For now, abortion remains accessible even in states where it’s banned — at least for those who know where to look. It’s still legal in two-thirds of the country, and numerous websites explain how to order medications from international pharmacies to end early pregnancies at home.
But not all patients have equal access to reliable information. Even before Roe v. Wade’s reversal, the most vulnerable U.S. patients — particularly low-income women, women of color and first-generation immigrants — disproportionately lacked accurate knowledge about abortion access. Today almost half of Americans are uncertain about the legality of medication abortion.
That’s why we should be alarmed by a recent report from KFF, which found that in states that make it a crime for a doctor to provide an abortion, 78% of OB-GYNS don’t make an out-of-state referral and 30% don’t inform their patients about online resources explaining their abortion options. In states that ban providing abortion between six and 22 weeks, 44% of OB-GYNs don’t refer for abortion services, and 10% don’t offer information.
These numbers mark a dramatic departure from all-options pregnancy counseling, which has been the governing standard of care for decades. Clinicians are duty-bound to provide abortion information because it is legal in most states, patients have a constitutional right to travel, and abortion care remains essential for preventing maternal morbidity and mortality. Globally, unsafe abortions cause 39,000 deaths a year, along with millions of hospitalizations. Without access to accurate abortion information, U.S. patients have begun adding to these numbers.
Widespread availability of abortion medications has made illegal abortion less dangerous than in the past, but not all patients possess the health literacy required to navigate their options. Vulnerable populations such as poor people of color are disproportionately likely to struggle to identify accurate health information. Crucially, these patients come from the same segment of the population that is more likely to experience an unwanted pregnancy. They also are more likely to seek abortions: Prior to Dobbs, 75% of abortion patients were people living below or just above the poverty line.
This context creates an ethical imperative for clinicians to provide abortion information. Doctors’ silence violates their central ethical obligations to respect patients’ autonomy, advance justice, and promote beneficence. Patient autonomy is the lynchpin of modern medical ethics and withholding information strips patients of it because it denies or delays their ability to make an informed decision, consistent with their values. It is unjust for doctors to leave those with lower health literacy unable to exercise the options available to more educated patients.
This withholding also escalates medical and legal risks for the most vulnerable patients, who may use later, riskier methods, fall prey to anti-abortion misinformation, experience poorer outcomes, and, when things go wrong, bear the risks of prosecution, which disproportionately targets poor Black and brown women. The KFF survey shows OB-GYNs already understand the racist impact of abortion bans: 70% of OB-GYNs report a worsening of racial and ethnic inequities in maternal health since the Dobbs decision. Bound by the duty of beneficence, the requirement of doing good for patients, doctors must lessen these risks by sharing accurate abortion information.
The astonishing thing about clinicians’ rapid shift away from all-options counseling is that, to date, no state has prosecuted a doctor for sharing abortion information. In fact, no state law includes a blanket ban on the sharing of abortion information. Instead, the chilling effect of these bans has led doctors to pull back from ethical medical practice. They fear sharing even basic information — the fact that abortion is legal elsewhere, or the names of trustworthy websites — could trigger negative legal and professional consequences.
Their concern is understandable because the question of whether sharing abortion information creates real risk is largely untested. But this legal uncertainty works to the advantage of abortion opponents: Uncertainty silences clinicians and traps patients without requiring unpopular prosecutions or controversial laws implicating the First Amendment or the constitutional right to travel.
Witness the rapid about-face of Idaho’s attorney general, Raúl Labrador, who in March 2023 issued an advisory opinion asserting that Idaho law “prohibits an Idaho medical provider from … referring a woman across state lines to access abortion services” on the grounds that referrals amount to assisting abortion, and asserting that Idaho law “requires the suspension of a health care professional’s license” for doing so. He quickly withdrew this guidance after being sued for constitutional violations by the ACLU and local physicians. Still, one might understand if Idaho clinicians feel reluctant to test his position by sharing abortion information.
Practicing in a legal climate that threatens prison sentences for standard medical care takes a horrible toll on clinicians, and the chilling effect that converts bans on providing abortions into silence on anything related to abortion is predictable. Indeed, sometimes it is driven by hospital lawyers, whose guidance may emphasize reducing risk to institutions, rather than patients.
However, refusing to provide abortion information in order to minimize legal risk violates a strong professional norm against permitting outside concerns to undermine sound medical practice. The American Medical Association’s Code of Ethics’ preamble instructs that, “In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal duties.” When doctors prioritize their own interests in avoiding potential legal risks above the health of their patients, they negate their core ethical and professional obligations to their patients. They also saddle vulnerable patients with risks that are more serious and more likely to ensue.
No clinician should face these risks alone. Professional organizations in any clinical practice area in which a health care provider might encounter a pregnant patient should adopt guidelines requiring the sharing of abortion information. They should specify, at a minimum, that clinicians share the names of trusted websites where patients can find accurate information about abortion options, and counsel their patients on data privacy. This guidance would protect doctors and patients, making it plain that regardless of whether providing an abortion is legal in their state, sound medical and ethical practice requires all-options counseling. Further, these organizations should commit to supporting members who suffer repercussions for providing abortion information. A full year after the end of Roe, clinicians practicing under abortion bans are still left largely to chart their own course.
Ultimately, the decision to avoid sharing abortion information implicates the medical profession as a whole. In remaining silent, clinicians adopt a standard of care set not by sound practice, but by fear of state lawmakers. Their silence marks their willing conscription into a battle that weaponizes educational, economic, and health disparities, leading the most vulnerable patients to incorrectly conclude they have no option but to continue unwanted pregnancies.
Michelle Oberman is professor of law at Santa Clara University and author of “Her Body, Our Laws: On the Front Lines of the Abortion War From El Salvador to Oklahoma,” and co-author of “Doctors’ Duty to Provide Abortion Information.” Katie Watson is associate professor of medical education, medical social sciences, and OB-GYN at Northwestern Medical School, and author of “Scarlet A: The Ethics, Law and Politics of Ordinary Abortion.” Lisa Lehmann is associate professor of medicine at Harvard Medical School and associate professor of health policy and management at the Harvard T.H. Chan School of Public Health, and co-author of “Doctors’ Duty to Provide Abortion Information.”