Pregnant patients experiencing miscarriage who live in states with abortion bans have fewer options for healthcare management, according to a new study published by the Journal of the American Medical Association.

The study, published May 18, found a shift away from managing miscarriages with a two-drug approach that includes mifepristone — which has been the subject of numerous legal battles that are still playing out in federal courts — and toward approaches that include only misoprostol, which has a lower rate of effectiveness.

The states with abortion bans had a nearly 3% increase in expectant management, the study showed, which means a health provider monitors the condition without prescribing any form of treatment to see whether the condition resolves without intervention. The study was conducted by researchers in the Department of Obstetrics and Gynecology at Oregon Health and Science University.

Among those patients who received medication, there was a nearly 14% increase in the use of misoprostol-only regimens, which goes against the American College of Obstetricians and Gynecologists’ recommendation of using a combination of mifepristone and misoprostol as the most preferred method of managing miscarriages. Used together, the medications are the most effective at completing expulsion of pregnancy tissue and reducing side effects such as bleeding and cramping.

The expectant management approach, the study said, could increase the risk of hemorrhage and retained pregnancy tissue, which can cause infection if it is not removed.

The method of treatment for a miscarriage is the same two-drug regimen that is used to terminate a pregnancy before 12 weeks. A group of anti-abortion doctors unsuccessfully tried to revoke the U.S. Food and Drug Administration’s approval of mifepristone altogether in 2023, and government officials in Louisiana are trying to strike down a 2023 rule enacted by the FDA that allows the drug to be prescribed by telehealth and mailed to a patient. That case is ongoing.

Using healthcare claims data, the study included nearly 123,600 commercially insured patients who had a miscarriage before 77 days’ gestation between the beginning of 2018 and the end of September 2024. That time frame includes 53 months of data from the years before the U.S. Supreme Court’s Dobbs decision in June 2022 to allow states to regulate abortion access, and 27 months after at least a dozen states implemented abortion bans.

The states with bans that affect pregnancies at six weeks of gestation or earlier are Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia. They were compared with 18 other states that do not have bans before fetal viability, which is generally considered to be about 24 weeks.

Some of those states with bans have gone further in adding criminal penalties to the use of mifepristone for abortion, which doctors have said affects abortion patients as well. Louisiana classified mifepristone and misoprostol as controlled substances in 2024, which meant providers had to start treating the storage and access to the medication much differently. Patients have tried to fill a prescription for misoprostol at major pharmacies in Louisiana, only to be told it’s unavailable, Louisiana Illuminator reported.

“It’s definitely getting more and more challenging to provide for patients and provide for them adequately,” Dr. Nicole Freehill, an OB-GYN in New Orleans, told Stateline in March. “That criminalization, more than anything, has created so many problems, because so many providers are just afraid to act.”

Mississippi enacted a law in April adding mifepristone and misoprostol to the state’s drug trafficking law, making it a crime punishable by up to 10 years in prison to distribute or intend to distribute the drugs. Lawmakers said the law would help limit the number of people sending the medications through the mail.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.