The Safety Gap: Why Maternal Health is Declining in Abortion-Restrictive States

Abstract

The 2022 Dobbs v. Jackson Women's Health Organization decision, which overturned Roe v. Wade, ostensibly returned the regulation of abortion to individual states. However, the legislative and medical reality that has emerged in the years following this ruling demonstrates that abortion services cannot be surgically excised from the broader body of reproductive healthcare without inflicting systemic damage. This report provides an exhaustive, multi-dimensional analysis of the collateral consequences of abortion restrictions on fertility treatments, specifically In Vitro Fertilization (IVF), and general maternal health outcomes. Drawing on data from Oregon Health & Science University (OHSU), the Association of American Medical Colleges (AAMC), and legal precedents from the Alabama Supreme Court, this analysis argues that the legal frameworks designed to restrict abortion—specifically "fetal personhood" statutes and TRAP (Targeted Regulation of Abortion Providers) laws—create a hostile environment for all reproductive medicine. This environment is characterized by a statistically significant deterioration in patient safety, a mass exodus of medical professionals from restrictive states, and the imposition of insurmountable economic and legal barriers to family building. The findings suggest that the distinction between "abortion" and "fertility care" is medically artificial; legally and practically, the suppression of one inevitably compromises the other, leading to a public health crisis that disproportionately affects high-risk and marginalized populations.

Part I: The Ecosystem of Reproductive Healthcare

Introduction: The Myth of the Silo

In the public and political discourse surrounding reproductive rights in the United States, a sharp dichotomy is often drawn between abortion—the termination of a pregnancy—and fertility treatments like IVF—the technological assistance to create a pregnancy. This binary framing suggests that legislation targeting abortion clinics and providers can exist in a vacuum, isolated from the clinics and laboratories dedicated to helping patients conceive. The years following the Dobbs decision have shattered this illusion. The medical infrastructure required to safely manage a miscarriage, treat an ectopic pregnancy, or preserve fertility prior to cancer treatment is largely identical to the infrastructure used for abortion care.¹ The medications used to induce labor or manage a miscarriage (such as mifepristone and misoprostol) are the same agents used in medication abortions. The surgical techniques used to clear the uterus after an incomplete miscarriage (dilation and curettage, or D&C) are the same procedures used for surgical abortions. Consequently, when a state enacts a legal framework that criminalizes these tools or imposes heavy regulatory burdens on the providers who use them, the shockwaves are felt across the entire spectrum of reproductive medicine.

A seminal study published in JAMA Health Forum by researchers at Oregon Health & Science University (OHSU) provided one of the first comprehensive quantifications of this "spillover" effect. The study, which analyzed over 400,000 births conceived through fertility treatments between 2012 and 2021, found that states with strict abortion regulations—specifically Targeted Regulation of Abortion Providers (TRAP) laws—had significantly worse maternal health outcomes for fertility patients.¹ These were not patients seeking to end pregnancies; they were patients who had invested significant emotional, physical, and financial resources to achieve pregnancy. Yet, the erosion of the reproductive safety net in their states meant that when complications arose—such as hemorrhage or hypertensive disorders—the system was less equipped to save them.¹ This report dissects the mechanisms driving this correlation, exploring the legal, medical, and workforce dynamics that link abortion bans to the degradation of fertility care.

The Concept of Reproductive Infrastructure

To understand why abortion bans affect IVF and maternal health, one must conceptualize "reproductive infrastructure." This infrastructure is not merely a collection of clinics; it is a web of legal protections, specialized workforce pipelines, supply chains for pharmaceuticals, and established standards of care.

