A University of California, San Francisco September 2024 report documents how the Dobbs v. Jackson Supreme Court decision that overturned Roe has impacted health care. New evidence indicates that stripping abortion access from millions of people is affecting many aspects of health care nationwide, from physician training to cancer treatments.
Delays and barriers for non-abortion reproductive health care
The UCSF report identifies issues in care for miscarriages, ectopic pregnancies, pregnancy complications in the second trimester, and underlying medical conditions that increase the risk of pregnancy complications, delays in non-abortion-related care, and difficulty obtaining post-abortion care.
The report includes narratives from health care providers about pregnant and potentially pregnant patients whose medical treatments, including cancer treatment and organ transplants, were refused or delayed due to uncertainty about legality. The researchers conclude that patients in states with abortion bans may face long-term negative health impacts, including loss of fertility, infection, heart problems, and mental health conditions.
Data from ongoing research at UCSF and Duke University supports this conclusion, suggesting that pregnant people receive poorer quality of care in states with abortion bans. Additionally, a recent AP investigation revealed that some emergency rooms refused to treat pregnant people post-Roe, resulting in cases such as that of a Texas woman who miscarried in a hospital restroom and a woman in North Carolina who gave birth in her car to a baby who later died.
Black and Indigenous people are also more impacted by abortion restrictions than women of other races. Around six in 10 Black and American Indian or Alaska Native women live in states where abortion is banned or restricted.
Maternal mortality varied by race even before the overturning of Roe. Pregnant Black women were around three times as likely to die as white women, and pregnant American Indian or Alaska Native women were twice as likely. Those disparities will undoubtedly worsen in the wake of the Dobbs decision.
Worsening maternity care
Abortion bans are worsening maternity care deserts, which are parts of the country without a single maternity or obstetrics provider. According to a 2024 March of Dimes report, over 35 percent of U.S. counties—serving over 2.3 million women of reproductive age—are maternity care deserts. Maternity providers are beginning to flee states that are eroding access to abortion and adding barriers to medical training and practice.
A January 2024 study found that OB-GYNs in states with total abortion bans report facing pressure to delay necessary patient care, confusion about the legality of certain procedures, and fears about potential legal repercussions for treating patients. More than half of the physicians considered moving to a less restrictive state to practice, and 11 percent ultimately moved. One participant described the experience of treating patients in an abortion-ban state as “pitting my own livelihood against patient well-being.”
At a June 2024 Harvard T.H. Chan School of Public Health panel discussion on post-Roe threats to abortion access, Dr. Stella Dantas, president of the American College of Obstetricians and Gynecologists, explained how health care providers are forced to navigate unclear legal restrictions while trying to provide lifesaving care.
“There’s confusion in the laws. There’s confusion for both patients—when they can seek care, where should they seek care, do they need to leave the state—and then for physicians.”
Dantas warned that when this confusion causes critical delays in treatment, they create life-threatening situations.
A KFF survey of OB-GYNs found that four in 10 practitioners in abortion-ban states were concerned about their ability to treat miscarriages and other pregnancy-related emergencies. More than half of OB-GYNs in these states say that the bans have hindered their ability to practice.
Disrupted and complicated health care training
Practicing physicians are not the only ones impacted. Recent research shows that abortion restrictions have become a major deciding factor for future OB-GYNs when choosing a location for their residency training after medical school. In states that ban abortion outright, OB-GYN residents are forced to travel out of state to complete their training and may face additional legal hurdles.
“As training opportunities diminish, potentially leading to a decline in clinical skills, knowledge, and experience in the provision of abortion, the rate of complications and maternal mortality are likely to rise,” concluded a 2023 analysis of the impact of Dobbs on medical education.
Faced with the prospect of insufficient training and legal restrictions, many medical trainees are opting to avoid training in states with abortion restrictions. In the 2023-2024 residency application cycle, applications in states with abortion bans decreased by 4.2 percent.
More than three-quarters of medical students surveyed said that abortion access was likely to influence where they choose to do their residency. Another survey of OB-GYN residents found that 17.6 percent changed where they intended to practice after Roe was overturned, with those who intended to practice in abortion-restrictive states being eight times more likely to change their minds.
Resources to access reproductive health care can be found here.