The 2022 Supreme Court decision reversing the constitutional right to abortion has had profound and varied effects on maternal-fetal medicine, which focuses on the care of complex pregnancies and fetal disorders and relies on the expertise of prenatal genetic counselors. Rapid technological advances have expanded the clinical utility of prenatal genetic testing and opportunities for fetal therapy; however, abortion restrictions limit the optimal and equitable provision of this care. This study is documenting the impacts of evolving abortion regulations on prenatal genetic counseling (GC) practice and training. Findings from qualitative interviews with GC Masters program directors, instructors and clinical supervisors (n=27) include: GCs experience moral distress when communicating results of genetic anomalies alongside the news that their patient cannot obtain an abortion in state, a situation compounded by patient assumptions that a legal exception would apply to their case. Counterintuitively, GC Masters programs in states protecting abortion provide less didactic training on abortion compared to restrictive states, while not surprisingly students in restrictive states have less opportunity to participate in termination discussions in clinical rotations. Evidence of less transparent medical documentation practices (e.g. vague or coded language; verbal communication replacing written notes) raise concerns about the potential impact on care continuity, but may also offer protections to patients and providers. These findings suggest profound and varied impacts on the practice and education of prenatal genetic counselors, and the need for training programs to share curricula and training opportunities across states with differing abortion restrictions.
Authors: Galen Joseph, University of California, San Francisco; Julie Harris-Wai, University of California, San Francisco; Julia Silver, University of California, San Francisco; Leslie Riddle, University of California, San Francisco; Mary Norton, University of California, San Francisco
