The Society for Maternal-Fetal Medicine (SMFM) has issued a special statement urging maternal-fetal specialists to incorporate abortion care as a fundamental aspect of their practice, particularly in states with restrictive abortion laws. The guidance comes amid growing concerns that legal limitations on abortion across the United States are undermining the delivery of evidence-based, standard-of-care medicine for pregnant patients.
Currently, 41 states impose abortion bans at various stages of pregnancy, complicating clinicians’ ability to provide comprehensive care. The challenges intensified following the 2022 Supreme Court Dobbs decision, which led several states to enact stricter abortion restrictions. A recent analysis by ProPublica indicated that deaths related to ectopic pregnancies approximately doubled between 2020 and 2025. Providers in states that preserve abortion access report patients seeking care at more advanced and precarious stages of pregnancy.
Justin Lappen, chair of SMFM’s reproductive health committee and co-author of the statement, emphasized that maternal-fetal medicine is closely intertwined with family planning and abortion care. He underscored the importance of preparing health systems to deliver safe, effective care within the constraints of state laws. “It’s really important for health systems, for hospitals, to be able to create safe systems of care and to understand what the state reproductive health legal landscape looks like,” Lappen said. The society encourages medical providers and institutions to expand access to abortion care up to the legal limits and to fully utilize exceptions outlined in state bans.
The statement highlights the complexity providers face when the law offers exceptions that are often difficult to interpret. Lappen noted that while abortion laws are typically framed as clear-cut, medical realities involving pregnancy complications are far more nuanced, requiring individualized clinical judgment.
The statement is illustrated by patient experiences such as those of Kate Dineen, who in 2021, at approximately 33 weeks pregnant, was informed that her unborn child had suffered a catastrophic stroke in utero, with little chance of survival. Residing in Massachusetts, where abortions were prohibited past 24 weeks except under limited circumstances, she was initially denied local access to termination. Dineen and her husband traveled hundreds of miles to Maryland to receive care at a later abortion clinic. Reflecting on her experience, she said obtaining care locally would have provided a more compassionate and less disruptive process.
Dineen, now an advocate and board member of Reproductive Equity Now, stressed that providers should "exploit exceptions to the fullest extent in ban states" but cautioned against viewing abortion bans with exceptions as an effective means to ensure access. She described such bans as often functioning effectively as full prohibitions because patients frequently cannot obtain care in a timely and accessible manner.
Following testimonies from Dineen and others on the impact of Massachusetts’ restrictions, the state expanded its exceptions in 2022 to include “grave fetal diagnoses.” While this was a positive development, some patients remained unable to access care. Massachusetts has since moved to remove the 24-week abortion ban entirely, a change that Dineen and SMFM specialists say will better support providers in delivering comprehensive reproductive healthcare.
Maternal-fetal specialists in Massachusetts have played a vital role in shaping this legislative progress, contributing expertise that has guided the policy shift. Dineen described this collaboration as a “game-changer” in ensuring that reproductive decisions remain between patients and their healthcare providers throughout pregnancy.
The SMFM statement calls for proactive institutional advocacy and preparation, emphasizing that critical decisions related to severe pregnancy complications often require urgent action, and delays caused by legal uncertainties can jeopardize patient health. By fostering expanded abortion care within the bounds of state laws, maternal-fetal medicine professionals aim to uphold patient-centered, evidence-based care in a challenging legal environment.