Unintended pregnancies don’t care whether you do or don’t support abortions.
Reproductive healthcare providers face this hard truth when treating their patients.
We conducted interviews with reproductive healthcare providers in Tennessee after the overturn of Roe v. Wade in June of 2022, and the subsequent implementation of one of the strictest abortion bans in the country. At the time of the interviews, the Tennessee law3 had no exceptions. The law changed slightly in the spring of 2023 to grant rare exceptions for pregnancy termination. The Tennessee law ambiguously criminalizes the provision of abortion care: anyone who “provides an abortion” can be charged with a felony and face up to 15 years in prison.4
The interviews offer valuable insight regarding the new conditions in which providers work and expose elevated dangers faced by patients and providers1. In our article published in Social Science & Medicine2, we explore the manifestation of these consequences in a new form of medical practice that we title “hesitant medicine.” We hope to give a voice to the patients and providers impacted by enigmatic abortion laws and express our concerns about the future of reproductive healthcare. While these interviews were conducted exclusively in Tennessee, these consequences are relevant to other abortion-restricted states.
1. Death and Danger are Inevitable
Death and danger were two major interview themes. One provider shares how they navigate these risks, stating:
Some patients who prematurely rupture their membranes…there’s still fetal cardiac activity, but then they get septic, go into shock, and die. You have to wait until they are on the brink of death to intervene and provide this abortion that could have been used as a preventative measure before getting to this point.
The implications of the law’s ambiguity extend beyond pregnancy, leaving significant room for interpretation when determining how much a pregnancy would threaten a patient’s health. However, there is no language in the law to guide physicians, making it difficult to navigate.
2. People Require Abortions for More Reasons than You Think
Why might someone who intended to become pregnant choose to have an abortion? What happens when the law imposes convoluted regulations, and they have no choice but to suffer? A provider shares a heart-wrenching story:
A family had a fetus with lethal anomalies…they knew their baby was not going to live. They had no option but to wait and see what would happen. It would have been within their scope of morality not to continue the pregnancy in this manner. I will never forget the turmoil and the wailing of the father in that room with all of this going on, just outright grief. To have the right stripped from people who don’t align with the same philosophy is heartbreaking. People who do align with the current change have always had the option to remain pregnant, to be honored, respected, and, within the parameters of safety, be cared for.
Forcing a family to suffer an already indescribable pain, losing a wanted pregnancy, while simultaneously barring them from receiving autonomous care, though perhaps not the intention of the law, is the grim reality.
3. The Law Infiltrates Patient-Provider Relationships
Supporting an individual’s right to choose their reproductive path does not always mean that the individual will choose abortion. The role of a healthcare provider is to “do no harm5,” and care for the patient, regardless of their choice, in a compassionate and evidence-based manner.
If you had cancer, would you want a politician or a legislator making decisions about your care? I think everybody would say no, and pregnancy care is no different.
Ambiguous laws created without medical knowledge are harmful and degrading. Legislation that controls complex medical care without acknowledging the intricacies of medicine, pregnancy, reproduction, and ethics is harmful and unethical to physicians, patients, and their families.
4. The Consequences of Abortion Bans Extend Beyond the Pro-Choice vs. Pro-Life Debate
One provider shares their evolving understanding of the value of abortion in the medical setting.
I was raised Catholic in a pro-life household. I actually worked at a “pro-life” organization for a time. It became very clear to me that healthcare is a bottom line, and you can’t impose any sort of morality, faith, or belief system on it because not everybody has the same faith, belief system, and moral code.
We trust physicians with our lives: to operate, medicate, and treat our ailments. The sanctity of this unique relationship is obscured when providers must operate under blanket regulations based on political viewpoints. Another provider shares her own story with a patient:
I probably wouldn’t want an abortion myself, but having that feeling was a choice in and of itself. There was one woman I met who was devastated, and she was like, ‘I never thought I would be this person or want to do this. I always thought this was terrible, but I have a six-month-old and a two-year-old, and I just cannot do this to my family.’. People often view it as an act of hate or a sad thing, but it is often an act of love and autonomy.
Providers hear countless stories from patients who find their beliefs change once put in the position of an unexpected or potentially harmful pregnancy. These patients in particular emphasize the complexity of pregnancy and termination. It is impossible to apply a black and white law to a situation that is always grey. In medical school, we learn to prioritize our patients’ values and beliefs. We worry about maintaining this standard when the law overrides evidence-based care and the values of our patients.
Concluding Thoughts: Medical Students’ Perspectives
As medical students, we are taught from day one the importance of patient autonomy. This concept guides our education in equipping us with the tools necessary to enable our patients to make informed decisions about their health. Now, medical students across the country are confronted with a harsh reality: there are strict, yet ambiguous, laws in place that limit our ability to promote autonomy among our patients. If our learning environments do not allow proper education and exposure, we will not be equipped to provide safe and evidence-based care. We are only at the beginning of our career journey, and already are feeling the immense moral and ethical weight of what fear-mongering restrictions mean for the routine care of healthy and sick pregnant patients alike. Before us looms an already understaffed and overworked workforce that strives every day to save, cure, and care for as many people as possible. As applications to residency programs in restrictive states dwindle7, we see the toll overflowing hospitals take on attendings and residents who are left to battle their responsibility to their patients and their ability to decipher laws written without the humanity of this relationship in mind.
Abortion bans aren’t going to stop abortions; they’re going to make abortions dangerous and deadly.6 Lives will be lost as reproductive healthcare providers practice medicine hesitantly and deviate from standard medical practice.2 We encourage the public to listen to the stories of those on the front lines and see the necessity of protecting provider autonomy and evidence-based care for the future of states like Tennessee.
Bibliography
- Lilly, A.-G., Newman, I. P., & Bjork-James, S. (2024, October 25). Doctors are preoccupied with threats of criminal charges in states with abortion bans, putting patients’ lives at risk. The Conversation. http://theconversation.com/doctors-are-preoccupied-with-threats-of-criminal-charges-in-states-wit h-abortion-bans-putting-patients-lives-at-risk-240524
- Lilly, A.-G., Newman, I. P., & Bjork-James, S. (2024). Our hands are tied: abortion bans and hesitant medicine. Social Science & Medicine, 350, 116912. https://doi.org/10.1016/j.socscimed.2024.116912
- Tennessee General Assembly Legislation. (n.d.). Retrieved May 9, 2025, from https://wapp.capitol.tn.gov/apps/BillInfo/default.aspx?BillNumber=HB1029&GA=111
- Tennessee – Center for Reproductive Rights. (n.d.). Retrieved May 9, 2025, from https://reproductiverights.org/maps/state/tennessee/
- Dickens, B. M. (2012). Patients’ Rights. In R. Chadwick (Ed.), Encyclopedia of Applied Ethics (Second Edition) (pp. 370–379). Academic Press. https://doi.org/10.1016/B978-0-12-373932-2.00160-5
- Abortion is a human right. (n.d.). Amnesty International. Retrieved May 9, 2025, from https://www.amnesty.org/en/what-we-do/sexual-and-reproductive-rights/abortion-facts/
- Orgera, K., Grover, A. (2024). States With Abortion Bans See Continued Decrease in U.S. MD Senior Residency Applicants. Research and Action Institute. https://doi.org/10.15766/rai_dnhob2ma
