Table 1. Sources of evidence characteristics.

Reference (including location)	Study design	Data collection	Study aim	Findings	Recommendations	Limitations
Tucker et al. (2017), U.S. [17]	Case Study	Data were collected from patient charts with patient consent (n = 1).	To describe the case of a delayed diagnosis of a second-trimester, ectopic, abdominal pregnancy and the patient outcome	The patient’s decision to terminate the pregnancy, while overcoming perceived provider disapproval and legislative barriers, likely prevented a catastrophic intra-abdominal rupture of her misdiagnosed pregnancy.	Legislation limiting access to abortions may hurt women’s health and increase mortality.	Small sample size due to the nature of the study type.
Blomberg (1980), Sweden [18]	Retrospective Cohort Study	n = 1,263 women who were denied abortions (proband group), n = 1263 women who did not seek abortions (control group).	To investigate whether emotional stress in pregnant women might have an adverse effect in the form of malformation on fetal development.	Emotional stress in pregnant women (defined as unwanted pregnancies in this study) may interfere with fetal development and result in a higher incidence of malformation. The direct or indirect nature of this correlation is not known.	Explore ways to limit the impact of confounding variables such as the incidence of malformations increasing with lower social class, to ensure that malformations were not from food insecurity, poor prenatal care, or lifestyle aspects.	Results may not apply to the general world population since it occurred in Sweden, and cultural impacts may have influenced the results. Data used for the study was from 1960, so results may not be able to be applied to current times due to attitudes towards abortion changing in the past few decades.
Bullard et al.(2019), U.S. [19]	Theoretical Cohort Study	n = 921 women diagnosed with fetal congenital diaphragmatic hernia.	To estimate the effect of 20-week abortion bans on maternal and consequent neonatal health outcomes and costs in the setting of fetal congenital diaphragmatic hernias.	Congenital diaphragmatic hernias affect 1 in 2,200 births with mortality up to 75% (29% of these are associated with chromosomal abnormalities). Surviving children endure associated “pulmonary, neurologic, gastrointestinal, and nutritional complications.” Congenital diaphragmatic hernias are often not definitively diagnosed until 22 weeks gestation. For the cohort, the calculated cost of the abortion ban was estimated at $159,419,623 and significantly decreased happiness/quality of life for the pregnant women. The 20-week bans were associated with worse health outcomes from the maternal perspective and increased costs across all ranges.	The 20-week abortion bans are not cost-effective in the case of congenital diaphragmatic hernias. Similar economic effects on other severe anomalies would need to be explored separately.	The reliability of this model depends on assumptions made and estimates found in the literature. The model itself may oversimplify the outcomes of these pregnancies and the effects of the policies in place.
Henkel et al. (2011), U.S. [20]	Retrospective Cohort Study	n = 1,983 patients undergoing an anatomy ultrasound in 2017 at a tertiary referral center.	To quantify the likelihood of assessing all mandated fetal views during the second-trimester anatomy ultrasound prior to the proposed federal 20-week abortion ban.	For patients receiving their “anatomy ultrasound” prior to 20 weeks gestation, the risk of incomplete initial views increased and was indirectly correlated to gestational age. There were 6.4% with fetal anomalies with 38% of those diagnosed on another follow-up ultrasound. About one in five with anomalies chose to terminate the pregnancy (with cardiac and central nervous system being the most common anomalies found). Overall, moving the “anatomy ultrasound” earlier in the pregnancy would likely miss a significant number of anomalies especially impacting obese people who are less likely to have complete views before 20 weeks.	Legislation limiting abortion to 20 weeks would impact a patient's ability to make informed decisions about their pregnancy. The need for repeat ultrasounds prior to the 20-week group may account for the delay from the initial ultrasound to the termination.	The generalizability of this study may be limited beyond the geographic area in which it was conducted. A specific institution has access to services and resources that may streamline time from diagnosis to termination, suggesting the median amount of time from diagnosis to termination may be an underestimate, particularly outside of a tertiary referral network where this study was completed.
