New Study: Most Oklahoma Hospitals Unable to Explain Their Policies on Emergency Abortion Care

04.25.23 (PRESS RELEASE) — Not a single hospital in Oklahoma appears able to articulate clear, consistent policies for emergency obstetric care to pregnant patients, according to a new study published Tuesday. When called by prospective patients, Oklahoma hospitals offered opaque, contradictory, and incorrect information about abortion availability and approval processes in obstetric emergencies, as well as little reassurance that clinicians’ medical judgment and pregnant patients’ needs would be prioritized.

Using a “simulated patient” methodology, researchers called all Oklahoma hospitals that provide prenatal and peripartum care to ask questions related to emergency pregnancy care. Among the 34 Oklahoma hospitals reached by prospective patients:

• 65 percent (22 hospitals) were unable to provide information about procedures, policies, or support provided to doctors when it is clinically necessary to terminate a pregnancy to save the life of a pregnant patient.
• Only two of the 34 hospitals described providing legal support for clinicians in such situations.
• In 14 cases (41 percent), hospital representatives provided unclear and/or incomplete answers about whether doctors require approval to perform a medically necessary abortion.
• Four hospitals stated they have formal approval processes that clinicians must go through if they deem it medically necessary to terminate a pregnancy.
• Three hospitals indicated that they have policies for these situations but refused to share any information about them.
• Three representatives stated that their hospitals do not provide abortions at all, despite abortion remaining legal in the cases of medical emergencies or to “preserve the life” of the pregnant person.
• Four hospitals provided information that was factually wrong.  

Oklahoma hospitals that are affiliated with an Indigenous nation were excluded from the study; because they operate under federal oversight, it is unclear how the Oklahoma bans impact them.

In conversations with hospital staff and clinicians, researchers received a range of misleading, unclear, and even factually incorrect answers about emergency pregnancy care available at the facilities, such as:

• “If the situation is truly life-threatening, decisions will be made,” said one Oklahoma hospital representative, without explaining how those decisions would be made or by whom.
• In one circumstance, hospital representatives told the caller that the pregnant patient’s body would be used as an “incubator” to carry the baby as long as possible.
• “It is tricky because of state laws, but we will not let the mom die,” said another hospital representative. 
• At one hospital, a staff member put the simulated caller on hold and, after consulting with a hospital physician, told the caller, “Nowhere in the state of Oklahoma can you get an abortion for any reason,” even though the bans have exceptions.

No One Could Say: Accessing Emergency Obstetrics Information as a Prospective Prenatal Patient in Post-Roe Oklahoma highlights how the state’s abortion bans fuel confusion about clinicians’ ability to provide abortion care to save a pregnant patient’s life during obstetric emergencies without punishment. The report findings raise grave concerns about the ability of a pregnant person in Oklahoma – and in the other 11 U.S. states with similar abortion bans – to receive clear, sufficient, and necessary information to make informed decisions about their medical care and treatment in the wake of the U.S. Supreme Court’s overturning of Roe v. Wade. 

The report – the first study of its kind – is jointly published by Physicians for Human Rights (PHR), Oklahoma Call for Reproductive Justice (OCRJ), and the Center for Reproductive Rights (CRR). All three human rights organizations are calling on the Oklahoma legislature to repeal Oklahoma’s abortion bans and decriminalize abortion. 

The report co-authors also simultaneously published a Comment in leading medical journal The Lancet about the impacts of abortion bans, titled “US abortion bans violate patients’ right to information and to health.”

Oklahoma residents currently live under three overlapping abortion bans, which impose severe civil and criminal penalties on health care professionals who violate them. The situation in Oklahoma offers important insight into the effects of total abortion bans on pregnant patients and the clinicians who care for them in all 12 states with such bans.

“The laws criminalizing abortion in Oklahoma place both patients and providers in an untenable situation,” said Michele Heisler, MD, MPA, report co-author, medical director at PHR, and professor of internal medicine and public health at University of Michigan. “Oklahoma hospitals and medical professionals have been thrust into a crisis of ‘dual loyalty,’ where they have to abide by punitive laws that can harm patients while seeking to provide ethical, high-quality, patient-centered medical care.” 

“Our report found that prospective patients were not able to access even basic information about the emergency care they might receive during pregnancy,” said Dr. Heisler. “These findings should be a wake-up call to health professionals everywhere to speak out against laws criminalizing abortion, which jeopardize clinicians’ medical decision-making to prioritize their patients’ health, well-being, and human rights.”

“Oklahoma’s abortion bans threaten the lives and health of pregnant Oklahomans. We know that this callous, intentional disregard for pregnant people from the state’s elected leaders will disproportionately harm those who already face discrimination in accessing medical care, including Black, Indigenous, and other Oklahomans of color, young people, and people living on low-incomes,” said Tamya Cox-Touré, chair, Oklahoma Call for Reproductive Justice. “It is preposterous that the State can force people to sacrifice their health and lives. We hope that these powerful research findings will help lead to the removal of these dangerous barriers to safe and quality healthcare for pregnant people. We ask all Oklahomans and their health care providers to speak out against the serious harms caused by Oklahoma’s abortion bans. Let this report inspire action because we need everyone in this fight.”

“This report is a stunning indictment of post-Roe medical care for pregnant people. Oklahoma’s extreme and inconsistent abortion bans put peoples’ health and lives at risk every day,” said Risa Kaufman, director of U.S. human rights at the Center for Reproductive Rights, which has legal challenges pending against abortion bans and restrictions in 10 states, including two in Oklahoma. “These devastating findings from Oklahoma are consistent with accounts we are hearing from patients and health care professionals in other abortion ban states. These bans undermine the ability and freedom of patients and their providers to make safe, evidence-based health care decisions.”

The U.S. medical community has largely condemned the wave of abortion criminalization laws sweeping across parts of the country, with American Medical Association president Jack Resneck, Jr. saying that physicians are now “caught between good medicine and bad law,” struggling to “meet their ethical duties to patients’ health and well-being, while attempting to comply with reckless government interference in the practice of medicine that is dangerous to the health of… patients.”

Pregnant people who live in a state that has banned abortion are up to three times more likely to die during pregnancy, childbirth, or soon after giving birth compared to pregnant people in states that do not ban abortion, according to a January 2023 study by the Gender Equity Policy Institute. 

In light of these stark findings, PHR, OCRJ, and CRR call on the Oklahoma legislature to repeal Oklahoma’s abortion bans and decriminalize abortion. The organizations also call on the state to ensure that health care services for pregnant people and all Oklahomans are accessible and of good quality. Critically, the organizations also urge Oklahoma’s hospitals and clinicians – as well as state and national medical associations – to speak out against laws criminalizing abortion or otherwise restricting access to abortions, including during obstetric emergencies.

The organizations also call for national lawmakers to pass legislation recognizing the right to abortion and for the federal administration to take steps to ensure access to abortion in all states, without discrimination.

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MEDIA CONTACTS:

PHR: [email protected]; +1-917-679-0110

OCRJ: [email protected] 

Center for Reproductive Rights: [email protected]