Shocking Revelations: What Obstetricians and Gynecologists Reveal After Dobbs – You Won’t Believe the Results!

Introduction

A year ago, the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization tipped over Roe vs. Wade and opened the door for states to ban or severely restrict the availability of abortion services. Today, people seeking an abortion in large parts of the country must travel to other states to obtain abortion services or obtain a medical abortion through self-directed or other means. In many states, abortion is not prohibited, but laws impose pregnancy limits and other restrictions that limit access to abortion. This has left large parts of the US, particularly in the South and Southeast, without meaningful access to abortion. In states where abortion remains available in most circumstances, abortion providers have had to accept additional patients who travel to their states for abortions. Additionally, the situation in many states remains uncertain, with the implementation of new bans often followed by legal challenges creating a complicated landscape for patients and doctors, particularly those who provide services to pregnant people.

To understand the impact of the changing abortion landscape on clinical care, KFF conducted a nationally representative survey of office-based OB/GYNs in the United States who spend the majority of their working hours (60% or more) to direct patient care and provide sexual care and reproductive health care to at least 10% of patients. The survey was conducted from March 17 to May 18, 2023, and responses were received from 569 obstetricians and gynecologists. This survey examines the delivery of sexual and reproductive health services by obstetricians and gynecologists before and after the Dobbs decision, comparing the experiences of obstetricians and gynecologists who practice in states where abortion is completely prohibited, states with pregnancy restrictions, and states where abortion remains available in most circumstances. All differences highlighted in the text of this report are statistically significant.

Additional Piece: The Impact of Abortion Restrictions on Women’s Health

The Supreme Court decision in Dobbs v. Jackson Women’s Health Organization marked a significant turning point in the reproductive rights landscape in the United States. With the tipover of Roe vs. Wade, states now have the power to ban or severely restrict the availability of abortion services. While the intention behind these regulations may be driven by moral or ideological beliefs, the consequences are far-reaching and detrimental to women’s health.

One of the most prominent effects of these restrictions is the limited access to abortion services across many parts of the country. In states where abortion is completely prohibited, women must undertake significant travel to seek essential healthcare. This places a significant financial and logistical burden on individuals, particularly those who are already vulnerable due to socioeconomic factors or lack of transportation. Additionally, self-directed abortions or obtaining abortion medications online can lead to unsafe practices and increased health risks.

Even in states where abortion remains available in most circumstances, laws imposing pregnancy limits and other restrictions hinder access to timely and appropriate care. Women may face significant delays in obtaining an abortion, pushing them further into a pregnancy they may not be prepared for emotionally or financially. These restrictions also create uncertainty, as legal challenges and ongoing debates surrounding reproductive rights further complicate the landscape for patients and healthcare providers alike.

The consequences of limited access to abortion extend beyond the individual level. Obstetricians and gynecologists, who are on the frontline of providing reproductive healthcare, face challenges in delivering comprehensive care to their patients. The autonomy and decision-making authority of these healthcare professionals have been compromised by the Dobbs decision, leading to ethical dilemmas and potential legal risks.

Additionally, the impact of the Dobbs decision goes beyond abortion services alone. The survey conducted by KFF highlights the worsening ability of OB/GYNs to handle pregnancy-related emergencies, increased pregnancy-related mortality rates, and racial and ethnic disparities in maternal health. These alarming trends illustrate the systemic impact of abortion restrictions on women’s overall reproductive and maternal healthcare outcomes.

It is crucial to recognize that comprehensive reproductive healthcare includes more than just access to abortion services. Contraception plays a crucial role in family planning and preventing unwanted pregnancies. However, the survey indicates that while most OB/GYNs offer some form of contraceptive care, there are gaps in the provision of emergency contraception methods, leaving women without essential options in times of need.

The COVID-19 pandemic has further underscored the importance of telehealth in delivering healthcare services. The expansion of telehealth has facilitated access to care, particularly during times when in-person visits may be challenging. However, the limited availability of medical abortions via telehealth highlights the ongoing barriers faced by women in obtaining necessary reproductive healthcare remotely.

In conclusion, the Dobbs decision has had a profound impact on women’s access to abortion services, reproductive healthcare, and overall health outcomes. Limited access to abortion, compromised decision-making autonomy for healthcare providers, and disparities in contraception options all contribute to a landscape that compromises women’s reproductive rights and healthcare. It is crucial for policymakers and advocates to recognize the importance of comprehensive reproductive healthcare and address the barriers women face in obtaining the care they need.

