Why High-Risk Pregnancy Doctors Call Abortion Core Care
The Society for Maternal-Fetal Medicine says doctors who manage high-risk pregnancies should treat abortion care as a "core component" of their work where laws restrict it. The guidance was described on Sept. 16, 2026, in a landscape where 41 states ban abortion at some point in pregnancy. The Guardian
The special statement says legal restrictions make it difficult or impossible for clinicians to practice standard-of-care, evidence-based medicine. That phrase means treatment grounded in research and accepted medical guidelines. Justin Lappen, chair of SMFM's reproductive health committee, is a co-author of the statement. The Guardian
Deaths from ectopic pregnancies in the U.S. nearly doubled between 2020 and 2025, according to a ProPublica analysis cited in that reporting. An ectopic pregnancy develops outside the uterus. It is nonviable and potentially fatal, and it is managed within obstetric emergency care. The figure was presented alongside the guidance as an indicator of risk when timely pregnancy management is delayed or constrained. The Guardian
What the guidance says
The document is titled 'Considerations for management of high-risk pregnancies when abortion care is restricted.' It replaces the 2022 document titled 'Clinical considerations for management of severe complications when abortion care is restricted.' The Society of Family Planning endorsed the new Special Statement in July 2026. SMFM Publications
The statement centers on patients at elevated risk. It says individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care. It recommends that counseling about maternal and fetal health include abortion among the options for pregnancy management.
Counseling should incorporate informed patient preferences in a shared decision-making process between patient and provider. Risk and patient preferences may change or evolve during pregnancy. The emphasis is longitudinal. Like updating a forecast as new data arrive, risk stratification in maternal-fetal medicine is not fixed at intake.
How hospitals and training are affected
The statement also addresses systems. It suggests actions clinicians and institutions can take to build consensus and create systems to ensure patients receive optimal care. Protocols, referral pathways and institutional alignment are described as clinical infrastructure, not administrative detail.
Training is a separate concern. The statement says abortion restrictions affect training and will result in shortages of skilled providers for high-risk pregnancies. Procedural competence in dilation and evacuation, induction management, and treatment of previable preterm rupture of membranes and severe preeclampsia depends on supervised volume. Fewer training exposures means fewer subspecialists prepared for complex cases.
The statement says abortion care by maternal-fetal medicine subspecialists helps reduce maternal morbidity and mortality and operationalize reproductive justice for pregnancy-capable people. The Society's official publications site lists the guidance under its Special Statements. The organization has previously issued a statement on a Supreme Court decision upholding access to medication abortion, emphasizing support for evidence-based reproductive healthcare. The Society of Family Planning has also issued a joint public statement led by the Society for Maternal-Fetal Medicine following U.S. Supreme Court decisions regarding EMTALA. SMFM Publications
The broader context here is operational. For health-system leaders, the question is not only what the law permits. It is whether on-call coverage, anesthesia, pharmacy, ethics consultation and transfer agreements allow a maternal-fetal medicine team to act within the standard of care when maternal risk escalates. SMFM is directing that planning to occur before the emergency. Consensus built in committee is easier to defend than ad hoc decisions at the bedside.
Looking at what this means for the subspecialty, SMFM is asserting scope. Maternal-fetal medicine has long managed selective reduction, termination for lethal anomalies, and intervention for maternal indications. The statement places those interventions inside core subspecialty identity rather than outside referral. That has implications for fellowship curricula, privileging, and retention in restrictive states. Clinicians who cannot maintain competencies may relocate. Institutions that cannot support them may lose coverage for all high-risk care, not only abortion.
