Maternity Care Providers and Trainees Are Leaving States with Abortion Restrictions, Further Widening Gaps in Care

Maternity care deserts — that is, areas with no obstetric providers or hospitals or centers providing maternity care — were recently identified in 35 percent of U.S. counties. These gaps in the maternal care workforce precede the June 2022 Supreme Court ruling (i.e., the Dobbs decision) that overturned Roe v. Wade. But since the Dobbs decision, some states have enacted restrictions on abortion, making access more difficult and heightening disparities among states. In addition to providing maternity care, ob/gyns and certified nurse midwives deliver comprehensive health care for women, including preventive care and contraception. Residency applications, along with surveys of and interviews with medical students, residents, and practicing ob/gyns suggest access to maternity care providers could worsen in some states following the implementation of post-Dobbs abortion restrictions and bans. The Commonwealth Fund’s 2024 State Scorecard on Women’s Health and Reproductive Care found that states with abortion bans and restrictions in place tend to have fewer maternity care providers practicing in obstetrics and gynecology. This post explores current research that shows how post-Dobbs abortion restrictions may further limit access to maternity care providers in some states.

A Decrease in Residency Applicants in Abortion Ban States

Data indicate that medical students may be less likely to apply for residency training in states with abortion bans. Data from the 2023 and 2024 application cycles showed an overall decrease in the number of graduating M.D. students applying to residencies, but an even greater decrease in applicants to states with abortion bans. While training slots continue to be almost entirely filled for now, the number of applicants to ob/gyn residency programs during the 2024 application year decreased 6.7 percent in states with abortion bans from the prior year. In contrast, there was a small (0.4%) increase in ob/gyn residency applicants to states that maintained legal access to abortion. Family medicine residency applicants were also less likely to apply to states with abortion bans during the 2023 application cycle. Surveys of medical students and residency applicants find that most respondents regarded abortion training, along with abortion access for themselves or a partner, as important considerations in deciding where to apply for residency.

Residents Face New Barriers to Training and Providing Care

Standards for ob/gyn training require access to clinical experience in abortion care, even if this must be arranged in a different jurisdiction, that is, one where it is lawful. Surveys and interviews with current residents and training leaders identified uncertainty about residents’ ability to achieve training milestones in restrictive states, along with concerns regarding the potential loss of skills needed to provide the full spectrum of reproductive care. Others have reported on the moral distress experienced by ob/gyn residents in states with restrictive abortion laws. Residents shared experiences of being unable to provide or delaying evidence-based care for their patients due to legal constraints. Some participating residents reconsidered their career choices, including where they would practice medicine in the future. In another survey of graduating ob/gyn residents, 17.6 percent reported changing their intended practice or fellowship training location following Dobbs.

Clinical and Personal Impact on Practicing Physicians

Media reports have highlighted stories of ob/gyns and maternal–fetal medicine specialists leaving states with abortion bans in place, and research has identified clinical and personal impacts on providers. Clinical impacts include the inability to provide appropriate care, along with restrictions on patient counseling and referrals. Participants also reported cases of having to delay medically necessary care related to a pregnancy until a patient was at risk for serious harm or death. On the personal level, physicians reported experiencing moral distress and mental health consequences, including symptoms of depression and anxiety, along with fears concerning legal risk and the potential for criminal prosecution. Some participating physicians reported that they had already moved their practice to more protective states, while others had considered doing do.

Conclusion

Findings suggest disparities in access to maternal care providers could worsen as physicians, those currently in practice as well as those in training, avoid or leave states with restrictive abortion laws. These states already tend to have lower numbers of maternal care providers relative to the population of women of reproductive age. Early evidence suggests that access to reproductive health care may already be affected; a recent study identified a decreasing number of oral and emergency contraceptive prescriptions filled in the most restrictive states. Further study is needed to understand the effects of Dobbs on other members of the maternal care workforce, including certified nurse midwives and other advanced practice providers of reproductive care and women’s health services.

For more details on the effects of the Dobbs decision on the maternity care workforce, see the appendix.