Moral Distress Among Abortion-Providing Clinicians After the US Supreme Court Dobbs Decision

Importance: Moral distress among abortion-providing clinicians could lead to burnout and attrition from the workforce, worsening reproductive care disparities. Objective: To describe situations associated with moral distress among abortion-providing clinicians since the US Supreme Court's Dobbs v Jackson Women's Health Organization decision across a range of policy environments. Design, Setting, and Participants: For this qualitative study, purposive sampling was conducted from May to December 2023 through listservs and snowball sampling across the US. Participants were clinicians providing abortion care in the US in the year following Dobbs. Data were analyzed from March 2024 to April 2025. Main Outcomes and Measures: The primary outcome was determining which situations were associated with moral distress in both protective and restrictive abortion policy environments. Deductive and inductive coding approaches were used to analyze open-ended responses. Results: Of 310 respondents completing the full survey (271 women [87.7%]; 132 aged 36-45 years [43.6%]), 160 (51.6%) responded to the optional open-ended question. The 160 respondents described situations associated with moral distress in state policy environments that were both protective and restrictive of abortion. Through thematic analysis, 3 main themes of situations associated with moral distress were identified: (1) bans prohibiting conscientious provision of abortion care; (2) forced adjustments to medical practice, including being forced to provide inaccurate information, substandard care, or to limit care due to resource scarcity; and (3) distress related to the broader national environment. Conclusions and Relevance: In this qualitative study, clinicians in both abortion-protective and abortion-restrictive environments reported situations associated with moral distress. Solutions for combating moral distress should be targeted to specific situations and sources, including at institutional, state, or national levels.