OBGYN Exodus Reaching Crisis Point

8.5.2024

Click to skip ahead: In America’s Invisible Post-Roe Deaths, a new report reminds us about the abortion ban consequences we’re not seeing. OBGYN Exodus reports on the ramping up of docs leaving anti-choice states. In the States has news on Indiana, New Mexico, Utah and more. Ballot Measure Updates looks at Arkansas, Arizona, Kansas, Colorado and Utah. In Care Crisis, OBGYNs are losing critical skills. Finally, In the Nation, what the attacks on Pete Buttigieg tell us about what anti-abortion tactic is coming next.

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America’s Invisible Post-Roe Deaths

One of the hardest things about doing this work is knowing that people are dying. Not that they’re at risk of dying, or that they’ve come close to dying—but that women are dying as a result of abortion bans. And for all sorts of reasons, we’re not hearing about those deaths—they’ve become invisible.

I was reminded of that fact while reading about the death of woman mentioned briefly in report from House Democrats on the Energy and Commerce Committee. Appropriately titled, “It Will Only Get Worse,” the report is the result of a 10-month investigation, and interviews with leaders and educators at 20 OBGYN residency programs.

On page 15, the report describes an OBGYN residency program in a “Southern restrictive state” that is seeing an increase in complicated and dangerous cases—women who have been “bounced around” different hospitals and doctors who are too afraid of the state’s abortion ban to provide proactive care:

“[A] program director described one harrowing case where a pregnant patient was transferred to their emergency room with an infection and with no fetal heartbeat. Because an abortion could not be provided earlier due to restrictive state laws, the patient became increasingly sick and ultimately died in the Intensive Care Unit (ICU) from sepsis.”

Who was this woman? Was she already a mother? We know she was someone’s child, a person who was denied basic healthcare and died as a result of Republican abortion bans. Yet this two-sentence paragraph may be all we ever learn about her.

Another residency program director in an anti-abortion state told interviewers about a pregnant woman who was admitted to the hospital with serious complications, yet she wasn’t told she could get an abortion in another state. You see, the law prohibited her doctors from giving her that information.

“The program director said that every resident that participated in this case had cried and was traumatized because the woman would likely die, and the fetus may not survive due to the delay in appropriate care.”

We’re not told what ended up happening to this patient. But I think we all know.

For more on invisible post-Roe deaths, read my column from this past March about why we’re not hearing these stories:

Searching for Savita

OBGYN Exodus

Given that bans are killing women, it’s hard to blame doctors for leaving anti-abortion states. As you all know, OBGYNs have been leaving anti-abortion states en masse since Roe was overturned—unwilling to work in a place where the law prevents them from providing the standard of care, and where they could face jail time if they do provide that care.

So it makes sense that a new report from AMN Healthcare, the nation’s largest healthcare staffing group, shows that demand for OBGYNs is the highest it’s ever been since they started doing reports more than 30 years ago.

In fact, that demand for OBGYNs by hospitals, clinics and other groups is now only second to demand for family practice physicians. And AMN makes clear that part of the reason there’s a lack of “supply” of OBGYNs is because of the Supreme Court decision overturning Roe.

Naturally, we don’t need a report to tell us that: We’ve watched maternity wards shutter, and states like Idaho lose nearly a quarter of their OBGYNs. Now, all eyes are on Indiana, which is a year out from their near-total abortion ban taking effect. Indiana Public Media reports that like other anti-abortion states, Indiana is having a hard time retaining and recruiting OBGYNs and other reproductive healthcare workers.

Maternal fetal medicine specialist Dr. Caroline Rouse says, “Moving to a state where there are criminal penalties for providing evidence-based reproductive health care is not something that a lot of people want to entertain.” And OBGYN Dr. Julie Tillman, the vice chair of the Indiana American College of Obstetricians and Gynecologists, notes that fewer residents are training in Indiana:

“And then we're also seeing subsequently fewer people are sticking around in Indiana. Many of them are choosing to practice outside of Indiana once they graduate.”

Dr. Nicole Scott, director of Indiana University Health’s OBGYN training program, relayed similar concerns to the IndyStar. She says her program has seen a 10-15% drop since Roe was overturned, and that she’s worried that the residents who do match there will leave the state as soon they graduate. What makes all of this even worse is that Indiana was already having a staffing shortage in reproductive health care fields.

Iowa, too, is starting to prepare for what experts see as an inevitable loss of reproductive healthcare workers. Lyz Lenz, who is on the board of the Iowa Abortion Access Fund tells CNN, “It’s not just this amorphous fear that doctors are leaving. We cannot recruit doctors to come here.” Already, more than 33% of Iowa counties there are maternity care deserts.