Introduction

A year ago, the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization tipped over Roe vs. Wade and opened the door for states to ban or severely restrict the availability of abortion services. Today, people seeking an abortion in large parts of the country must travel to other states to obtain abortion services or obtain a medical abortion through self-directed or other means. In many states, abortion is not prohibited, but laws impose pregnancy limits and other restrictions that limit access to abortion. This has left large parts of the US, particularly in the South and Southeast, without meaningful access to abortion. In states where abortion remains available in most circumstances, abortion providers have had to accept additional patients who travel to their states for abortions. Additionally, the situation in many states remains uncertain, with the implementation of new bans often followed by legal challenges creating a complicated landscape for patients and doctors, particularly those who provide services to pregnant people.

To understand the impact of the changing abortion landscape on clinical care, KFF conducted a nationally representative survey of office-based OB/GYNs in the United States who spend the majority of their working hours (60% or more) to direct patient care and provide sexual care. and reproductive health care to at least 10% of patients. The survey was conducted from March 17 to May 18, 2023, and responses were received from 569 obstetricians and gynecologists. This survey examines the delivery of sexual and reproductive health services by obstetricians and gynecologists before and after the Dobbs decision, comparing the experiences of obstetricians and gynecologists who practice in states where abortion is completely prohibited, states with pregnancy restrictions, and states where abortion remains available in most circumstances. All differences highlighted in the text of this report are statistically significant.

key results

Access to abortion and limitations in care from Dobbs

• From the Dobbs decision, half of OB/GYNs who practice in states where abortion is prohibited say they have had patients in their practice who were unable to obtain the abortion they sought. This is the case for one in four (24%) obstetricians in offices nationwide.
• Nationally, one in five office-based OB/GYNs (20%) report that they have personally felt limitations in their ability to provide care for miscarriages and other pregnancy-related medical emergencies since the Dobbs decision. In states where abortion is prohibited, this proportion rises to four in ten obstetricians and gynecologists (40%).
• Four in 10 obstetricians and gynecologists nationally (44%), and six in 10 who practice in states where abortion is prohibited or where there are pregnancy limits, say their autonomy in decision-making has worsened since the ruling Dobbs. More than a third of OB/GYNs nationally (36%), and half who practice in states where abortion is prohibited (55%) or where there are pregnancy limits (47%), say their ability to practice within of the standard of care has worsened.
• Most OB/GYNs (68%) say the ruling has worsened their ability to handle pregnancy-related emergencies. Large percentages also believe the Dobbs decision has worsened pregnancy-related mortality (64%), racial and ethnic disparities in maternal health (70%), and the ability to attract new OB/GYNs to the field (55%) .

Abortion policies and concerns about legal risk

• Two-thirds of obstetricians and gynecologists nationwide (68%) say they fully understand the circumstances under which abortion is legal in the state where they perform it. However, among OB/GYNs in states where abortion is restricted by gestational limits, the proportion is lower (45%) compared to those who practice in states where abortion is available in most circumstances (79%). or is prohibited (68%).
• More than four in ten (42%) OBGYNs report that they are very or somewhat concerned about their own legal risk when making decisions about patient care and the need for abortion. This rises to more than half of OB/GYNs practicing in states with gestational limits (59%) and abortion bans (61%).
• Eight out of ten OB/GYNs approve of a recent FDA policy change that allows certified pharmacies to dispense abortion pills with medication.

abortion services

• Nearly one in five (18%) obstetricians and gynecologists nationally say they are providing postpartum abortion services. Dobbs About three in 10 obstetricians and gynecologists (29%) practicing in states where abortion is available in most circumstances offer abortion services, compared to just 10% in states with pregnancy restrictions. There were already big differences between states before the Supreme Court ruling. Many of the states that currently have abortion restrictions had these or similar restrictions before the Dobbs decision.
• Nationally, 14% of OB/GYNs say they provide medical abortions in person, but only 5% say they provide medical abortions via telehealth.
• In states where abortion is prohibited, virtually no OB/GYNs offer abortions, except in very limited circumstances. Additionally, nearly half (48%) of OB/GYNs in these states only offer information, such as online resources, to help patients seek abortion services on their own, but 30% do not even offer referrals to their patients to another doctor or any information about abortion.

Contraception

• More than half (55%) of OB/GYNs nationwide say they have seen an increase in the proportion of patients seeking some form of contraception since Dobbs regulations, particularly sterilization (43%) and IUDs and implants (47%).
• Almost all OB/GYNs offer their patients some form of contraceptive care, but only 29% make all methods of contraception available to their patients, including all three methods of emergency contraception (copper IUD), ulipristal acetate/Ella and levonorgestrel/Plan B).
• Only one-third of OB/GYNs (34%) prescribe or provide all three methods of emergency contraception, and one in seven (15%) do not provide any emergency contraception to their patients. A quarter of OBGYNS (25%) only prescribe or provide Plan B, which is available without a prescription.
• The availability of care via telehealth expanded tremendously after the onset of the COVID-19 pandemic. Today, nearly seven in ten OB/GYNs (69%) nationally say they provide at least some care via telehealth.