State Abortion Policy and Provider Moral Distress Levels After Dobbs [ID 2683541

Abstract

INTRODUCTION: Moral distress occurs when individuals feel powerless to carry out ethically correct actions, including when prevented from providing necessary health care. We aimed to measure self-reported moral distress levels among abortion providers after the Dobbs decision and to assess differences by state-level abortion policy. METHODS: In 2023, we surveyed abortion providers nationally through professional listervs. Institutional review board-exempt surveys queried demographics, practice characteristics, and the Moral Distress Thermometer (MDT), a validated psychometric tool that measures moral distress level from 0 (lowest) to 10 (highest). Providers reported whether their moral distress level had changed since Dobbs. We assessed overall moral distress level and differences by state restrictiveness (using Guttmacher’s classifications) using one-way ANOVA (continuous variables) and chi-squared tests (categorical variables). RESULTS: In total, 253 practitioners completed the MDT for one or more states where they practiced (N=285 MDTs analyzed), with 56.8% of responses for “protective” states and 43.2% for “restrictive” states. Moral distress levels ranged from 0 to 10 (mean=5.09) and were twice as high for providers in restrictive compared to protective states (mean=7.15 versus 3.52; P<.001). Change in distress post Dobbs differed by state restrictiveness: In restrictive states, 89.4% reported an increase compared to 71.6% in protective states (P<.01). CONCLUSION: Moral distress levels for abortion providers were high following Dobbs, and higher in restrictive states. Most providers experienced increased distress across policy contexts. Moral distress has been associated with burnout, errors in patient care, and attrition. High and increasing moral distress levels, especially in abortion restrictive states, may worsen provider shortages, and lead to poor patient outcomes.