Miller et al.(2000), U.S. [21]	Multi-Case Study; Fiscal Comparison Study	n = 514 cases of second-trimester terminations from 1990-1997, 60% of cases with a prenatal abnormality diagnosis resulted in termination.	To determine what the fiscal impact of a legislative ban on elective abortions for prenatally diagnosed abnormalities would be at a specified hospital system, Hutzel Hospital in Detroit.	The estimated cost at the Detroit Medical Center (DMC), a group of facilities including Hutzel Hospital, would be $8.5 million a year. If there were a legislative ban on elective abortions for prenatally diagnosed fetal abnormalities, the additional total cost to DMC would be $74 million. This cost would be translated to about $15.30 per year per employee working in Michigan. The article also calculated a roughly $2 billion cost increase across the U.S. if elective terminations for prenatally diagnosed abnormalities were banned. This cost would have to be budgeted appropriately.	Explore what new treatment costs would be and how advances in treatment may lessen the financial strain on the hospital system for children born with prenatally diagnosed abnormalities.	Assumes the financial costs would increase if more fetuses with abnormalities were carried to term, delivered, and required medical care after delivery. This is assuming a legislative ban on second-trimester terminations for prenatally diagnosed abnormalities was enacted. Some prenatal abnormalities may be less severe at birth and therefore incur less cost over a lifetime and cohort year.
Jayaraman et al. (2021), U.S. [22]	Survey	A 22-question survey was created and sent to genetic counselors and put into 3 groups depending on the severity of abortion laws in their state. Data from n = 113 respondents were analyzed.	To analyze the impact of abortion legislation on genetic counselors and patients.	Genetic counselors reported that legislative gestational age restrictions impact their counseling and coordinating of abortion services. They also reported that regulations limit the decision-making time frame for patients with fetal abnormalities. Genetic counselors also perceive financial and emotional burdens on their patients seeking abortion services.	Larger sample.	Small sample size.
Shepard et al. (2014), Chile, [23]	Semi-structured Interview	Semi-structured interviews were conducted with n=41 women who had abortions, n=12 partners/friends, and n=8 healthcare providers in Chile. Information on hospitalizations and maternal death related to abortions was gathered from the Ministry of Health statistics.	To explore the impact of abortion bans in Chile and its effect on health care providers and pregnant women.	Chile is one of few countries that ban abortion under all circumstances. In 2008, more than 30,000 women were hospitalized due to complications of abortions in Chile. A review of 10 years of hospital data indicated that 40% of abortions are associated with fetal abnormalities. Interviewees indicated the use of safe and unsafe methods of obtaining an abortion. Misoprostol was used in some cases with access directly related to socioeconomic status. Prosecution of these women was also correlated with socioeconomic status. Three women were propositioned for sex as payment for abortive services, one woman experienced blackmail. The abortion ban prevented healthcare providers from intervening in anomalous pregnancies including anencephalic fetuses leading to declined health in pregnant women.	Abortion should be legally available at the woman’s request, at least in the first trimester, and throughout pregnancy to protect the life and health of the woman, in case of serious fetal anomalies.	Small sample size of interviews. More women who had abortions, partners/friends, and healthcare providers should be interviewed. Many of the examples detailed in this article are the accounts of a single person on the impact of the abortion ban. Additionally, the illegality of the matter brings about issues regarding accurate testimony.
Sahid et al. (2000), Chile [24]	Retrospective Cohort Study	n = 8, cases followed post-diagnosis of prenatal iniencephaly.	To explore the obstetric management of iniencephaly in a country where elective abortion is not allowed.	Iniencephaly is the rarest form of neural tube defect, with most cases being sporadic. Other defects are associated with this condition including central nervous system (CNS) and extra-CNS-associated malformations. In nations where elective abortions are legal, termination of pregnancy with this condition is common practice due to the prognosis of the condition. In nations where elective abortion is illegal, the goal is to avoid maternal trauma and obstructed labor. Inducing labor while the cephalopelvic ratio is still adequate lowers the likelihood of maternal dystocia during labor and lowers the risk of an unnecessary cesarean section.	The sample size of women who have prenatal iniencephaly cases should be expanded to further explore the effective induction of labor in lowering the risks associated with the condition.	The small sample size is due to the infrequency of the condition.