“We're seeing here in Texas that there is a brain drain happening, where, of course, people don't want to work here, and they don't feel safe working here, and it’s because of all the repercussions that can happen to providers here. But on top of that, we are seeing that health care clinics are underfunded and understaffed.”

- Abortion rights activist DakotaRei Frausto, San Antonio Current

In the States

New Mexico is using the OBGYN exodus to recruit new reproductive healthcare workers. I told you last week that the pro-choice state’s Department of Health is running billboards in Texas urging doctors to come practice there. Now, the “Free to Provide” campaign has gone a step further.

Chron reports that New Mexico Gov. Lujan Grisham took out full-page ads this past weekend in five Texas newspapers, publishing a letter to healthcare providers, inviting them to come practice medicine in New Mexico:

“I know that legal restrictions on healthcare in Texas have created a heavy burden for medical practitioners—especially those of you now barred by law from providing the full spectrum of reproductive healthcare. It must be distressing that a draconian abortion ban has restricted your right to practice and turned it into a political weapon.  

…Whether you are a nurse, a resident, a physician assistant, or a doctor, we cordially and enthusiastically invite you to the Land of Enchantment, where you are free to care for your patients.”

Speaking of Texas and billboards, Mayday Health is running quite the doozy in San Antonio:

As you may remember, infant mortality in Texas has risen significantly since they implemented an abortion ban. The state has had a 13% overall jump in infant deaths and a 23% jump in infant deaths to due to congenital anomalies. Researchers say that the increases are largely because of the state’s mandate that women carry nonviable pregnancies to term.

The Texas Signal reports that Mayday Health is putting four billboards for four weeks, with the intent to get people’s attention and drive them to resources for care, if needed.

IndyStar reports on the impact of Indiana’s near-total abortion ban now that it’s been a year since the law went into effect. From denials of care to growing maternity deserts, Indiana is dealing with all of the abortion ban consequences we’ve seen in every other anti-abortion state.

Meanwhile, a UK-based abortion rights group has put up billboards in Indiana telling pregnant people how to cover their digital tracks if they’re seeking abortion care. (MSI Reproductive Choices’ billboard directs women to VaginaPrivacyNetwork.org.)

Urging folks to protect their privacy is the right thing to do, especially in Indiana, where the Attorney General has been fighting to make individual’s abortion reports public records in the same way that birth and death certificates are.

Finally, The Salt Lake Tribune has a helpful article about what happens now that the Utah Supreme Court has blocked a total abortion ban from going into effect—including the possibility of a different 6-week abortion ban being introduced by a Republican lawmaker. (More on Utah in Ballot Measure Updates.)

Quick hits:

• Wisconsin abortion providers are expecting to see an influx of Iowa patients in the wake of the state’s 6-week ban going into effect;

• Kansas abortion clinic Trust Women has re-opened after a two-month closure;

• More on the anti-abortion lawsuit against California over abortion ‘reversal’;

• And Arizona’s governor is pushing for expanded birth control access.

Ballot Measure Updates

The ballot measure fight continues on in Arkansas, where Republican leadership doesn’t want to count all of the signatures collected in favor of putting abortion on the ballot in November. On Friday, Arkansans for Limited Government (AFLG) argued in a court filing that Republican Secretary of State John Thurston politically discriminated against the pro-choice group.

Not only was Thurston endorsed by Arkansas Right to Life, the Republican secretary of state donated to the organization, and participated the group’s “March for Life.” From AFLG’s brief:

“The Secretary’s viewpoint is clear. He wants to keep the Amendment off the ballot. Doing so furthers his anti-abortion personal beliefs and political interests…This viewpoint discrimination infringes petitioners’ First Amendment rights and harms the integrity of the ballot initiative process.”

An Arizona Supreme Court Justice, Clint Bolick, has recused himself from a case about whether or not the term ‘unborn human being’ should be included in a summary of an abortion rights ballot measure. That’s because Bolick’s wife, Shawnna, is on the legislative council that approved the clearly biased language.

The language fight in Arizona mirrors other attacks on democracy we’ve seen in states like Ohio, where Republicans put a biased ballot summary in front of voters—though abortion rights won anyway! (In related news, Bloomberg has a roundup of some of the recent attacks on ballot measure language.)

Apparently, folks on both sides of the issue are considering an abortion-related ballot measure in Utah. In the wake of the state Supreme Court ruling that a block on a total abortion ban can remain in effect, the Republican lawmaker who crafted that law says, “I have not excluded anything from consideration thus far, including a constitutional amendment.”

The head of Planned Parenthood Association of Utah, Kathryn Boyd, also told a local media outlet that they’re considering a ballot initiative. She said, “We’re in the early stages of that discussions of what that would look like and the framework to do that.”

