A new study reveals that abortion restrictions in the United States are making it more difficult for patients to access proper care for miscarriages. Since the Supreme Court's Dobbs v Jackson Women's Health Organization decision in June 2022, which overturned Roe v Wade, pregnancy care has become increasingly fragmented along state lines. In states with abortion bans, miscarriage management is shifting away from medications like mifepristone and toward a wait-and-see approach, limiting options for patients and falling below standard care guidelines.
Study Findings on Miscarriage Management
The study, published in the Journal of the American Medical Association on May 18, analyzed data from 123,598 people with private insurance. Of these, 54,181 lived in states with abortion restrictions triggered by Dobbs, while 69,417 lived in comparison states. In trigger-ban states, there was a 2.8 percentage point increase in expectant management (sending patients home to wait) and a 2.2 percentage point decrease in medication management. Among those prescribed medication, there was a 13.8 percentage point increase in misoprostol-only treatment, which is safe but not the US standard of care and may cause longer discomfort.
Lead author Maria Rodriguez, a professor of obstetrics and gynecology at Oregon Health & Science University, explained that restricting abortion access affects people experiencing pregnancy loss. Patients had fewer choices and received lower-quality care. The study likely underestimates the problem as it only included privately insured individuals, who are generally wealthier. Rodriguez noted that the impact is probably worse for Medicaid patients and those without insurance, who face higher risks of maternal mortality.
Miscarriage Prevalence and Risks
More than one million pregnancy losses occur annually in the US, with at least 400,000 miscarriages in states with abortion bans, according to a September 2024 study in Health Affairs. Jenna Nobles, lead author of that study and a demography professor at UC Berkeley, emphasized the need for medical capacity to support patients, as mismanaged miscarriage care can be dangerous. Miscarriage affects 25% to 30% of recognized pregnancies, impacting not only patients but also partners, families, and friends.
Rodriguez, an obstetrician-gynecologist for 20 years who has personally experienced a miscarriage, stressed that patients want to choose how they are cared for. Standard miscarriage management includes three options: expectant management (waiting for natural passage), medication (mifepristone plus misoprostol as recommended by ACOG), or a procedure. Failure to treat miscarriages according to medical standards can lead to life-threatening infections, reduced fertility, and trauma.
Restrictions on mifepristone increase complication risks, as penalties on providers, insurers, and pharmacists reduce prescribing and coverage. This means fewer patients receive ACOG-recommended care. The broader impact includes harder access to fertility treatment and growing healthcare deserts for obstetrician-gynecologists.
Rodriguez called for moving beyond fragmented views of pregnancy care, emphasizing that miscarriage management and abortion care are part of a continuum. Despite one in four American women having an abortion by age 45, the topic remains stigmatized. Understanding that banning abortion affects miscarriage care is crucial for improving reproductive health outcomes.