In states that have protected abortion access, this infrastructure remains robust. Physicians are trained in the full scope of obstetrics and gynecology, including the management of complex miscarriages and second-trimester complications. In contrast, states with bans have seen a dismantling of this infrastructure. Clinics close, taking with them the ultrasound machines, anesthesiologists, and specialized nursing staff needed for both abortions and complex gynecological procedures. The "chilling effect" of potential criminal liability leads to what is known as "defensive medicine," where clinical decisions are driven by legal risk mitigation rather than patient well-being.²

For the IVF patient, this degradation of infrastructure is catastrophic. Infertility is not merely a failure to conceive; it is often a marker of underlying health issues that place the patient in a high-risk category for pregnancy. Patients undergoing IVF have higher rates of multiple gestations (twins or triplets), placenta previa (where the placenta covers the cervix), and gestational hypertension.¹ Managing these risks requires a healthcare system that is responsive, well-staffed, and legally empowered to intervene swiftly when a pregnancy threatens the life of the mother. In states with abortion bans, that responsiveness is paralyzed by the fear of prosecution, leading to delays that can turn manageable complications into life-threatening emergencies.

Part II: The Legal Singularity – Fetal Personhood and IVF

The collision course between abortion restrictions and fertility treatment reached a critical inflection point in early 2024 with the Alabama Supreme Court’s ruling in LePage v. Center for Reproductive Medicine. This case did not involve abortion in the traditional sense; it involved the accidental destruction of frozen embryos in a fertility clinic's storage tank. However, the legal logic applied by the court—that an embryo in vitro (in glass/lab) is legally equivalent to a child—exposed the existential threat that "fetal personhood" poses to the practice of IVF.⁴

The LePage Decision: Anatomy of a Crisis

The facts of the LePage case were tragic but, in the context of clinical operations, effectively an industrial accident. A patient at a hospital wandered into the fertility clinic’s unsecured cryogenic storage area, removed embryos from a tank, and dropped them, resulting in their destruction.⁵ The plaintiffs (the couples whose embryos were lost) sued the clinic. While a lower court dismissed the wrongful death claim on the grounds that embryos outside the womb were not covered by the state's Wrongful Death of a Minor Act, the Alabama Supreme Court reversed this decision.

The Court’s majority opinion relied heavily on a theological and absolutist interpretation of the state constitution, declaring that the Wrongful Death of a Minor Act applies to "all children, born and unborn, without limitation".⁵ Crucially, the court rejected any distinction based on the developmental stage or physical location of the embryo. An eight-cell embryo frozen in liquid nitrogen was granted the same legal status as a term neonate in a nursery. The opinion went so far as to describe the cryogenic storage tanks as "cryogenic nurseries," a terminological shift that signaled a profound reordering of legal reality.⁸

The Immediate Fallout: Freezing the Freeze

The response from the medical community was immediate and panicked. The University of Alabama at Birmingham (UAB) Health System, the largest hospital system in the state, paused all IVF treatments. Alabama Fertility Specialists and the Center for Reproductive Medicine followed suit.⁵

This pause was not an act of political protest; it was a necessity of legal survival. IVF, by its nature, involves the handling of microscopic biological material that is fragile. Embryos do not always survive the thawing process. In a standard IVF cycle, some fertilized eggs fail to develop to the blastocyst stage and are discarded. If every embryo is a "child," then the routine cessation of development in the lab could be construed as a wrongful death. Furthermore, the standard practice of "batching" or freezing surplus embryos for future use—vital for preventing multiple births and reducing costs—became a liability trap. If a power outage or mechanical failure compromised a storage tank, the clinic could face mass homicide or wrongful death charges for hundreds of "children".⁸

The Legislative Band-Aid and Persistent Ambiguity

Facing national outcry and the sudden inability of Alabama citizens to access standard medical care, the Alabama legislature rushed to pass a bill granting civil and criminal immunity to IVF providers for the destruction of embryos.¹² While this allowed clinics to reopen, legal experts and bioethicists emphasize that it is a temporary and fragile fix. The legislation did not challenge the underlying Supreme Court ruling that embryos are children; it merely carved out a liability shield for the doctors who handle them.

