Sweeping restrictions and even outright abortion bans adopted by states in the year since the landmark Dobbs v. Jackson Women’s Health Organization ruling have had an overwhelmingly negative effect on maternal health care, according to a survey of OBGYNs released Wednesday that provides one of the clearest views yet of how the U.S. Supreme Court decision has affected women’s health care in the United States.
The poll by the health research nonprofit KFF reveals that the Dobbs ruling — which ended federal protection on the right to abortion — affected maternal mortality and how pregnancy-related medical emergencies are managed, precipitated a rise in requests for sterilization and has done much more than restrict abortion access. Many OBGYNs said it has also made their jobs more difficult and legally perilous than before, while leading to worse outcomes for patients.
The findings are the first nationally representative survey of OBGYNs since the Dobbs ruling, after which at least 15 states now ban abortion outright or within a few weeks of conception.
Nearly 7 in 10, or 68 percent of OBGYNs, said the effects of Dobbs have made the management of pregnancy-related medical emergencies worse, while 64 percent said the ruling has worsened pregnancy-related mortality. The poll, conducted between March 17 and May 18, collected responses from a random sample of 569 board-certified OBGYNs across the country who provide sexual and reproductive health care to patients in office-based settings.
The striking responses come as the number of Americans who die while giving birth — or in the weeks after — has been on the rise since 2018, from 658 that year to 1,205 in 2021, according to a March report from the Centers for Disease Control and Prevention. Data from 2022 has not yet been released.
The responses were even grimmer regarding the already stark racial and ethnic inequities in maternal health care: 70 percent of OBGYNs said Dobbs has widened that gap. 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.
Some of the earliest signs of the impact of Dobbs on women’s health were evident within weeks of the ruling. Patients with emergencies such as miscarriages, ectopic pregnancies and other complications were confronted with a maze of delays or denials of care as providers were mired in confusion over swiftly changing restrictions.
The Washington Post reported on several such instances last July, including on a Wisconsin woman who experienced an incomplete miscarriage and bled for more than 10 days after emergency room staff refused to remove the fetal tissue amid confusion over restrictions. At a hospital in Kansas City, Mo., administrators temporarily required “pharmacist approval” before dispensing medications used to stop postpartum hemorrhages because those drugs can also be used for abortions.
In the months since, those challenges have not abated. In the KFF poll, 40 percent of OBGYNs in states where abortion is banned said they have personally experienced “constraints on management of miscarriages,” while 37 percent reported constraints on management of pregnancy-related medical emergencies.
Abortion access across swaths of the country receded immediately after the Dobbs ruling, due to “trigger laws” in 13 states, mostly in the South, that immediately banned abortion when Roe v. Wade was struck down. Half of OBGYNs in states that banned abortion or had gestational limits said they had a patient who was unable to get an abortion they sought.
Due to the existing conditions by which abortion was already heavily restricted in several states before last June’s decision, OBGYNs reported little difference pre- and post-Dobbs when it comes to the kinds of abortion services they provide. The share of providers of medical abortions, aspiration abortions and dilation and evacuation abortions remained virtually unchanged, while the share of office-based OBGYNs who provided any type of abortion also remained steady — about 1 in 5. State bans and institutional policies against abortion at an OBGYNs workplace were the most commonly cited reasons for not providing abortion services.
Although the majority of OBGYNs said they do not provide abortion services, 62 percent said they use mifepristone with misoprostol for miscarriage management. But the drug’s future availability is under threat after antiabortion advocates filed a lawsuit challenging access to mifepristone.
The drug is used to manage miscarriages and is also commonly used in medical abortions — which now account for more than half of abortion procedures in the country. They became critically important after Dobbs, because they were seen as the key way to circumvent strict state bans by enabling patients to manage an abortion in the privacy of their own homes after procuring them out of state or having them sent through the mail.
As abortion access grew scarce in parts of the country, more than half of OBGYNs (55 percent) reported an increased number of patients seeking some form of birth control — particularly long-lasting solutions: 43 percent of OBGYNs saw an increase in requests for sterilization, while 47 percent saw increased demand for intrauterine devices and implants. OBGYNs in states with abortion bans or where it is greatly limited were more likely to report an increase in demand than those in states where abortion is generally available.
Though nearly all OBGYNs reported providing contraceptive care, far fewer offered emergency contraception. About one-third of OBGYNs prescribe or provide all three methods of emergency contraception (IUDs and two forms of pills), while 15 percent of OBGYNs said they did not provide patients any method of emergency contraception.
After Dobbs last June, some states rushed to tack on penalties for abortion providers that dramatically increased both criminal and civil liability for OBGYNs — a new legal climate that forced many providers to second-guess maternal health-care decisions once considered routine.
Forty-two percent of OBGYNs nationwide reported being “very” or “somewhat” concerned about the legal risks they could face when making decisions about patient care and the necessity of abortion. The number was higher — 61 percent — for providers in states with abortion bans and 59 percent in states with gestational limits, compared with 27 percent of providers in states where abortion is available.
More than half of OBGYNs nationwide — 55 percent — said the Dobbs ruling made it harder to attract new OBGYNs to the field.
Early data suggests the fear could be well-placed, though it’s disproportionately being seen in parts of the country most hostile to abortion access. States that have enacted abortion bans saw a 10.5 percent drop this year in applicants for obstetrics and gynecology residencies compared with the previous year, according to an April report from the Association of American Medical Colleges.
Doctors have said laws that restrict abortion with carve-outs for saving the life of the pregnant person are vague and confusing, and force providers into the impossible position of weighing a medical judgment against a legal one. A miscalculation in some states could mean prison time.
Already, the calculus has proved to be too much for some providers or their hospitals. Earlier this year, a hospital in rural Idaho said it was shuttering its obstetrics unit after almost 75 years, owing to a shortage of pediatricians, fewer deliveries and the “legal and political climate” in a state where abortion is highly restricted in most circumstances.
Scott Clement contributed to this report.