Semantics Matter: Maternal-Fetal Medicine Physician Perspectives on Defining Abortion Care in the Post-Dobbs...

This study examines how maternal-fetal medicine (MFM) physicians in the Southeastern United States define abortion care in the context of legal restrictions following the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization. We conducted qualitative, semistructured interviews with 35 MFM physicians in 10 Southeastern states between February and June 2023. We analyzed interviews using a descriptive qualitative approach and identified emergent themes through inductive coding. This analysis explores the emergent theme that increased legal penalties in state abortion restrictions post-Dobbs prompted many MFMs to more closely examine the definition of abortion care and its potential impact on patient care. Whether participants believed a given scenario involved abortion care differed among participants and depended on situational factors such as intended fetal status at the time of delivery, gestational duration, and type of intervention. Regardless of participants' personal convictions, many expressed uncertainty over the legal definition of abortion. With little legal clarity and significant potential consequences, provider willingness to uphold the standard of care depended on their level of risk tolerance, leading to discrepancies in care. These findings demonstrate that provider definitions of abortion are nuanced and varied in ways that cannot be adequately captured in legal language. While individual conceptualizations of abortion are irrelevant to medical best practices, abortion restrictions position providers and institutions as gatekeepers of access to essential medical care based on how they define abortion. Fearing legal repercussions, providers may feel compelled to limit care beyond the scope of the law, resulting in delayed, denied, or inappropriate care and violation of patient rights to informed consent and bodily autonomy.