This leaves the legal status of the embryo in a "quantum state"—simultaneously a child under the constitution but a piece of property that can be destroyed without penalty under the immunity statute. This incoherence creates a deeply unstable environment for long-term investment and practice. Providers know that immunity statutes can be repealed or challenged, while the constitutional interpretation of personhood remains the law of the land.⁸ Moreover, this "immunity" approach does not address the broader push in other states to enact similar personhood laws, meaning the Alabama crisis is viewed not as an anomaly, but as a preview of a national strategy.¹⁴

Table 1: Legal Status of Embryos and Clinical Implications

Legal Framework	Definition of Embryo	Clinical Consequence for IVF	Provider Risk Level
Standard Medical Model	Biological tissue with potential for life; property of patients.	Discard of non-viable/surplus embryos permitted; PGT-A testing standard.	Low (Malpractice/Negligence only)
Fetal Personhood (Alabama Model)	"Extrauterine Child" with full rights.	Discard = Wrongful Death/Homicide; freezing carries liability.	Critical (Criminal/Civil Liability)
Immunity Statute (The "Fix")	"Child" (technically), but providers shielded from liability.	Clinics operate but under threat of legislative reversal.	Moderate (Regulatory uncertainty)
Strict Abortion Ban (No Exception)	"Unborn Human Being" from fertilization.	Ambiguity on "selective reduction" and ectopic management.	High (Felony charges for "abortion")

Part III: The Disruption of Clinical Standards in Fertility Medicine

The legal environment created by abortion bans and personhood rhetoric forces fertility specialists to deviate from evidence-based standards of care. This deviation is not driven by medical innovation but by "defensive medicine"—the practice of recommending treatments based on protecting the physician from liability rather than optimizing the patient's outcome.⁵

The Threat to Preimplantation Genetic Testing (PGT)

One of the most significant advancements in modern IVF is Preimplantation Genetic Testing for Aneuploidy (PGT-A). This technology allows embryologists to biopsy a few cells from a developing embryo to check for chromosomal abnormalities (aneuploidy) before transfer. Aneuploid embryos (those with too few or too many chromosomes) almost invariably result in implantation failure, miscarriage, or severe congenital conditions incompatible with life (such as Trisomy 13 or 18).¹⁶

In a standard clinical setting, embryos identified as aneuploid are discarded or donated to research, sparing the patient the physical and emotional trauma of a doomed pregnancy. However, under a strict personhood regime, discarding an aneuploid embryo could be legally equated to euthanizing a disabled child.¹⁴

This creates a harrowing dilemma for clinicians in restrictive states:

1. Transfer the Abnormal Embryo: A physician might feel compelled to transfer an embryo known to be non-viable to avoid the legal act of "destruction," thereby knowingly subjecting the patient to a miscarriage or the birth of a child who will suffer and die shortly after birth.

2. Indefinite Storage: Alternatively, clinics may be forced to store non-viable embryos in perpetuity. This imposes a "storage tax" on patients, who must pay annual fees to keep aneuploid embryos frozen, effectively turning fertility clinics into permanent warehouses for biological material that can never result in a healthy pregnancy.¹⁶

Altered Stimulation Protocols and Lower Success Rates

To avoid the liability of surplus embryos, some clinics in restrictive environments may move toward "limited insemination" or "compassionate transfer" protocols.

• Limited Insemination: Instead of fertilizing all retrieved eggs to create a robust cohort of embryos (the standard which allows for the selection of the healthiest candidate), a clinic might only fertilize two or three eggs—the exact number intended for immediate transfer.

