In the year since the U.S. Supreme Court overturned Roe v Wade and removed the federal protection to the right to an abortion, a survey of OBGYNs released Wednesday shows that it has had an overwhelmingly negative effect on maternal health care.
Since the landmark Dobbs v Jackson Women’s Health Organization, states have adopted extensive restrictions and some have even outright abortion bans. The survey provides the most direct and clear effects of the decision on women’s health care in the United States.
The poll by the health research nonprofit KFF revealed that the Dobbs ruling affected maternal mortality, how pregnancy-related medical emergencies are managed, restricted more than just abortion access and led to a rise in requests for sterilization.
Many OBGYNs said that these restrictions lead to worse outcomes for their patients while making their jobs more difficult and legally risky.
Since the Dobbs ruling at least 15 states have banned abortion outright or within a few weeks of conception. This is the first nationally representative survey of OBGYNs since the ruling.
The poll collected responses from a random sample of 569 board-certified OBGYNs across the nation, who provide sexual and reproductive health care to patients in office-based settings, between March 17 and May 18.
More than half — 68% — of OBGYNs said that Dobbs decision made managing pregnancy-related medical emergencies worse. 64% said that the ruling worsened pregnancy-related mortality rates.
These responses come as the number of Americans who die while childbirth or in the weeks after, have been on the rise since 2018, to 1,205 in 2021 from 658 in 2018, according to a March report from the Centers for Disease Control and Prevention.
The data from 2022 has not been released yet.
Since Dobbs, the stark racial and ethnic inequities in maternal healthcare have further widened according to 70% of OBGYNs.
Black women are already twice as likely to suffer serious complications during pregnancy and are three times as likely to die as women of other races.
The earliest signs of Dobbs impact on women’s health care were evident within weeks of the ruling. Patients with emergencies such as miscarriages, ectopic pregnancies and other complications had to be confronted with an entanglement of delays or denials of care as providers were confused over the quickly changing restrictions.
According to the KFF poll, in states where abortion is banned 40% of OBGYNs said they have personally experienced “constraints on management of miscarriages,” and about 37% reported constraints related to the management of pregnancy-related medical emergencies.
Abortion access sees stark difference in states with bans
In the 13 states with “trigger laws” (mostly in the South), when Roe v. Wade was struck down, abortion was immediately banned. Half of the OBGYNs in the states that banned abortion or had gestational limits said that they had a patient who wasn’t able to get an abortion they sought.
In states where abortion access was already heavily restricted before the decision, OBGYNS reported little difference in the services they provided in pre- and post-Dobbs.
The providers of medical abortions, aspiration abortions and dilation and evacuation abortions stayed unchanged, in addition to that, the share of office-based OBGYNs that provided any type of abortion remained stable as well — 1 in 5.
The state restrictions and institutional policies at OBGYNs workplace were the most common reasons given for not providing abortion services.
While the majority of OBGYNs say that they do not provide abortion services, about 62% of them say they use mifepristone with misoprostol for miscarriage management. However, the availability of the drug in the future is under threat after anti-abortion advocates filed a lawsuit challenging access to mifepristone.
Mifepristone is used to manage miscarriages and is often used in medical abortions — which make up more than half of abortion procedures in the country.
The use of the drug became increasingly crucial following Dobbs, as it is seen as the keyway to evade strict state bans by enabling patients to manage an abortion they need, in the privacy of their own homes after obtaining them through mail.
A rise in demand of contraceptives
More than half OBGYNs – 55% — reported an increase in the number of patients seeking birth control options, particularly long-term solutions.
With abortion access growing scarce in parts of the country, 47% of OBGYNs saw an increased demand for intrauterine devices and implants and 43% saw an increase in requests for sterilization.
The states with abortion bans or greatly limited access were more likely to report an increase in demands than states where abortion is protected or available.
However, almost all OBGYNs reported providing contraceptive care. Although only a few offered emergency contraception. While one-third of OBGYNs prescribe or provide all three methods of emergency contraception (IUDs and two forms of pills), only 15% of OBGYNs said they had not provided any method of emergency contraception to patients.
Dobbs Effect on OBGYNs profession
Since Dobbs, some states have attached penalties for abortion providers that strikingly increased both criminal and civil liabilities for OBGYNs, this new legal climate forced many providers to second-guess material healthcare decisions which were once routine.
About 42% of OBGYNs nationwide reported being “very” or “somewhat” concerned with the legal risks they face when they make decisions regarding their patient’s care and the necessity of abortion. Providers in states that had abortion bans were 61% and 59% in states with gestational limits, compared to states where abortion is available — 27%.
The Dobbs ruling made it harder to attract new OBGYNs to the field according to 55% of the OBGYNs nationwide.
Early data indicates that the fear is well-placed. According to an April report from the Association of American Medical Colleges, states with abortion bans saw a 10.5% drop in applications for obstetrics and gynecology residencies compared to previous years.
States, where abortion restrictions have an exception for saving the life of the pregnant person, are vague and confusing. Doctors say that it forces providers into an uncomfortable position of weighing a medical judgment against a legal one.
In some states, a miscalculation could lead to prison time. And these calculations have already been proven to be too much for some providers or their hospitals.
Due to a shortage of pediatricians, fewer deliveries and the “legal and political climate” a hospital in rural Idaho said it was shutting its obstetrics unit after almost 75 years – abortion is highly restricted in most circumstances in the state.