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| OHSU researchers highlight dangerous clinical impacts of abortion bans for women experiencing a miscarriage, including delayed care and limitations in treatment options. Photo Credit: OHSU/Christine Torres Hicks |
Scientific Frontline: Extended "At a Glance" Summary: The Impact of Abortion Bans on Miscarriage Management
The Core Concept: State-level abortion bans have inadvertently degraded the quality of medical care for miscarriages, driving a reduction in evidence-based clinical interventions.
Key Distinction/Mechanism: Because the medical management of a miscarriage utilizes the exact same medications (mifepristone and misoprostol) and clinical procedures as induced abortion, legal restrictions and liability concerns have forced a shift away from effective combined medication therapies toward "expectant management"—essentially waiting for the miscarriage to resolve naturally without clinical intervention.
Origin/History: Following the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization (which overturned Roe v. Wade), researchers from Oregon Health & Science University (OHSU) analyzed insurance data from 2018 to 2024. Their findings were published in JAMA on May 18, 2026.
Major Frameworks/Components:
- Rise in Expectant Management: A 2.8% increase in non-intervention approaches in states with abortion bans.
- Decline in Medication Care: A 2.2% decrease in overall medication management for early pregnancy loss.
- Substandard Regimens: A 13.8% increase in misoprostol-only prescriptions in ban states, reflecting a departure from the safer, more effective mifepristone-plus-misoprostol protocol.
- Data Scope: A retrospective cohort study evaluating medical data from 123,598 commercially insured individuals who experienced a miscarriage prior to 10 weeks of pregnancy.
Branch of Science: Obstetrics and Gynecology, Public Health, Reproductive Medicine, and Epidemiology.
Future Application: The data emphasizes the necessity of establishing clear legal and clinical frameworks that separate miscarriage management from abortion legislation to protect access to vital medications like mifepristone and preserve core reproductive health infrastructure.
Why It Matters: Restricting these standard medical protocols forces patients to wait longer for necessary treatments, limits their safe medical choices, prolongs the grief of pregnancy loss, and forces them to carry nonviable pregnancies in ways that can pose severe risks to their overall health and future fertility.
Research from Oregon Health & Science University (OHSU) sheds new light on the unintended consequences of the overturn of Roe v. Wade: worse medical care for miscarriages.
Miscarriage—or the spontaneous, unexpected loss of a pregnancy before 20 weeks—is the most common complication in early pregnancy. The study, published in JAMA, found that state-level abortion bans were associated with a reduction in evidence-based medical care for miscarriage management.
Clinician-scientists at OHSU’s Center for Reproductive Health Equity identified a shift away from medication management toward “expectant management”—essentially waiting for a miscarriage to happen on its own without treatment or intervention.
“We can’t restrict one area of reproductive health care without there being far-reaching impacts,” said Maria Rodriguez, MD, MPH, professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Women’s Health. “Patients are having to wait longer to receive treatment, and when they arrive, they have fewer choices. These are very real and dangerous clinical implications for the hundreds of thousands of women experiencing miscarriages annually.”
Clinical Impacts
Management of miscarriage requires the same medications and procedures used for abortion, including mifepristone and misoprostol, a combination proven to be safer and more effective than misoprostol alone.
In the retrospective cohort study, researchers used a national commercial insurance database to evaluate medical data from 123,598 individuals who experienced miscarriage prior to 10 weeks of pregnancy between the years of 2018 and 2024.
Analysis showed that abortion bans were associated with a 2.8% increase in expectant management and a 2.2% decrease in medication management. Further, among those individuals who did receive medication, abortion ban states had a 13.8% increase in misoprostol-only regimens relative to the evidence-based mifepristone-and-misoprostol combination.
This means more women were forced to carry pregnancies that were not viable, potentially putting their health and fertility at risk and prolonging the grief of a lost pregnancy.
Most concerning, these findings are likely only the tip of the iceberg, Rodriguez said.
“These data account for commercially insured people, so generally people of higher socioeconomic status who have better access to health care,” she explained. “If we’re seeing an effect in this population, there’s likely an even greater impact to individuals insured through Medicaid, who are generally poorer with less access. That deeply worries me.”
Legal Uncertainty
OHSU’s study aimed to quantify how state-level abortion bans triggered by the US Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization—which overturned Roe v. Wade’s constitutional right to an abortion—have impacted the availability of the evidence-based regimen for miscarriage compared with the misoprostol-only protocol.
Ongoing legal challenges to mifepristone distribution and institutional restrictions on its use have limited the availability of this treatment, even in settings where abortion remains legal and accessible. As a result, patients may face delayed or denied treatment for miscarriage due to provider concerns about criminal liability.
Having the full spectrum of treatment options is critical to support patient comfort, safety, and autonomy, Rodriguez said. Some women experiencing a miscarriage prefer to have the process completed as soon as possible; for these individuals, medication or a surgical procedure may be the best option. Others want more time to grieve and process the loss; for them, expectant management may be preferred.
Whatever the choice, Rodriguez emphasizes that every patient is unique and deserves to be treated with dignity.
“Going through miscarriage is a uniquely terrible experience. What women want in those situations is choices and respect for those choices.”
Looking forward, Rodriguez warns that efforts to make miscarriage management legally distinct from abortion and protect access to mifepristone will be crucial.
“If we don’t fight to preserve what’s left of our reproductive health infrastructure, we’ll continue to see these consequences over time. Women’s health across the country is at stake—we can’t take our foot off the gas.”
Published in journal: JAMA
Authors: Maria I. Rodriguez, MD, MPH; Megan Fuerst, MD, MPH; and Kaitlin Schrote, MPH, MS
Source/Credit: Oregon Health & Science University | Nicole Rideout
Reference Number: med051826_01
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