• The Statistical Cost: This drastically reduces the cumulative pregnancy rate per cycle. IVF is a game of attrition; typically, only a fraction of fertilized eggs become blastocysts, and only a fraction of those are genetically normal. By limiting the starting number, the likelihood of having any transferable embryo drops precipitously. This forces patients to undergo multiple rounds of ovarian stimulation and egg retrieval—procedures that carry risks of Ovarian Hyperstimulation Syndrome (OHSS), infection, and significant financial cost ($15,000–$30,000 per cycle).¹⁹

The Logistics of "Embryo Trafficking"

For patients in restrictive states who wish to move their embryos to a safer legal jurisdiction, the barriers are becoming formidable. Following the Alabama ruling, several major cryo-shipping logistics companies paused operations in the state, refusing to transport embryos in or out due to fears that a transport accident could result in wrongful death liability.¹¹

Even when shipping is available, it is prohibitively expensive. The cost to ship a tank of embryos from a restrictive state to a protective state ranges from $1,000 to $3,000, with some international or expedited options reaching as high as $8,000.²¹ This creates a socioeconomic filter: wealthy patients can "rescue" their embryos and continue treatment in states like California or New York, while low-to-middle-income patients are effectively held hostage by their state's laws, unable to afford the ransom to move their own genetic material.²⁴

Part IV: The Metrics of Harm – Maternal and Infant Outcomes

The assertion that abortion restrictions lead to worse outcomes for fertility patients is not merely theoretical; it is visible in the epidemiological data emerging from 2024 and 2025.

The OHSU Findings: A Closer Look

The study from Oregon Health & Science University (OHSU) is critical because it controls for the "desirability" of the pregnancy. These are not patients seeking abortions; these are patients who deeply want to be parents. The study found that in states with TRAP laws and abortion restrictions, IVF patients experienced higher rates of:

• Gestational Hypertension and Preeclampsia: Conditions that require careful monitoring and, often, preterm delivery to save the mother's life.

• Hemorrhage and Transfusion: Indicators of severe obstetrical complications.

• Hysterectomy: The surgical removal of the uterus, often a last-resort measure to stop uncontrollable bleeding.¹

The mechanism here is the degradation of high-risk obstetrical care. In states where abortion is banned, the skillset required to manage complex uterine evacuations (D&C) is atrophying. When an IVF patient experiences a second-trimester miscarriage or a massive hemorrhage, the "muscle memory" of the healthcare system—the ability to act swiftly to empty the uterus and stop the bleeding—is compromised by hesitation and lack of practice.¹

Maternal Mortality and the "Wait and See" Death Toll

Data from the Gender Equity Policy Institute and other surveillance bodies reveals a stark divergence in maternal mortality rates post-Dobbs.

• The Mortality Gap: Mothers living in abortion-ban states are nearly two times as likely to die during pregnancy or postpartum compared to those in supportive states.²⁶

• Racial Disparities: The burden falls disproportionately on Black women, who are 3.3 times as likely to die as White women in banned states. In Texas, specifically, the maternal mortality rate for Black women rose dramatically in the years following the implementation of its strict bans.²⁶

This increase is driven in part by the "wait and see" approach mandated by strict bans. In states like Texas, Idaho, and Tennessee, "medical exceptions" to abortion bans are often vaguely worded, allowing termination only to prevent the "death" or "substantial impairment" of the mother. Physicians, fearful of felony charges and loss of licensure, are waiting until patients are in frank sepsis or organ failure before inducing labor or performing an abortion for non-viable pregnancies (such as PPROM).²⁷

A notable statistic from Texas indicates a nearly 50% increase in sepsis rates among women managing second-trimester pregnancy loss.²⁷ Sepsis is a life-threatening response to infection. In a protective state, a patient with ruptured membranes at 18 weeks would be offered an immediate induction to prevent infection. In a ban state, she is often sent home and told to return only when she has a high fever or signs of toxicity—a policy that directly trades maternal safety for fetal "life" expectancy, even when the fetus has zero chance of survival.

