Ob/Gyn Access Suffered in Abortion-Restrictive States After Dobbs Decision

States with abortion restrictions enacted after the Dobbs v. Jackson Women’s Health Organization decision lost ob/gyn and women’s health specialist coverage compared with states where abortion access did not change, an empirical analysis of workforce data found.

From 2018 to 2024, practitioner supply increased overall, but states with abortion restrictions post-Dobbs saw comparative declines in ob/gyns per population, reported Jane M. Zhu, MD, of Oregon Health & Science University in Portland, and colleagues.

The 12 most restrictive states saw a 4.2% decrease in ob/gyn practitioners per 100,000 reproductive-aged females compared with states that maintained stable abortion access, a difference of 3.0 practitioners per 100,000 women (95% CI −5.9 to −0.2, P=0.04), they wrote in a JAMA Internal Medicine research letter.

“There have been some surveys and anecdotal reports of ob/gyns leaving states which have imposed strict abortion laws due to concerns about restricted clinical autonomy and decision-making, but there has not been any empirical evidence on the extent to which this is happening,” Zhu told MedPage Today, noting that this evidence now confirms the results of those past surveys.

In the past 3 years since the Dobbs decision overturned Roe v. Wade and upended federal abortion protections, ob/gyns have sounded the alarm on its wide impacts, from worsened obstetric care and changing how ob/gyns deliver care to influencing where ob/gyns want to match for residency.

Zhu said this trend is worrisome because maternal morbidity and mortality is higher in the U.S. than other high-income nations, and this burden is not felt equally across the country.

“Many of the states where reproductive rights are most restricted already experience poorer pregnancy outcomes and disparities in care,” she said, and thus more people moving away from this area can contribute to maternity care deserts that could in turn worsen inequality and “cause harm to communities that already have low access to ob/gyns.”

The paper concluded that “clinician migration has implications for reproductive care access, quality, and equity as abortion rights are increasingly decided at the state level.”

Cynthia Gyamfi-Bannerman, MD, of the University of California San Diego, who was not involved in the study, said that it’s “both unfortunate and predictable that ob/gyns might choose to practice in states where they are allowed to care for women in the way that makes the most medical sense for the woman’s health.”

She also noted that maternity care deserts — where there are no ob/gyn, family medicine, or midwifery providers — have worse obstetric outcomes, and the abortion restricted states have many of these care deserts.

“If more ob/gyn providers leave these areas, there will be a direct negative effect on women’s health,” Gyamfi-Bannerman said.

Researchers used state-level abortion policy data from the Guttmacher Institute’s legislation tracker and focused on the 12 states with the most intense abortion restrictions following Dobbs: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia.

Fourteen states where abortion legislation did not change served as the control group: Delaware, Florida, Iowa, Kansas, Michigan, Montana, Nevada, New Hampshire, Pennsylvania, Rhode Island, Utah, Virginia, Wisconsin, and Wyoming.

The 2018 to 2024 National Plan and Provider Enumeration System (NPPES) data determined specialty and primary practice locations for women’s health specialists.

The primary outcome was state practitioner supply, which the researchers defined as the number of women’s health specialists per 100,000 reproductive-aged females. Prior to Dobbs, ob/gyn practitioner patterns between these two groups of states were similar.

Researchers performed sensitivity analyses removing Wisconsin and Texas and added family medicine physicians and nurse practitioners who had secondary ob/gyn-related taxonomy, and the findings were robust; analyses without these states saw a 4.5% relative decrease in ob/gyns per 100,000 females of reproductive age (P=0.04).

Authors noted limitations, including a condensed 2-year follow up period; reliance on NPPES data, which can be delayed; and the unaccounted for influence of factors like state tax policies.

In terms of next steps, Zhu said longitudinal assessments of workforce trends and care outcomes are still needed.

Please enable JavaScript to view the

comments powered by Disqus.