Laws restricting abortion are affecting more than just access to the procedure itself, a new study suggests.
“Access to maternity care in the United States is already strained, and more than one-third of U.S. counties are considered ‘maternity care deserts,’ meaning they lack a birthing facility or an obstetric clinician,” says Quan Qi, PhD, an author of the study and a postdoctoral fellow at Johns Hopkins University in Baltimore.
Legal Limits on Abortion Were Linked to 2 Fewer Ob-Gyns per 100K Women of Reproductive Age
To investigate the effects of newly enacted abortion restrictions, researchers tallied the number of providers in the maternal healthcare workforce between 2010 and 2021 at the county and state level. They looked specifically at time frames 2 to 9 years after the enactment of state abortion laws.
For the study, the maternal healthcare workforce included:
- Obstetrician-gynecologists
- Newly graduated ob-gyns
- Medical school and residency program applicants
- Nurse practitioners (NPs) and physician assistants (PAs) who practice women’s healthcare
- Advanced practice nurse midwives
The research team found that on average, each time a so-called TRAP law was passed, the ob-gyn supply fell by more than 2 doctors per 100,000 women of childbearing age, compared with otherwise similar counties in states without such laws. This decline was especially pronounced in older and newly trained doctors, and was consistent regardless of county economic factors.
“Ob-gyn supply declined in both rural and urban counties, in both higher- and lower-poverty areas, and in counties with both higher and lower uninsured rates,” Dr. Qi says, which means the workforce impact doesn’t appear to be confined to a single type of community.
The data also showed there were no corresponding increases in other types of women’s healthcare providers (PAs, NPs, and midwives) that would help fill those gaps in physician care.
Bethany Everett, PhD, an associate professor and sociologist at the Ohio State University in Columbus, says the declines don’t surprise her.
“The fact that these declines started to happen even before Roe [v. Wade] was repealed was a harbinger, I think, of some of the fear that providers have around offering care to pregnant people in climates that are hostile to the full range of reproductive healthcare options, including abortion,” she says.
What Are the Practical Implications of Fewer Ob-Gyns?
“The U.S. already has healthcare shortages and reduced access in many settings, so fewer physicians will add to the barriers,” says Daniel Cook, PhD, an associate professor of public health at the University of Nevada in Reno. “The worse health outcomes from restricted care are shown in other work to increase disparity, meaning that poor women have worse health outcomes from the new laws.”
On a logistical level, the decrease in doctors could affect all women in a given area, especially in areas that already have very few ob-gyns, says Kelly DeBie, PhD, an adjunct instructor of medicine at the University of Colorado Anschutz School of Medicine in Aurora. Dr. DeBie is a legal epidemiologist who has researched the impact of abortion laws on population health.
“Lower rates of ob-gyns have real-life impacts on patients and may increase travel time for appointments and increase delays in care if providers are caring for a higher volume of patients,” she says.
“These lower rates may manifest especially in already impacted maternity care deserts, which could lead to increased morbidity [illness] and mortality associated with pregnancy complications,” she explains.
Other Potential Health Complications of Abortion Restrictions
This study focused on the maternal healthcare workforce, so it didn’t directly measure the impact on specific patient outcomes like birth results or pregnancy complications.
- Raising the risk of pregnancy-related complications
- Forcing women to carry life-threatening pregnancies to term
- Worsening of existing medical conditions
- Higher teen birth rates
- Higher rates of hypertensive disorders of pregnancy
- Worse outcomes for people using in vitro fertilization (IVF) to get pregnant
While this study offers additional considerations to the existing body of research, the researchers point out that it does have some limitations, including summarizing complex state laws into a quantitative measure (which may not capture every legal nuance) and using physician-level data that suggests the decline could be driven more by doctors leaving practice than by relocating.
Qi recommends more studies to clarify the nature of these physician practice exits, along with expanding on how ob-gyn workforce reductions in affected states translate into real-world access to care — such as access to timely appointments, appointment wait times, and adequate labor and delivery coverage at hospitals.
What Women Seeking Reproductive Care Should Know
For women in search of reproductive care, Qi recommends resources such as ACOG and March of Dimes as a starting place for reliable health information.
“People who are worried about access to reproductive health services can start by looking up what services are available locally and whether clinics are accepting new patients. If someone doesn’t have a primary care provider, local health departments and federally qualified health centers can be a good entry point for general reproductive healthcare and referrals,” she says. “Telehealth may fill some gaps for certain services depending on what’s available in a given state.”
In addition, AbortionFinder.org offers information about how the laws in your state may impact your ability to get an abortion, and includes more than 750 health centers along with a comprehensive directory of trusted and verified abortion service providers in the United States.
“Women and all patients should have access to the full range of evidence-based medicine,” Dr. Cook says.