Infant Mortality and Congenital Anomalies

The impact extends to infants. In states with bans, infant mortality rates have risen by 11% above expected levels.²⁴ This rise is largely driven by deaths due to congenital anomalies. These are cases where a fetus is diagnosed with a fatal condition (such as anencephaly or renal agenesis) in utero. In protective states, many parents choose to terminate these pregnancies to spare the child suffering and avoid the physical risks of term delivery. In ban states, these pregnancies are forced to term, resulting in the birth of infants who die within hours or days—a traumatic outcome that is statistically recorded as an increase in infant mortality.²⁴

Table 2: Comparative Health Outcomes (Restrictive vs. Protective States)

Health Metric	Restrictive (Ban) States	Protective States	Statistical Delta
Maternal Mortality Risk	~2x higher likelihood of death 26	21% decline post-Dobbs 26	Ban states worsening while others improve.
Infant Mortality Rate	11% higher than expected 27	Baseline or declining	Driven by forced birth of non-viable fetuses.
Sepsis (Pregnancy Loss)	50% increase (Texas data) 27	No significant rise	Direct result of delayed intervention protocols.
Fertility Rate (Minorities)	2.0% higher than expected (Black/Hispanic) 24	Baseline	Indicates lack of access to reproductive choice.

Part V: The Great Exodus – The Reproductive Workforce Crisis

Perhaps the most damaging long-term consequence of abortion restrictions is the "brain drain" of medical professionals. The ability to provide safe IVF and high-risk obstetrical care depends on a pipeline of highly trained physicians. That pipeline is breaking.

The Residency Match Divergence

Medical residents—the doctors of tomorrow—are voting with their feet. Data from the Association of American Medical Colleges (AAMC) shows a distinct shift in where medical students are applying for residency training.

• The Application Drop: In the 2023-2024 application cycle, residency programs in states with complete abortion bans saw a 6.7% to 10% decline in applications from US MD seniors.²⁵ This is not a general decline; applications to states with abortion protections remained stable or increased.

• OB/GYN Specifics: The field of Obstetrics and Gynecology is hit hardest. Applicants know that training in a ban state means they will not learn standard procedures like dilation and evacuation (D&E), leaving them with a gap in their skillset that could make them ineligible for board certification or employment in other states.²⁹

This creates a vicious cycle. As residency programs in states like Texas, Alabama, and Idaho become less competitive, they may struggle to fill spots or may have to rely on less qualified applicants. Over time, this degrades the quality of care available in the state for decades to come.

The Flight of Practicing Physicians

It is not just trainees who are leaving. Established physicians, particularly those in high-demand subspecialties like Maternal-Fetal Medicine (MFM) and Reproductive Endocrinology and Infertility (REI), are relocating.

• Moral Injury: The primary driver for this exodus is "moral injury"—the psychological distress caused by being forced to act against one’s ethical and professional judgment. Interviews with OB/GYNs in restrictive states reveal deep anguish over being forced to delay care for septic patients or being unable to help patients with doomed pregnancies.³¹

• Survey Data: A survey of graduating OB/GYN residents found that those who had originally planned to practice in restrictive states were 8.5 times more likely to change their plans and move to a protective state post-Dobbs.³⁴

• Maternity Care Deserts: The exodus accelerates the formation of maternity care deserts. Already, 35% of US counties are considered maternity care deserts (having no obstetric providers). As rural hospitals close their labor and delivery units due to staffing shortages and liability risks, women in these areas—often low-income and uninsured—are left with nowhere to go.²⁵

Part VI: The Oncological Intersection – Cancer and Fertility

The collision of oncology and abortion restrictions highlights the indiscriminate nature of these laws. Cancer does not pause for pregnancy, and the treatments required to save a patient’s life often require the termination of a pregnancy or the complex management of fertility preservation.

The "Life vs. Life" Dilemma in Cancer Care

When a pregnant patient is diagnosed with cancer, the standard of care often involves a heartbreaking calculation. Chemotherapy and radiation are teratogenic, meaning they cause severe birth defects or fetal death. To treat the cancer aggressively and save the mother, the pregnancy must often be terminated, especially if the diagnosis occurs in the first or second trimester.36

In ban states, this calculation is taken out of the hands of the patient and the oncologist.

