Abortion bans are making miscarriage treatment harder, research shows

Abortion restrictions across the US are making it harder for people to access proper medical care during miscarriages, according to research published by the Journal of the American Medical Association on 18 May. The study examined 123,598 patients with private insurance and found that pregnancy care has diverged dramatically between states since the June 2022 Dobbs v Jackson Women's Health Organization decision overturned Roe v Wade.

The research compared two groups: 54,181 patients who lived in states that enacted abortion restrictions after the Dobbs decision, and 69,417 patients in states without such restrictions. In the restricted states, treatment patterns shifted sharply away from medication-based care. States with trigger bans saw a 2.8 percentage point increase in expectant management, meaning more patients were sent home to wait and see if their miscarriage would resolve on its own.

At the same time, medication management dropped by 2.2 percentage points in restricted states. When patients in these states did receive medication, they were 13.8 percentage points more likely to receive misoprostol alone, which is considered safe but is not the standard recommended treatment in the US and often takes longer, causing more discomfort.

"We wanted to understand how, when you restrict access to abortion, that might affect people who are having a pregnancy loss or an early miscarriage," said Maria Rodriguez, the study's lead author and a professor of obstetrics and gynecology at Oregon Health & Science University. "What we found was that people had fewer choices to the type of care they got, and they were receiving lower-quality care as well."

Doctors treat spontaneous abortion—the medical term for miscarriage—using the same medications and procedures as induced abortion. Rodriguez explained: "We use the same medications, it's the same procedure." This overlap means that laws restricting abortion directly limit options for treating miscarriage, even though miscarriage is a natural pregnancy loss that requires urgent medical attention.

The study likely understates the real problem, Rodriguez noted, because it only included privately insured patients, who tend to be wealthier and have more resources. "The population at the highest risk for maternal mortality and severe maternal morbidity – people on Medicaid – it's going to be worse," she said.

At least 400,000 miscarriages occur each year in states with abortion bans, according to a September 2024 study published in Health Affairs. About 25 to 30 percent of recognized pregnancies end in miscarriage, meaning the condition affects enormous numbers of people. Jenna Nobles, lead author of that 2024 study and a professor of demography at the University of California, Berkeley, stressed the scale of the problem: "It's enormous. It's absolutely enormous."

Proper miscarriage care involves three medically appropriate options. Expectant management means waiting to see if the pregnancy loss passes naturally. Two medications—mifepristone followed by misoprostol—are recommended by the American College of Obstetricians and Gynecologists (ACOG). A surgical procedure can also clear the pregnancy quickly. Restricting access to these options creates serious risks.

Mismanaged miscarriage care can lead to life-threatening infections, reduce fertility, and cause deep physical and emotional pain, Nobles warned. She added that "anything that constrains standard forms of medical care has spillover effects." When providers face increasing penalties for prescribing mifepristone, insurers avoid covering it, and pharmacists hesitate to fill prescriptions, fewer miscarrying patients receive the standard ACOG-recommended treatment.

The restrictions have broader effects beyond miscarriage treatment. They have made it harder for some patients to access fertility treatment and significantly more difficult for obstetrician-gynecologists to practice, leading to healthcare shortages in some areas. Rodriguez has worked as an obstetrician-gynecologist for 20 years and said she has cared for thousands of women experiencing miscarriage. "But what people want, when they're in that kind of pain, is to be able to pick how they're taken care of," she said.

Many people do not realize that miscarriage and abortion require the same medical care, or that abortion restrictions therefore complicate miscarriage treatment. Rodriguez emphasized that doctors should think of all these situations as parts of one medical field. "It's pregnancy care, and it's very much a continuum, and there's a lot more gray and nuance in this than people realize," she said.