Three years after the U.S. Supreme Court's Dobbs decision ended federal abortion protections, new research reveals complex patterns in how obstetrician-gynecologists are responding to state abortion bans, with significant implications for women's healthcare access.
A recent study published in JAMA Network Open shows that while most OB/GYNs didn't immediately flee states where abortion was banned following the 2022 ruling, the healthcare landscape is now shifting. The number of OB/GYNs in states with bans initially rose by approximately 8% in the months after the decision, similar to growth in states where abortion remains legal. However, a more recent study indicates a significant decline is now occurring in the 12 most restrictive states.
Physician Decision-Making in Restrictive States
For physicians specializing in women's healthcare, the decision to stay or leave states with abortion bans involves complex personal and professional considerations.
"The tone of the conversation is, 'How do I do the best job I can for my patients, and how do I stay out of legal trouble at the same time, and how do I reconcile those?'" explained Lori Freedman, a sociologist and bioethicist at the University of California, San Francisco. She noted that each physician must weigh their own tolerance for risk.
Dr. Nikki Zite, an OB/GYN in Tennessee, chose to remain despite her state's abortion ban. Working at a large academic center, she prioritized continuing to educate future physicians.
"When it came down to it, I feel like being in an academic center in a banned state trying to continue to both provide care and educate students and residents and fellows on why abortion care is health care and part of what all OB/GYNs should be trained to take care of is important," Zite said.
She acknowledged her decision was influenced by her "privileged" position in terms of family situation and institutional support, which she felt allowed her to continue practicing without "too much risk" to her personal liberties and freedom.
The Impact of Specialist Migration
While overall OB/GYN numbers may not show dramatic shifts, the departure of specialists in maternal-fetal medicine has outsized impacts on healthcare systems. Dr. Leilah Zahedi-Spun, who relocated from Tennessee to Colorado where abortion is protected by state law, was one of just eight abortion providers in Tennessee. Her departure left only five remaining.
"It's less about the sheer volume of providers and more about what that care actually looks like," Zahedi-Spun explained. "I was the only person who trained residents to do procedures in the second trimester. So now they're graduating multiple classes of residents that have never done that care before, and they're going to go into communities and not be able to provide that care."
The research comparing OB/GYN practice patterns showed a more than 4% decrease in the percentage of these specialists for every 100,000 women of reproductive age in the most restrictive states compared to states with unchanged abortion policies.
Changes in Clinical Practice
Even physicians who remain in restrictive states report that legal concerns have altered their clinical approach.
"Doctors are definitely very uncomfortable, very scared. They're doing a lot of things differently. They're punting a lot of things that they could have handled before to other people who are more comfortable taking on that sort of risk or the intensity," Freedman noted.
Dr. Zite described experiencing moments of doubt during procedures, not about the clinical decision itself, but about potentially having to defend her medical judgment to non-medical authorities.
The Broader Healthcare Impact
Dr. Jane Zhu, lead researcher of one of the studies and associate professor of medicine at Oregon Health and Science University, expressed concern about the implications of these workforce shifts.
"Health care providers are like any other group — they can vote with their feet — and the fact that they are leaving the states in which clinical autonomy and decision-making is constrained is very worrisome," Zhu said. "These shifts have enormous ramifications for care access and quality."
Dr. Cynthia Gyamfi-Bannerman, chair of obstetrics, gynecology and reproductive sciences at the University of California-San Diego, called the migration pattern "both unfortunate and predictable," noting that "OB/GYNs might choose to practice in states where they are allowed to care for women in the way that makes the most medical sense for the woman's health."
She warned, "If more OB/GYN providers leave these areas, there will be a direct negative effect on women's health."
Patient Impact and Interstate Travel
The changing provider landscape has contributed to significant patient travel for care. According to the Guttmacher Institute, more than 155,000 people traveled out of state for an abortion in 2024, with Illinois alone providing care to more than 20% of those individuals.
For physicians like Zahedi-Spun who relocated, the decision came with emotional complexity. She described feeling guilty about leaving patients behind in Tennessee, having previously felt pride in practicing in states with abortion restrictions.
"When it came time to be like, 'Am I willing to go to jail for that, or lose my license, or not be able to practice medicine anymore?' That's when the rubber hit the road for me," she explained. "I was like, 'I can't take care of anybody if I don't have my license, and I do a lot of good for a lot of people in banned states here in Colorado now, and that feels like the fight I need to fight.'"
As these workforce shifts continue, healthcare systems in restrictive states face mounting challenges in maintaining comprehensive women's healthcare services, particularly for high-risk pregnancies and specialized care.
