‘An Exodus of OB-GYNs’: How the Dobbs Decision Has Shaken the Reproductive Health Landscape – Time Magazine

Report on the Impact of Abortion Restrictions on Healthcare Providers and Access

Introduction

Since the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization ruling overturned Roe v. Wade, significant changes have occurred in abortion laws across the United States. This report examines the consequences of these legal changes on healthcare providers, patient care, and access to reproductive health services, emphasizing the alignment with Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities).

Healthcare Providers’ Relocation Due to Legal Restrictions

1. Background: Following near-total abortion bans in 12 states, including Texas, many clinicians have relocated to states where abortion remains legal.
   • 42% of abortion providers in states with near-total or six-week bans moved to other states within a year after the Dobbs decision.
   • Only 9% of providers in states without bans relocated.
2. Impact on Workforce:
   • About 20% of obstetricians and gynecologists in Texas considered leaving the state.
   • Idaho lost approximately 22% of its obstetricians within 15 months after imposing restrictions.
3. Case Studies:
   • Dr. Lou Rubino left Texas for Virginia to provide comprehensive abortion care without legal barriers.
   • Dr. Kristl Tomlin moved from South Carolina to Virginia due to restrictive six-week abortion laws and associated legal hurdles.
   • Dr. Leilah Zahedi-Spung relocated from Tennessee to Colorado to practice unrestricted reproductive healthcare.
   • Dr. Stacy De-Lin moved from Florida to New York following increased abortion restrictions.
   • Dr. Danielle Gershon moved from New York to Alabama to provide limited abortion care despite near-total bans.

New Barriers to Care and Moral Distress

• Healthcare providers face increased legal and administrative obstacles, including:
  • Multiple legal consultations before providing care.
  • Additional medical procedures mandated by law.
  • Pharmacy refusals and medication access issues.
• Providers report moral distress when unable to provide necessary care due to legal restrictions.
• Fear of legal repercussions affects healthcare professionals’ willingness to provide care and patients’ willingness to disclose information.

Impact on Maternal and Infant Health

• The United States already had one of the highest maternal mortality rates among developed countries before the Dobbs ruling.
• Research indicates:
  • Increased pregnancy-related dangers and maternal mortality in states with abortion restrictions.
  • Higher infant mortality rates in states enforcing abortion bans.
• Recent rescinding of federal guidance on emergency abortion care may exacerbate confusion and restrict access further.

Consequences for Healthcare Access and Equity

1. Healthcare Deserts:
   • 13% of counties in South Carolina are maternity care deserts.
   • 15 counties in South Carolina have no obstetricians or gynecologists per 10,000 women.
2. Exodus of Providers:
   • Significant outmigration of ob-gyns from states with restrictive abortion laws exacerbates healthcare disparities.
   • Patients in restrictive states face increased barriers to comprehensive reproductive healthcare.
3. Emotional Toll on Providers:
   • Providers experience guilt and emotional distress over leaving patients behind.
   • Stress and fear related to legal risks affect providers’ well-being and career sustainability.

Alignment with Sustainable Development Goals (SDGs)

• SDG 3: Good Health and Well-being
  • Access to safe, legal abortion is critical to reducing maternal mortality and ensuring comprehensive reproductive healthcare.
  • Restrictions undermine health outcomes and increase risks for pregnant individuals.
• SDG 5: Gender Equality
  • Abortion access is essential for women’s autonomy and empowerment.
  • Legal barriers disproportionately affect women and marginalized groups, exacerbating gender inequalities.
• SDG 10: Reduced Inequalities
  • Healthcare deserts and provider shortages deepen disparities in access to reproductive health services.
  • Travel burdens and financial barriers increase for patients seeking care out of state.

Conclusion

The overturning of Roe v. Wade and subsequent state-level abortion restrictions have led to significant healthcare provider relocations, increased barriers to care, and adverse health outcomes. These developments challenge the achievement of key Sustainable Development Goals related to health, gender equality, and reduced inequalities. Addressing these challenges requires policy interventions that prioritize patient-centered care, protect healthcare providers, and ensure equitable access to reproductive health services nationwide.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article discusses access to reproductive health care, maternal mortality, and the impact of abortion restrictions on health outcomes.
2. SDG 5: Gender Equality
   • The article highlights issues related to women’s reproductive rights, bodily autonomy, and gender-based health care access.
3. SDG 10: Reduced Inequalities
   • Disparities in access to abortion and reproductive health care across different states and populations are discussed.
4. SDG 16: Peace, Justice and Strong Institutions
   • The article touches on legal restrictions, law enforcement involvement, and the impact of legislation on health care providers and patients.

2. Specific Targets Under Those SDGs Identified

1. SDG 3: Good Health and Well-being
   • Target 3.1: Reduce the global maternal mortality ratio.
   • Target 3.7: Ensure universal access to sexual and reproductive health-care services.
2. SDG 5: Gender Equality
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
3. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of gender or other status.
4. SDG 16: Peace, Justice and Strong Institutions
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
   • Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making.

3. Indicators Mentioned or Implied to Measure Progress

1. SDG 3 Indicators
   • Maternal mortality ratio (number of maternal deaths per 100,000 live births) – implied through discussion of high maternal mortality rates and worsening outcomes.
   • Proportion of women who have access to reproductive health services, including abortion care – implied by the discussion of access barriers and provider relocation.
   • Infant mortality rate – mentioned as higher in states with abortion bans.
2. SDG 5 Indicators
   • Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care – implied by the discussion on bodily autonomy and legal restrictions.
3. SDG 10 Indicators
   • Disparities in access to health services across regions and populations – implied by the description of “health care deserts” and unequal access across states.
4. SDG 16 Indicators
   • Number of legal cases or prosecutions related to abortion care providers – implied by doctors’ fear of arrest and legal repercussions.
   • Existence and enforcement of laws affecting health care provision – implied by the discussion of restrictive abortion laws and their impact on medical practice.

4. Table of SDGs, Targets, and Indicators

Source: time.com