Are Abortion Bans an Occupational Hazard for Ob/Gyns?

In post-Roe America, abortion restrictions had both adverse clinical and personal impacts on ob/gyns, according to a qualitative study of semistructured, remote interviews.

In the clinical realm, many felt they had to delay care until patients got sicker or until they obtained legal sign off on a medical exemption, were restricted on counseling patients about the full range of pregnancy options, and were unable to refer patients to adequate care or provide it themselves, reported Kavita Arora, MD, of the University of North Carolina at Chapel Hill, and colleagues.

Regarding personal impacts, ob/gyns faced moral distress, increased anxiety and depression, fear of perceived consequences to violating state laws, and many thought about leaving the state they practiced in. Most ob/gyns in restrictive states (93%) had been in a situation where the laws prevented them from following clinical standards and a majority (87%) were worried about the risks of practicing in an uncertain legal environment, the researchers wrote in JAMA Network Open.

“We find that bans have, in many cases, placed heavy burdens on ob/gyns by asking them to choose between standard patient care and their own legal exposure. Such cases leave lasting scars on ob/gyns,” Arora and team wrote.

After the Supreme Court overturned Roe v. Wade in 2022, abortion access became a patchwork when trigger laws criminalizing abortion took effect in nearly a quarter of states. As a direct result of the Dobbs v. Jackson decision, 70% of study participants expressed increased anxiety and depression. Physicians already struggle with burnout and mental health.

Authors wrote that additionally, “the state of hypervigilance we observed in several participants — constantly worrying about potential consequences of providing care or counseling — increases the risk for longer-term physical and mental health problems.”

Some participants felt that their intuitions further harmed ob/gyns “through overly conservative interpretation of laws, prioritizing institutional protection over ethical obligations to patients.” The extra hurdles and stress caused 11% of respondents to move to states with stronger abortion protections and 60% to consider leaving their state. Job openings in restrictive states were harder to fill, too.

“The findings of this qualitative study suggest that state abortion bans have created an occupational health crisis for ob/gyns intertwined with a maternal health crisis for their patients,” the authors concluded.

David Hackney, MD, a maternal-fetal medicine doctor at Case Western Reserve University in Cleveland, who was not involved in the study, told MedPage Today that since Dobbs, nothing has gotten better for ob/gyns in restrictive states who have been facing unknown risks without meaningful guidance.

“Among the many noteworthy aspects [of this study] are the percentages of physicians who state that they are either considering leaving or would like to leave but logistically cannot,” Hackney said. One respondent said a shared-custody situation with their children prevented relocation.

“Ob/gyn physician shortages in states with abortion bans are likely to play out gradually, worsening over the next several years rather than being something you see immediately in a ban’s aftermath, because it can be difficult for many reasons to just up and leave,” Hackney said. “However, there will likely be a slow though relentless decline from physicians leaving combined with, perhaps even more importantly, an inability to recruit new physicians to replace even natural turnover, as described in the paper by the interviewed department chair.”

Hackney said he hopes this research “will serve as an alarm for legislators and healthcare administrators in restrictive states that they are facing a crisis among their ob/gyn workforce.”

The study recruited 54 ob/gyns (mean age 42) from March to August 2023 practicing in states that banned abortion with limited exceptions. This included 14 states: Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin.

Participants were recruited via ob/gyn listservs, social media, emails, networking, and snowball sampling. To achieve balance across states, practice characteristics, and sociodemographic characteristics, prospective participants were purposively sampled. Most participants were female (81%) and white (83%), while 6% were non-Hispanic Black or African American. In terms of subspecialty, 72% practiced general ob/gyn, 15% complex family planning, and 13% maternal-fetal medicine. Trainees were excluded.

Authors note the study was limited by inherent selection bias because participants may have stronger views on abortion than the general pool, though studies show ob/gyns are strongly supportive of abortion. Authors said there needs to be more studies on how Dobbs has impacted other types of clinicians’ work, too.

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