Responsibility for abortion in restrictive U.S. states: From professional marginalization to normalization to post-Dobbs centralization

• In Event: 30258 - Reproduction in the US Post-Roe

Abstract

Following legalization in 1973, the organization of abortion services that emerged was characterized by marginalization, well documented in medical sociology literature. Abortion clinics provided about 95% of abortions, and mainstream medical institutions largely avoided this extraordinarily common and safe procedure as well as the controversy, violence, harassment, and stigma that typically accompanied it. In response, a privately funded initiative supporting U.S. ob-gyn residency programs was launched in the late-1990s that effectively trained numerous physicians throughout red and blue states, normalizing the need for abortion care significantly within those teaching hospitals and clinics. Additionally, physician advocates and organizations launched national efforts to integrate abortion and abortion-related care into emergency medicine and primary care. Post-Dobbs, however, the integration and normalization of abortion within medical institutions retrenched or vanished entirely in states with bans. With very few abortions now allowed, the authority to interpret which abortions qualify for exceptions to state bans and to what extent abortion counseling, referral, or emergency intervention remains allowable is concentrated in the hands of a few expert lawyers, high-risk obstetricians, and complex family planning fellows. The sea of emergency medicine, ob-gyn, and family medicine doctors, who were once at the ready, have ceded this now smaller medical turf for fear of their own malignment or criminalization. Only the most expert and committed physicians are trusted – and trust themselves – to know what they can legally provide, with some doctors surprised to find themselves on the front lines. Drawing on qualitative interviews and ethnographic research conducted 2023-2025 with emergency medicine, ob-gyn, maternal-fetal medicine physicians (n>50) working in states with bans, this paper presents how a subset of doctors today find themselves doing more abortion care than ever, because of the centralization of professional responsibility.

Authors

• Lori Freedman, UCSF

• Risa Cromer, Purdue University

• Brownsyne Tucker-Edmonds, Indiana University

• Kathryn LaRoche, Purdue University

• Andreia Alexander, Indiana University

• Heather Gould, University of California, San Francisco

• Maryani Rasidjan, New York University