Navigating complexity: How shifting abortion regulations impacted prenatal genetic counselors practicing in restrictive states from 2020 to 2024

The 2022 Supreme Court of the United States' decision in Dobbs v. Jackson Women's Health Organization eliminated federal abortion protections, returning abortion regulation to the states. However, in many states, abortion was already heavily restricted prior to this decision. This study aimed to assess the impact of dynamic restrictive legislation passed from 2020 to 2024 on the prenatal genetic counseling process and to describe similarities and differences between state policy environments by focusing on a group of neighboring states with different legislation. Twenty-two genetic counselors practicing in Ohio, Kentucky, and Indiana participated in focus groups (n = 6) and one individual interview. The research team conducted reflexive thematic analysis of qualitative data. We found that participants' perspectives on the effects of legislation varied depending on state abortion policy, patient population served, and institutional resources and directives under which they worked. Most participants expressed changes to the way they document patient visits, approach counseling appointments with patients, and provide patients with resources in lieu of referrals to abortion care. Additionally, many participants expressed feeling more motivation and less burnout in the wake of restrictive legislation-a change from previous study findings. This study provides insights into the ways in which federal case law and state regulations on abortion have impacted genetic counselors' approaches to healthcare practices, documentation, and referrals to abortion care in three states that have experienced dynamic abortion regulatory environments since 2020. Findings may be useful for guiding additional support from professional societies, healthcare institutions, and training programs.