Study: Abortion Bans Creating OBGYN Crisis

Docs in anti-choice states are depressed, scared, and getting worse

This is a special edition/addition to the 2.1.24 issue of Abortion, Every Day

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A new study shows that abortion bans have created an “occupational health crisis” for OBGYNs in anti-choice states, 93% of whom report that they or a colleague have been unable to follow standards of care because of abortion laws.

Researchers from Harvard’s School of Public Health, Boston College, and University of North Carolina at Chapel Hill School of Medicine, report “deep and pervasive impacts” not just on patient outcomes—but physicians’ own health, and on state workforce sustainability.

Abortion, Every Day has been following the post-Roe care crisis closely: from the OBGYN exodus out of anti-abortion states, to doctors being legally prohibited from giving their patients adequate—or even health- and life-saving—care. This study, published in the JAMA Network, contains some of the most clear-cut examples I’ve seen of this crisis in action.

OBGYNs told researchers about having to delay medical care until a patient was at risk of death or permanent impairment because a fetal heartbeat was still present. From one doctor:

“Is a 5% risk of death enough? Does it take 20%? Does it take 50%? What is enough legally? And the legal people seem to have a different definition that also just feels horrible, to say until you’re at a greater than likely chance of dying, you can’t make a decision.”

Some reported having to delay vital care in middle-of-the-night medical emergencies because hospital lawyers were asleep and not answering phone calls.

“You have somebody hemorrhaging with an intrauterine pregnancy with a heartbeat…I [didn’t yet] have legal coverage for that, but there’s only so many times you can transfuse somebody and they’re begging for their life before you say, ‘This is unconscionable.’”

Researchers also reported that there was a serious chilling effect on speech, and the kind of advice OBGYNs could legally give patients. While doctors reported often having those conversations regardless—risking their careers in favor of caring for their patients—hospitals are warning OBGYNs that they shouldn’t talk about abortion “because you don’t know if you’re being recorded…they could use that against you.”

In cases where doctors did counsel patients on getting out-of-state care, they talked about having many patients who simply couldn’t afford to travel:

“It just doesn’t feel very fair to patients…I have reviewed all options that are available, but then my hands are kind of tied in terms of them saying, ‘Well, how do I get this?’ Or, ‘What’s next?’ I feel I’m just abandoning them.”

Again, a whopping 93% of these OBGYNs reported that they or their colleagues couldn’t follow clinic standards because of state law. And the researchers write that physicians’ inability to give their patients adequate care is having a huge impact on OBGYNs’ mental health and moral well-being. Seventy percent of the doctors had anxiety and depression as a direct result of Dobbs, with one Iraq veteran reporting that it was worse than practicing medicine in a war zone:

“My life was actually at risk in that scenario. I had to wear a flack vest and be armed when I was providing care…but I didn’t feel this way. I never had to see a counselor. I never had any treatment for mental health in all of those years.”

Other doctors used words like muzzled, handcuffed, and straitjacketed. Nearly 90% reported worrying about legal culpability while practicing:

“I’m in the [operating room] dry heaving. I’m not dry heaving because of this surgery. I know how to do this surgery. I trained for this surgery. I trained for the stress of treating an unstable…ectopic pregnancy. I did not train for, I am not ready for thinking about, ‘Is this the case that’s gonna make me a felon?’”

Some OBGYNs even hired criminal defense attorneys on their own dime, for fear that their hospital or institution wouldn’t legally protect them if necessary.

Another big concern from respondents was how to weigh the moral obligation to a current patient versus a future patient, should they be arrested: “Bending the rules [for 1 patient] would compromise my ability to take care of the next 5000 people.”

And while some of the OBGYNs that the researchers spoke to left their state to practice in a place with abortion protections, others were either trapped in anti-choice states because of family obligations, or couldn’t bring themselves to leave:

“I’ve thought so many times about leaving but I’m only 1 of 3 people, really, in this state who can take care of a patient who is possibly dying from their pregnancy. And that makes me want to stay.”

As you’d expect, the researchers also found that hiring and retention has become a huge issue in anti-choice states. They recommend that health care organizations working to attract and retain doctors invest in institutional protections for OBGYNs—like mental health support, resources for burnout, and medical guidance that prioritizes patient health over a conservative interpretation of abortion laws.

The researchers write, “Strong institutional support did not completely protect against adverse health and well-being impacts, but unsupportive institutions often amplified feelings of moral distress, poor mental health, and desire to leave.”

If you have the time to check out the full study, I’d highly recommend doing so. It paints a stark picture of widespread distress among OBGYNs in anti-choice states—and how the already-serious impacts we’ve seen since Dobbs could get even worse in the long term.