It’s been just about two years since Kansas voters defeated an anti-abortion ballot measure, making them the first state to vote directly on abortion after Roe was overturned. This weekend, The Kansas City Star ran an op-ed from Ashley All, who worked to beat the anti-choice amendment and who has spent the last two years working on other pro-choice ballot measure campaigns across the country. And it gave me some serious hope:

“We’ve learned many lessons from each one, but a few stand out. First, support for abortion access crosses political lines—it is not a Republican or Democratic issue. Second, Americans do not appreciate politicians meddling in their private lives. And finally, when abortion rights are under real threat, voters show up to defend them. This year will be no different.”

In keeping with hearing from kick-ass abortion rights activists, check out this interview with Dusti Gurule, president of Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR). COLOR is part of the coalition of groups supporting a Colorado abortion rights amendment, which Gurule says she’s confident will pass with overwhelming support from Latino voters:

“There’s this myth that all the Latinos that are religious, they’re anti-choice. That’s not true. Part of our polling shows Latinos who identify as Catholic, there’s still a large proportion of them who believe people should have the right to have an abortion.”

Care Crisis

I want to talk a little more about the report from House Democrats that I told you about at the top of the newsletter. “It Will Only Get Worse” doesn’t just outline abortion ban consequences for pregnant patients, but shows what’s happening with doctors. They found OBGYNs are leaving anti-abortion states, that there are fewer applicants to OBGYN residency programs, and—perhaps most alarming—that new doctors are not being adequately trained to treat patients with dangerous and life-threatening pregnancies.

Rep. Frank Pallone Jr. of New Jersey told NBC News, “I don’t think people realize how dire the situation has become so quickly.”

“It’s already happened in the restricted states that women who needed an emergency abortion were not able to get it because [doctors] were afraid to perform it. Now, on top of that, you layer the fact that even if the doctors wanted to do it, they don’t have the knowledge to do it.”

Remember, now that abortion is banned in so many states, residents can’t get the training they need in their home states. That means people have to travel to pro-choice states to learn abortion procedures, or work on models—like fruit. Here’s what one resident in an anti-abortion state said:

“I’m never going to see it, get to counsel, or learn the standard of care. For other niche procedures, we get simulations, but I don’t think I’m going to ever get to [perform one] on a person and not a dragon fruit.”

And while I’m so grateful for the doctors who are going out of their way to be trained—some are even paying out of their own pocket to get trained out-of-state—we have to be real about what this loss of generational knowledge means. As one residency director put it, “you can tell who has done it and who has learned it from a book. There is a gap…and you an already see it.”

And here’s the thing: States with abortion bans will have the sickest patients with the most complicated cases, because the law prevented them from getting early care. That means pregnant women who need the most help will have the doctors with the least training.

In the Nation

I can’t believe the anti-abortion movement is still obsessing over Pete Buttigieg’s completely innocuous comments on abortion. If you missed the brouhaha, here’s a reminder of what Buttigieg said:

“Men are also more free in a country where we have a president who stands up for things like access to abortion care. Men are more free when the leader of the free world and the leader of this country supports access to birth control and to IVF. And certainly men like me, and my husband, are more free when we have a president who supports our freedom to get married to who we love.”

Conservatives twisted that to mean that the Secretary of Transportation was somehow admitting that abortion allows men to be “free” from responsibility. Now, usually I’d be ignoring the right-wing media storm by now—but this week Erin Hawley of Alliance Defending Freedom has also written an op-ed about Buttigieg. Hawley is the lawyer who argued in front of the Supreme Court both against abortion medication and life-saving abortions. So she’s not just an asshole, but a powerful asshole.

Hawley writes that Buttigieg “said the quiet part out loud,” and quotes another conservative writer who claims “deadbeats are definitely freer to be deadbeats when they can have unprotected sex with a woman then pressure her into an abortion.” And that’s what Hawley ends up focusing on in her piece: the idea of “coerced abortion.”

This is something I started warning about last year: Anti-abortion activists and lawmakers know that Americans overwhelmingly support abortion rights, so they needed a talking point/boogeyman to justify abortion restrictions. Enter ‘coerced abortion,’ which they know no one supports.

And while coerced abortions certainly do happen, domestic violence experts point out that what’s far more common is coerced and forced pregnancy. But conservatives figure if they drum up statistics about women being forced into abortions, it will be that much easier to pass bans, and that much harder for Democrats to counter their messaging. (They’re even co-opting feminist rhetoric along the way; Hawley writes, “So much for women’s choice.”)

Consider this your reminder to keep an eye out for this language and tactic.

Quick hits:

• Rolling Stone points out the irony of Supreme Court Justice Neil Gorsuch—who helped overturn Roe—arguing in his new book that too many laws can infringe on Americans’ rights;

• The 19th on the $500 million increase in state funding to anti-abortion crisis pregnancy centers;

• And NPR and the Associated Press cover new research showing an increase of women self-managing their abortions since Roe was overturned.