State-level abortion bans have led to substandard medical care for miscarriages, according to a new study led by clinician-scientists at Oregon Health & Science University.
Management of miscarriage requires the same medications and procedures used for abortion, including mifepristone and misoprostol, which in combination has been proven to be safer and more effective than misoprostol alone. However, the research team identified a shift away from this medication management toward “expectant management,” which waits for the miscarriage to happen on its own without intervention.
“Patients are having to wait longer to receive treatment, and when they arrive, they have fewer choices,” said lead author Maria Rodriguez, professor of obstetrics and gynecology at the OHSU School of Medicine. “These are very real and dangerous clinical implications for the hundreds of thousands of women experiencing miscarriages annually.”
In an analysis of 123,598 commercially insured individuals who experienced miscarriage prior to 10 weeks of pregnancy between the years of 2018 and 2024, the authors found aborton bans were associated with a 2.8 percent increase in expectant management and a 2.2 percent decrease in medication management. Among those who did receive medication, abortion ban states had a 13.8 percent increase in misoprostol-only regimens relative to the mifepristone-plus-misoprostol combination.
The authors highlight the need for women to have the full spectrum of treatment options when experiencing a miscarriage. Some women may want to use medication or a surgical procedure to manage the process, while others may prefer expectant management. Regardless, patient autonomy should be the top priority, and the authors call for policymakers to make miscarriage legally distinct from abortion and protect access to mifepristone.
“If we don’t fight to preserve what’s left of our reproductive health infrastructure, we’ll continue to see these consequences over time,” said Dr. Rodriguez. “Women’s health across the country is at stake — we can’t take our foot off the gas.”
Dr. Rodriguez is director of the Center for Women’s Health and director of the Center for Reproductive Health Equity at Oregon Health & Science University. She is also the medical director for the state of Oregon’s Reproductive Health Program. Dr. Rodriguez received her medical degree and completed a residency in obstetrics and gynecology at Oregon Health & Science University. She completed a fellowship in complex family planning at the University of California, San Francisco and earned a master of public health degree from the University of California, Berkeley.