• Treatment Delays: Physicians report cases where patients are denied chemotherapy until their pregnancy is terminated, yet they cannot access an abortion in their state. This forces them to travel—often while immunocompromised and ill—or wait until the fetus is viable or the mother’s condition deteriorates enough to qualify for a "life of the mother" exception.

• Mortality Impact: Research indicates that every month of delay in cancer treatment increases mortality risk by 13%. For the estimated 750 pregnant women diagnosed with cancer annually in ban states, these delays are a death sentence.³⁷

Fertility Preservation at Risk

For young cancer patients (Adolescents and Young Adults, or AYA) who are not pregnant, the standard of care is "oncofertility"—preserving eggs or embryos before starting sterilizing treatments like chemotherapy.

However, the "personhood" ambiguity affects this as well. Oncologists may hesitate to refer patients for embryo banking if they fear the patient will be unable to manage those embryos legally in the future. If a patient freezes embryos but later dies of their cancer, the legal status of those "orphaned" embryos in a personhood state becomes a liability nightmare for the clinic and the family.38

The American Cancer Society estimates that over 32,000 AYA patients annually are in states where their access to fertility preservation could be compromised by these legislative shifts.38

Part VII: Socioeconomic Barriers and the Cost of Survival

The landscape of post-Dobbs reproductive care is defined by profound inequality. The "workarounds" to abortion bans—traveling out of state, shipping embryos, accessing telehealth—are expensive commodities available only to the privileged.

The High Cost of Interstate Care

For a patient in Texas or Alabama who needs an abortion or specialized fertility care not available locally, the only option is travel. This imposes a significant "reproductive tax."

• Travel Costs: The average cost for travel, lodging, and lost wages for an out-of-state procedure ranges from hundreds to thousands of dollars. For a low-wage worker without paid sick leave, this is insurmountable.⁴⁰

• Fertility Tourism: We are seeing the rise of domestic "fertility tourism," where wealthy patients from ban states fly to Colorado, California, or New York for IVF to ensure their embryos are created and stored in a jurisdiction that respects their property rights and medical autonomy.⁴²

• Employer Disparities: While some major corporations (e.g., Amazon, Microsoft) have announced benefits to cover travel for reproductive care, these benefits typically apply to salaried, white-collar workers. The hourly retail workers at these same companies often lack the same access, deepening the class divide.⁴¹

Racial Inequities and Structural Violence

The impact of these restrictions is not colorblind. Black and Hispanic women are disproportionately represented in the populations of states with the strictest bans (the South and Midwest). They are also more likely to rely on Medicaid, which is barred by the Hyde Amendment from covering abortion care and rarely covers fertility treatments.24

The higher-than-expected fertility rates among minority groups in ban states (approx. 2% higher for Black and Hispanic women) suggests a lack of reproductive autonomy. These are not necessarily "baby booms" of desired pregnancies; they are likely the statistical footprint of forced births among populations who lacked the resources to travel for care.24 Combined with the higher maternal mortality rates in these communities, the policy landscape functions as a form of structural violence, compelling the most vulnerable women to carry pregnancies in the most dangerous environments.

Part VIII: Future Outlook – The "New Abortion"

As we move into 2026, the legal and cultural battle lines have shifted. IVF is no longer a neutral medical technology; it has become "the new abortion," a target for the same legal theories and political movements that dismantled Roe.⁴³

The Threat of Federal Action

While the current crisis is driven by state laws, the specter of federal intervention looms. Political platforms and policy documents (such as "Project 2025") have explicitly called for the enforcement of the Comstock Act to ban the mailing of abortion-related materials—logic that could easily be applied to the shipping of equipment for IVF or the transport of embryos.⁴⁴ Furthermore, efforts to pass a federal "Life at Conception" Act would nationalize the Alabama standard, effectively ending IVF as it is currently practiced across the entire United States.

