Exploring how California obstetrician-gynecologists interpret the fetal viability concept

To understand how obstetrician-gynecologists (OBGYNs) in California, a state with viability-based abortion legislation, personally define and interpret the concept of fetal viability in their clinical practice and through the lens of hospital and state policy.

We conducted qualitative audio-only interviews of practicing generalist and Complex Family Planning (CFP) fellowship-trained OBGYNs in varied clinical and geographic environments across California to evaluate clinicians' approaches to obstetric and abortion care within and beyond the peri-viable period. Participants were purposively recruited via online physician message boards and email outreach. Interviews were digitally recorded, transcribed, coded, and iteratively analyzed for relevant themes.

We interviewed nine CFP-trained and 12 generalist OBGYNs (nine of whom did not routinely provide abortion care). Most interviewees were white women practicing in urban areas, split among Northern and Southern California. All CFP OBGYNS were familiar with the state's viability-based abortion restriction, while understanding varied among the 12 generalist OBGYNs. Many generalists equated viability with 24 weeks, commonly due to institutional policies. Accordingly, some physicians did not provide abortion care near or beyond 24 weeks for personal, professional, and political reasons. Overall, physicians approached peri-viable care through one or more of three frameworks: fetus-centered, institution-centered, and, rarely, person-centered.

Many California OBGYNs are unaware of state abortion legislation and practice peri-viable pregnancy care within the more conservative policies of their institutions that apply specific gestational duration limits to abortion care. Differing institutional and provider interpretations of viability result in inequitable access to abortion past 24 weeks in California.

Varied interpretations of "fetal viability" as a medico-legal concept among obstetrician-gynecologists and their institutions contribute to inequitable peri-viable abortion access across California.