Occupational Therapists Work with Abortion Patients. State Bans Could Handcuff the Way They Practice
BU’s Emily Rothman and Sargent students are researching possible effects of abortion restrictions on their profession
Occupational therapists at a national meeting in April gave Emily Rothman an earful. The Sargent College professor and chair of occupational therapy co-led a task force probing potential impacts on OTs from the Supreme Court’s Dobbs decision, which found that the US Constitution does not confer the right to an abortion.
OTs don’t perform abortions, of course; they treat patients with difficulty performing daily life skills, from incontinence to impaired movement. Yet the tendrils of Dobbs potentially reach into their field. At the meeting, Rothman recalls, “what came through in many of the comments was, I’m concerned because I don’t know what I’m allowed to say or not say to clients, or what kind of resources and phone numbers and documents I can hand out to somebody before I would be in trouble” in states that have banned or restricted abortions.
Funded by Sargent College, Rothman and two OT doctoral students, Darya Nemati (Sargent’24) and Delaney McKee (Sargent’24), hope to help OTs navigate this treacherous legal terrain. They’re researching the effects on the occupational therapy practice of abortion restrictions in 18 states—among them Texas, Florida, Michigan, Missouri, Oklahoma, South Dakota, and Kentucky—by interviewing therapists on the ground. Their findings are tentatively due next summer.
Rothman—also a School of Public Health professor of community health sciences—offers a hypothetical conversation of the type that is unnerving OTs, who, like other healthcare providers, seek a broad range of information about their patients’ lives and health to better serve them. She points to a client who might tell her therapist, “‘I just found out that I’m pregnant, and you work in healthcare, so can you tell me where I can get an abortion?’ Of course, occupational therapists would want to help their client. Normally, I think many of them would want to [say], ‘There’s no provider around here, but I can look into it for you.’”
But “legally, now, it’s unclear,” she says. “In some states, you absolutely couldn’t say, ‘I have a suggestion: why don’t you drive over the border’” to an abortion-permitting state?
That abortion laws could touch unlikely professionals like OTs shows the extent of the new legal landscape confronting many healthcare workers post-Dobbs. One poignant case arose in Florida, where a strict abortion curb (the procedure there is outlawed after six weeks of pregnancy) has exceptions for fetuses with fatal abnormalities. Yet in a recent case, doctors believed they didn’t have the legal option to abort and delivered a baby without kidneys or developed lungs. He died little more than an hour and a half after birth, traumatizing his family.
“All these different players in the healthcare system,” Rothman says, “are going to need information in their hands, very soon, about what they’re supposed to do, what they’re supposed to say.”
Despite the tremors at the OT national meeting, Rothman and her students aren’t leaping to any conclusions until they’ve completed their research interviews with therapists.
“Our empirical question,” Rothman says, “is really: are occupational therapists seeing and hearing things from their clients—as a result of these changes in abortion access and laws—that indicate to us that occupational therapists need some additional training and resources related to how to address clients’ needs and avoid any legal problems at the same time?”
The answer to that question, based on interviews with a dozen therapists, seems to be a provisional yes.
“We are noticing a trend that confirms that OTs are encountering difficulties with abortion restrictions in those 18 states,” Nemati says. Those interviewed variously reported spiking requests from clients about abortion resources in the wake of Dobbs, in case they decided to seek the procedure. And one client in an “involuntary psychiatric hold,” she says, told her OT that she was pregnant and needed an immediate abortion.
One representative comment from a therapist: “I personally was concerned about even giving people resources as to where to get an abortion in Idaho. I was worried that I would have ramifications.”
Rothman and her students suspect certain forms of occupational therapy may intersect with abortion. For example, “pelvic floor therapy,” which helps women build pelvic strength (to handle issues like incontinence, for example), often pre- or post-birth, was once the province of physical therapists, but is now done by OTs as well, says McKee. “That’s kind of the area where we are predicting that [OTs] will come across abortion,” she says. Dobbs likely “will change the way in which we practice, change the conversations that we may have.”
Nemati spied “a little bit of confusion [among therapists] on what is possible in our scope of practice. Occupational therapists oftentimes engage in conversations with clients that may…lead to a client asking about abortion or disclosing that they’re looking for resources. And giving those resources is also part of our scope of practice, but in those states where there are restrictions, is that allowed, and how can we find out that information?”
Michael Urban, an American Occupational Therapy Association (AOTA) board member and its representative assembly speaker, says his 57,000-strong group eagerly awaits the BU researchers’ findings.
“For those practitioners [in] states where abortion is now illegal or banned—or they’re on state lines, where they’re within driving distance to a state where it’s banned—those practitioners face some potential ethical dilemmas,” Urban says. “Someone comes into the clinic and says, ‘I just had an abortion,’ or they did an abortion illegally—[therapists] have to treat the aftereffects of that, regardless. And there’s patient confidentiality, but then balancing that with your ethical state requirements of licensure.
“How do we address these issues? What resources do our members need?…We’re really hoping to see what [Rothman and her students] gather more richly around what is going on.”