Texas Senate Bill 8 (SB 8), which went into effect went into effect in September 2021, prohibited most abortions after detection of embryonic cardiac activity. We surveyed how Texas health care professionals who care for patients experiencing medically complex pregnancies navigate this abortion restriction. We found that Texas health care professionals’ abilities to provide evidence-based abortion care to patients with medically complex pregnancies were constrained by institutional policies, and care options narrowed further after implementation of SB 8. Abortion restrictions limit shared decision making, compromise patient care, and put pregnant people’s health at risk.

For this study, we conducted in-depth interviews with health care professionals across Texas who cared for patients with life-limiting fetal diagnoses or who had existing or developed health conditions that adversely affected pregnancy. The first round of interviews were performed March–June 2021 and the second round of interviews January–May 2022, after the implementation of SB 8.

Participants reported presenting their patients with information about health risks and outcomes of continued pregnancy in each policy period; however, counseling on these options ceased after SB 8. Administrative approval processes for abortion delayed care and endangered patients’ health, which worsened after in-state options were eliminated after implementation of SB8. Participants noted that patients with limited resources who were unable to travel out of state often had to continue pregnancies, further increasing their risk of morbidity.

Excerpts from our interviews with healthcare providers:

“I sometimes think I spend more time as a psychiatrist than I do as an [obstetrician–gynecologist]. The toll that that takes on the patient, the toll it takes on their families, and I’ve seen countless relationships that have been destroyed by the stress and anxiety of having to keep a pregnancy when they would not have chosen to do so under any other circumstance.”

“There was a discussion of ‘Is she sick enough to qualify as this is a severe threat to her life? And if not, could she have that termination done in the outpatient clinic?’. There was a lot of discussion about what was safe and what line do you stretch to get somebody access where she wasn’t able to stay out of the hospital longer than a couple of days at a time.”

“My counseling has become very limited. We received guidance from our overarching medical organization about what we can tell patients and what we cannot say. I say there is the option of ending the pregnancy. It’s not an option available to you in Texas, and I can’t discuss it further.”