Society for Maternal-Fetal Medicine Special Statement: Considerations for management of high-risk pregnancies when abortion care is restricted

Individuals at high risk for pregnancy-associated morbidity and mortality have unique needs for reproductive health services, including abortion care. Legal restrictions on abortion care in many states make it challenging or impossible for clinicians to practice standard-of-care, evidence-based medicine and for institutions to implement evidence-based clinical guidelines for reproductive healthcare. This Special Statement suggests actions clinicians and institutions can take to build consensus and create systems to ensure patients can receive optimal care. In addition, it addresses counseling about maternal and fetal health that (1) recognizes that risk and patient preferences may change or evolve during pregnancy; (2) incorporates informed patient preferences in a shared decision-making process between the patient and provider; and (3) includes abortion among the options for pregnancy management. We also discuss how abortion restrictions affect training, which will result in shortages of skilled providers who can offer the level of care needed for high-risk pregnancies. Abortion care is a core component of practice for maternal-fetal medicine subspecialists, both to reduce the burden of maternal morbidity and mortality and to operationalize reproductive justice for pregnancy-capable people.

Endorsed by the Society of Family Planning July, 2026

This document replaces Clinical considerations for management of severe complications when abortion care is restricted, 2022.