Lipitz et al. (1996), Israel [25]	Retrospective Cohort Study	n = 36 twin pregnancies in this study. Of these, n = 23 cases with structural anomaly, and n = 13 cases with chromosomal anomaly.	To evaluate the outcome of late selective fetal termination in twin pregnancies based on combined data from eight tertiary perinatal centers.	Rates of fetal abnormality are significantly higher in both monozygotic and dizygotic pregnancies. Usually, the anomaly is discordant (in one fetus only) and selective termination of this twin is appropriate. Late (> 24 weeks) selective termination in twin pregnancies is associated with a favorable perinatal outcome in the healthy twin. Parents should be informed of this possibility in countries where the law permits late pregnancy termination.	The sample size needs to be expanded to include full-term pregnancies, as all women in the study had premature deliveries.	Participants' requests to delay the selective termination procedure interfered with the results.
Nomura et al. (2011), Brazil [26]	Retrospective Cohort Study	Data from n=30 cases were reviewed from pregnancies with conjoined twins determined to have no chance of extrauterine survival or separation observed at a hospital in Brazil from 1998 to 2010.	To describe pregnancies with conjoined twins in accordance with their request for legal termination of pregnancy.	In the case of conjoined twins with no possibility of extrauterine survival, if legal authorization for abortion was obtained then 83.3% of pregnancies were delivered vaginally compared to 16.7% by c-section. Without early intervention, delivery of conjoined twins in the third trimester was C-section 100% of the time.	Pregnancy termination in the case of conjoined twins with no chance of extrauterine survival aims to minimize the maternal risk when performed before the third trimester.	Small sample size and records from a single hospital. Data collected from 1998-2010 may not resemble modern-day data.
Zareba et al. (2019), Poland [27]	Cross-Sectional Study	n=150, between 2014 and 2016, eligible women with medical reasons for terminating pregnancy took a survey as to why they decided to end pregnancy.	To profile patients terminating pregnancies and assess plans for pregnancy.	The general profile of women were those under the age of 35 who planned pregnancy - most terminated based on genetic abnormalities. Some women changed their opinion on abortion when faced with medical implications for termination, and some women were opposed to having future pregnancies, but most women still wanted children in the future.	Larger sample size, taking surveys across more clinics within Poland and other countries (i.e., U.S.) as well.	The study took place in one clinic in Warsaw, which may not be the most generalizable population to conduct a study from.
Hamdi et al. (2016), Tunisia [28]	Cross-Sectional Study	n=100, between 2013 and 2015, a descriptive study looking at patients with ultrasound discoveries of fetal malformation cases.	To evaluate Tunish Hospital diagnoses of fetal malformations and compare to past literature in hopes to get a better future prognosis.	Diagnosis of fetal abnormalities at the hospital: 17% first trimester, 54% second trimester, 29% third trimester (literature states that usually abnormalities are detected earlier). A better future prognosis would require good staff, ultrasounds, and attention to time.	Larger sample size, a more standardized population with representation from multiple hospitals/countries where women got testing done at the same place each trimester.	A mixed population of women and women who were just there for routine ultrasounds were used, only very highly trained workers with good equipment in this study (not the most generalizable), and some women had testing done in their later trimesters at a separate center.
Gadow et al., (2006) Argentina/Uruguay [29]	Survey	n = 223 patients receiving genetic counseling (both medically referred and self-referred), n = 132 patients self-referred.	To analyze the decision-making process of couples who decided to undergo prenatal genetic analysis in an area where abortion is illegal.	Of the 132 patients who referred themselves to genetic counseling, 77.6% reported that their reason for undergoing genetic analysis was to reduce their fears of having a fetus with a genetic abnormality. Of both self-referred and medically referred couples, 68.2% reported they would contemplate illegal termination of pregnancy (TOP) if diagnosed with a severe genetic abnormality. Most couples wanted to undergo genetic testing despite not having access to legal TOP. The main reported reason was to reduce fears of their fetus having an abnormality and to receive accurate information about the fetus’ condition. A majority of participants reported that they would consider illegal TOP, despite the risks, if a severe abnormality was discovered.	A larger sample size of patients who underwent genetic counseling.	Only a portion of the original population size responded to the survey due to the sensitive nature of the questions asked.