Sources of moral distress among obstetrician-gynecologists after Dobbs: A qualitative, multi-state study

Since the US Supreme Court's 2022 decision in Dobbs v Jackson Women's Health Organization, 18 states have enacted functional bans on abortion, yet little is known about how these laws contribute to workplace stress and its sequelae among clinicians. The purpose of this study was to characterize sources of moral distress—which occurs when a clinician knows the right course of clinical action but is barred from taking that action by external constraints—among obstetrician-gynecologists (OB-GYNs) in states with abortion bans. We conducted qualitative, semi-structured interviews with 54 OB-GYNs practicing in 13 of 14 states where abortion was illegal as of March 2023. Using a qualitative descriptive coding approach, we identified four types of clinical situations leading to moral distress: delaying treatment for patients with obstetric complications, conflict with other clinicians, denying care they would have provided locally prior to Dobbs, and restrictions on clinical counseling. These situations provoked feelings of anger, frustration, helplessness, and emotional exhaustion. Participants attributed moral distress to the cumulative toll of routinely being unable to provide evidence-based healthcare, in addition to the acute burden of managing obstetric emergencies in legal gray areas, which was relatively rarer. The findings demonstrate a previously unreported source of moral distress: the everyday chipping away of professional integrity that occurs when OB-GYNs cannot care for patients in the way that patients need. Next steps include developing institutional-level policies and programs to support clinicians and enable them to practice ethical medicine in abortion-restrictive policy environments.