some states. Deaths from ectopic pregnancies nearly doubled between 2020 and 2025, a ProPublica analysis found, and later-abortion providers in haven states report that patients are showing up “later and sicker”.

“In some ways, the practice of maternal-fetal medicine is inseparable from family planning and abortion care,” said Justin Lappen, chair of SMFM’s reproductive health committee and a co-author of the statement.

In July 2021, Kate Dineen was about 33 weeks pregnant and giddy with excitement. Her husband was finally able to join her for his first ultrasound of their second child, after Covid restrictions were loosened. But then the room went quiet; the silence stretched on as the ultrasound tech lingered over images of the baby’s brain. Soon, after an MRI and consultation with a pediatric neurologist, they learned that their son had suffered a catastrophic stroke in utero, and his chances of surviving even the pregnancy were poor.

Dineen remembers asking, “What are my options?” One of the specialists said, “You may still be able to explore termination – if you’re able to travel.” Dineen was stunned. She lived in Massachusetts, where abortions were banned after 24 weeks except in specific cases – and her case didn’t qualify for an exception, she learned. The maternal fetal team at her hospital offered to link her to a later abortion clinic in Washington DC, Dineen said.

She and her husband rushed to find childcare for their 18-month-old son and made the long drive to Maryland, where they stayed multiple nights, to receive care.

“We’re just so grateful to get the compassionate care that we needed and deserved, and should have been able to get closer to home,” Dineen said. If she’d been able to get the abortion in Massachusetts, it would’ve been much easier to grieve and find closure, she said. “Instead, our lives were turned completely upside down,” she said. “I feel like I barely survived it.”

Maternal fetal specialists are at the forefront of many reproductive health decisions – including genetic diagnosis, ultrasound diagnoses and screening for anomalies, and complicated maternal medical conditions. That’s why guidance from professional societies on supporting abortion is key, so providers may expand their roles and “continue to provide as much care as possible” said Lappen.

The statement highlights what can be done on the individual level when it comes to caring for patients, and it points to the role that specialists play in “institutional advocacy” to make sure their health systems have plans to support patients ahead of time, he said.

“It’s really important for health systems, for hospitals, to be able to create safe systems of care and to understand what the state reproductive health legal landscape looks like,” Lappen said. That way, they can create the most comprehensive and expansive systems to provide care, he argued.

It’s imperative to set guidelines now, before emergencies arise, Lappen said. “When someone’s facing a really significant pregnancy complication, where decision-making has to happen in a critically acute or rapid time frame, that’s not the best time to get on the phone with the lawyers.”

Providers and health systems should “expand access to abortion care to the legal limit allowed by state law” to provide the most comprehensive care to patients, the statement says. That means understanding the exceptions to those laws and how providers may offer care in those scenarios, which can often be complicated to interpret but are no less important, Lappen said.

“The law is intended to be sort of black and white,” said Lappen. “And healthcare and physiology and pregnancy complications live in the shades of gray.”

Dineen, who is now an advocate and board member of Reproductive Equity Now, said it’s “really wonderful” for the medical society to highlight the key role that abortion care plays in maternal-fetal medicine.

Providers “should be exploiting exceptions to the fullest extent in ban states”, she said. At the same time, she added, “I wouldn’t want this to be interpreted as ‘bans with exceptions work.’” Maternal-fetal specialists can also advocate against abortion bans in order to serve all of their patients, she said.

It’s a “misconception” that adding exceptions to abortion bans means that patients who need abortions will be able to access them, Dineen said. “A ban with exceptions often functions just as a ban.” Even though she believes her providers wanted to give her the standard of care, and even though Massachusetts did carve out exceptions, she still had to travel hundreds of miles to get an abortion.

In Massachusetts, she said, “we uniquely are able to demonstrate why bans with exceptions don’t result in patients being able to access care.”

In 2022, after Dineen and others testified about how restrictions kept them from medically necessary care, Massachusetts legislators expanded the abortion exception to include “grave fetal diagnoses”. It was an improvement, Dineen said, but some patients were still not getting care. Now, Massachusetts is removing the 24-week ban, which means all patients will have access to standard reproductive care.

The law “unties the hands of our world-class MFMs and other providers here to ensure that these deeply personal medical decisions are made between the patient and their provider at any point in pregnancy”, Dineen said.

Maternal-fetal specialists in Massachusetts played an important role in changing the law, Dineen said.

“That has been a real game-changer, having their expertise guiding the discussion again,” she said.