Abortion Laws Linked to Fewer Ob-Gyns & Reduced Women’s Healthcare Access

Access to comprehensive women’s healthcare is facing new challenges as a recent analysis reveals a decline in the availability of obstetrician-gynecologists (ob-gyns) in states with restrictive abortion laws. The study suggests these limitations aren’t solely impacting reproductive care, but are extending to broader women’s health services, including maternal healthcare. This comes at a time when over a third of U.S. Counties are already considered “maternity care deserts,” lacking a birthing facility or an obstetric clinician.

Researchers found that for every TRAP (Targeted Regulation of Abortion Providers) law enacted, the supply of ob-gyns decreased by more than two doctors per 100,000 women of reproductive age, compared to similar counties in states without such laws. This decline was observed across both rural and urban areas, and wasn’t linked to economic factors or insurance rates, suggesting a widespread impact. The study, which analyzed data from 2010 to 2021, also indicated that this reduction wasn’t offset by an increase in other women’s healthcare providers like nurse practitioners or midwives.

The Broader Impact on Maternal Healthcare

The shrinking number of ob-gyns is particularly concerning given the existing strains on maternity care access in the United States. Quan Qi, PhD, a postdoctoral fellow at Johns Hopkins University and author of the study, highlights that “Access to maternity care in the United States is already strained.” This scarcity of providers can lead to longer wait times for appointments, increased travel distances for care, and potentially, delays in receiving crucial medical attention during pregnancy, and childbirth. The implications extend beyond simply accessing care; they can impact the quality of care received and contribute to poorer health outcomes.

Bethany Everett, PhD, an associate professor of sociology at Ohio State University, notes that the observed declines weren’t entirely unexpected. “The fact that these declines started to happen even before Roe [v. Wade] was repealed was a harbinger, I think, of some of the fear that providers have around offering care to pregnant people in climates that are hostile to the full range of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.” This suggests a proactive response from physicians anticipating increased legal and professional risks in certain states. Recent research also indicates that ob-gyn residents are less inclined to apply for residency programs in states with abortion bans, potentially exacerbating the shortage in the long term. Everett’s work supports this trend.

Understanding TRAP Laws and Their Effects

TRAP laws, or Targeted Regulation of Abortion Providers, are state-level regulations that impose specific requirements on abortion facilities beyond those typically required of other medical facilities. These regulations can include requirements related to facility size, admitting privileges at local hospitals, and the types of equipment required. While proponents argue these laws are intended to ensure patient safety, critics contend they create unnecessary barriers to abortion access and can lead to clinic closures. The American College of Obstetricians and Gynecologists (ACOG) firmly maintains that abortion is essential healthcare and opposes laws that restrict access to it.

The study’s findings suggest that these regulations have a ripple effect, impacting not only abortion services but also the broader availability of ob-gyn care. The researchers examined the maternal healthcare workforce, including ob-gyns, newly graduated ob-gyns, medical school and residency applicants, nurse practitioners, physician assistants, and advanced practice nurse midwives. The consistent decline in ob-gyn supply, without a corresponding increase in other providers, points to a specific challenge related to the practice environment in states with restrictive abortion laws.

Beyond Access: Potential Health Complications

The reduction in ob-gyn availability has implications that extend beyond simply making it harder to schedule an appointment. Daniel Cook, PhD, an associate professor of public health at the University of Nevada, Reno, explains that “The U.S. Already has healthcare shortages and reduced access in many settings, so fewer physicians will add to the barriers.” He further notes that restricted care is linked to worse health outcomes, particularly for women with lower incomes, exacerbating existing health disparities.

Kelly DeBie, PhD, an adjunct instructor of medicine at the University of Colorado Anschutz School of Medicine, emphasizes the logistical challenges. “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.” These delays can be particularly dangerous for women experiencing pregnancy complications. She adds that these effects are likely to be most pronounced in “maternity care deserts,” potentially leading to increased illness and mortality associated with pregnancy.

ACOG has also underscored the potential for increased risks associated with restricting abortion access, including a higher risk of pregnancy-related complications, being forced to carry life-threatening pregnancies to term, and worsening of existing medical conditions. Research has also linked abortion restrictions to higher teen birth rates, increased rates of hypertensive disorders of pregnancy, and poorer outcomes for individuals undergoing in vitro fertilization (IVF). ACOG provides comprehensive information on these issues.

What’s Next for Maternal Healthcare Access?

The researchers acknowledge some limitations to their study, including the challenge of quantifying complex state laws and the reliance on physician-level data, which suggests the decline may be driven by doctors leaving practice rather than relocating. Dr. Qi recommends further research to clarify the reasons behind these physician practice exits and to assess how reductions in ob-gyn workforce translate into real-world access to care, such as appointment wait times and hospital coverage.

For individuals seeking reproductive healthcare, resources like ACOG and the March of Dimes offer reliable information. The March of Dimes report on maternity care deserts is a valuable starting point for understanding local access to care. Telehealth may offer a partial solution for certain services, depending on state regulations. AbortionFinder.org provides information on abortion laws and a directory of verified providers. Ensuring equitable access to comprehensive women’s healthcare requires addressing the underlying factors driving physician shortages and protecting the full range of reproductive healthcare options.