Conversely, efforts to codify IVF protections at the federal level face significant hurdles. While public support for IVF is high (overwhelmingly so), the specific mechanisms of IVF—discarding embryos, genetic testing—are fundamentally at odds with the "personhood" doctrine adopted by a significant portion of the judiciary and legislative leadership.⁴⁵

The Evolution of a Defensive Standard of Care

In the absence of clear protections, the standard of care in restrictive states is likely to devolve permanently. We can expect to see:

• Bifurcation of Care: A high-quality, evidence-based system in "blue" states and a restricted, liability-focused system in "red" states.

• Reduced Innovation: Clinical trials and research into new fertility technologies will likely abandon restrictive states, further widening the gap in care quality.

• Patient Waivers: Clinics in restrictive states will likely require patients to sign extensive liability waivers, acknowledging the risk that the state may seize control of their embryos or forbid their discard, shifting the legal risk entirely onto the patient.

Conclusion

The evidence is overwhelming: abortion restrictions do not exist in a vacuum. They function as a wrecking ball that damages the structural integrity of the entire reproductive healthcare system. By defining life as beginning at fertilization and criminalizing the medical tools used to manage reproductive health, states have inadvertently (or perhaps indifferently) dismantled the safety net for women seeking to build families.

The fallout is measurable in the data: higher maternal mortality, rising infant deaths from congenital anomalies, a collapsing workforce pipeline, and the suspension of standard fertility treatments like IVF. For the patient in Alabama whose egg retrieval was cancelled, the cancer patient in Texas denied chemotherapy, and the resident in Idaho learning obstetrics without learning how to manage a miscarriage, the "abortion debate" is not a political abstraction. It is a tangible, daily crisis of access, safety, and basic human rights. As Dr. Molly Kornfield of OHSU summarized, "People with highly planned and desired pregnancies may not be who we typically think of when we discuss the impacts of abortion restrictions, but their health and safety are being considerably impacted".¹ The restriction of one right has cascaded into the restriction of all, leaving American reproductive healthcare in a state of perilous fragmentation.

Detailed Analysis of Key Studies and Cases

The OHSU Study (2025/2026):

Conducted by the Center for Women’s Health at Oregon Health & Science University, this retrospective cohort study analyzed over 400,000 births conceived via fertility treatment between 2012 and 2021. The findings established a clear link between state-level abortion restrictions (TRAP laws) and adverse outcomes such as blood transfusion requirements and severe maternal morbidity. This study is pivotal because it isolates patients who wanted to be pregnant, proving that restrictions harm the very demographic (mothers) they often purport to protect.1

LePage v. Center for Reproductive Medicine (Alabama, 2024):

This ruling by the Alabama Supreme Court applied the 1872 Wrongful Death of a Minor Act to extrauterine embryos. The decision forced a temporary but total cessation of IVF services at major state providers. While a legislative shield law allowed services to resume, the underlying classification of embryos as "children" remains, leaving the door open for future litigation regarding embryo storage and destruction.4

The AAMC Workforce Data (2024/2025):

Data from the Electronic Residency Application Service (ERAS) showed a sustained decline in US MD seniors applying to residencies in abortion-ban states. This trend is specific and statistically significant compared to states with gestational limits or no bans. The "brain drain" suggests that the next generation of physicians is self-selecting out of restrictive environments, prioritizing comprehensive training and legal safety over geography.29

The Texas Sepsis & Mortality Crisis:

Reports from Texas reveal that following the implementation of SB8 and subsequent total bans, the rate of sepsis in obstetrical patients rose dramatically. This is attributed to the "wait and see" approach mandated by law, where physicians cannot intervene in a miscarriage until the fetal heartbeat ceases or the mother is in immediate danger of death. Additionally, maternal mortality for Black women in Texas saw a staggering increase, highlighting the intersectional failure of these policies.26

Report by:

Date: January 11, 2026

Subject: Comprehensive Review of Abortion Restrictions and Fertility Treatment Outcomes

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