Texas' Abortion Ban Conflicts With Person-Centered Health Care: Experiences of Texans With Medically Complex...

Starting in 2021, the Texas law referred to as Senate Bill 8 (SB8) sharply restricted abortion care, with an exception for medical emergencies. As a result, many pregnant Texans with medically complex conditions are being denied abortion care. The purpose of this study was to evaluate the perspectives of Texans with medically complex pregnancies after SB8.

Texans who were pregnant in the 12 months before or after the study start date (October 2021), and received a diagnosis that indicated a pregnancy risk, engaged in semi-structured interviews exploring their health care experiences. Interviewers asked participants how they learned about complications with their pregnancy, counseling they received about medical complexity pregnancy options (including abortion care and/or other medical interventions), their decision-making process, how abortion laws impacted their options and access to care, and their reflections on the care they received. Interviews were recorded and transcribed and reviewed by five research team members. We conducted a thematic analysis using inductive and deductive coding. We used the World Health Organization framework to inform data interpretation about quality-of-care metrics.

We enrolled 25 participants with a range of maternal, fetal, or pregnancy-related medical conditions; half of participants received abortion care. Participants reported that information about pregnancy conditions and abortion options was ambiguous, leaving them to learn more on their own; they had limited autonomy to pursue abortion care given their unique medical concerns and found it challenging to engage their care team; and they lacked emotional support across their journey due to abortion stigma, fear of legal risks to others, and overall lack of mental health resources.

Pregnant Texans with medically complex conditions described major gaps in quality of care after SB8. Where abortion care cannot be provided by law, health systems can better meet patients' needs by providing effective transitions of care.