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P040“You're on your own”: A qualitative analysis of texas senate bill 8 on abortion care in patients with lethal or life-limiting fetal diagnoses

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      Objectives

      To describe experiences with abortion counseling and access to care among patients with lethal or life-limiting fetal diagnoses in Texas following enactment of Senate Bill 8 (SB8).

      Methods

      In this qualitative study, we recruited patients who had an abortion after the enactment of SB8 and used semi-structured interviews to explore how SB8 impacted abortion care. Two researchers coded all transcripts using an inductive technique and analyzed themes in an iterative approach.

      Results

      We interviewed 14 participants who reported gestational ages at the time of abortion from 13 to 29 weeks. Participants described a loss of the therapeutic physician-patient relationship and feelings of isolation while pursuing abortion due to the limitations imposed by SB8. For example, participants felt there was a physician “gag rule” regarding abortion (“the unspoken word of termination”), resulting in a greater need to initiate their own research and invest personal resources (eg, finances, knowledge) into understanding their pregnancy options and obtaining an abortion. Participants also expressed fears regarding confidentiality with clinicians and their support system (“I would joke around and say, ‘Well, don't sue me,’ but halfway mean it.”) and need to assess personal safety when self-referring for abortion (“‘You're on your own…go find somebody that can do this…’”).

      Conclusions

      Bounty hunter abortion restrictions like SB8 erode the physician-patient relationship. These restrictions evoke fear and safety concerns during a vulnerable time for those undergoing abortion for fetal diagnoses. Patients shoulder a significant burden of understanding pregnancy options and navigating the process of abortion alone, which could result in further disparities.
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