States with abortion restrictions have worse outcomes for patients using fertility treatment

Research from Oregon Health & Science University has found that laws restricting access to abortion may disproportionately affect pregnancies conceived through fertility treatment. 

The study, published today in JAMA Health Forum, found that states with targeted regulations of abortion providers, also known as TRAP laws, have worse maternal health outcomes for patients using fertility treatment compared with states that don’t have such laws.

Patients with infertility diagnoses already carry an increased risk of health complications during pregnancy and childbirth, including hemorrhage, gestational diabetes, growth restriction, hysterectomy, preterm birth and stillbirth. The OHSU study aimed to better understand how a lack of access to full-scope reproductive health care in many states creates additional risk for these patients.

“People with highly planned and desired pregnancies may not be who we typically think of when we discuss the impacts of abortion restrictions, but their health and safety are being considerably impacted,” said Molly Kornfield, M.D., assistant professor of obstetrics and gynecology in the OHSU School of Medicine and the study’s lead author. “These data prove what we already know: Abortion restrictions don’t exist in a vacuum — they affect everyone who needs reproductive healthcare.”

In the retrospective, population-based cohort study, researchers analyzed neonatal and maternal health statistics for over 400,000 births conceived through fertility treatments between 2012 and 2021. The results showed a statistically significant increase in serious maternal health complications, including blood transfusion, ICU admission, unplanned hysterectomy and uterine rupture — which can be life-threatening and have the potential to compromise future fertility.

While more research is needed to understand the root causes of these impacts, researchers hypothesize several factors are at play, including widespread fertility clinic closures, an exodus of abortion providers from restrictive states, as well as an ongoing national shortage of OB/GYNs.

The research team says that the impacts of TRAP laws have changed the way they counsel patients and deliver care. For example, they may advise patients to approach travel with more caution during pregnancy, since they won’t receive the same standard of care in all states. This is especially true for individuals who already face barriers and discrimination within the health care system, including people of color, immigrants and LGBTQ+ people.

“We’re lucky to be living and practicing in Oregon, where we’re able to offer evidence-based, full-scope reproductive health care, but sadly this isn’t the case in so many areas,” said Samuel Melville, M.D., resident physician in OHSU’s department of obstetrics and gynecology and the study’s co-author. “If we want to truly support the health of children and families, we need to acknowledge that safe reproduction includes abortion care.”