by The Supreme Court’s historic overturning of Roe v. Wade in 2022 has had implications for women’s health beyond abortion, accelerating the gap in obstetrics and gynecology care in some states across the country.
In Texas, the first state to pass more restrictive abortion laws, the fear of discussing abortion has impacted the doctors who practice there and the medical students and gynecologists who want to learn there.
“We asked for it [abortion care] in our curriculum they say, “Oh yeah, it’s a state-funded school. And since the state doesn’t support it, we probably shouldn’t teach it,” says Dr. Dani Mathisen, who earned her medical degree in Texas but moved to Hawaii to complete her gynecologist residency.
Mathisen said she discovered that education on all things abortion-related was so limited that she and her fellow students had to teach themselves. They rented classrooms, where abortion providers taught about abortion care and students practiced with papayas and dragon fruit.
“It’s actually very common,” Mathisen said. “[Fruit] is a really great model for a uterus.”
OB-GYN resident Dr. Adrianne Smith began her residency in Texas but was transferred to a hospital in New Mexico. Like Mathisen, Smith saw how abortion laws affected her education and said restrictions on education lead to restrictions on care — and not just during pregnancy.
“We are now seeing with these new restrictions that more gynecologists are leaving these states,” Smith said. “You need midwives for smear tests, for contraception, for mammograms. Not to mention routine pregnancy care. You need midwives to staff the hospitals and labor and delivery, who are already struggling to stay in rural areas. And so people have to travel further for care – pregnancy or other care – and then wait even longer to be seen.”
These vacancies contribute to what a recent report from the March of Dimes calls an “access crisis to maternity care.” More than a third of U.S. counties are considered maternity care deserts, according to the report. That means they don’t have a single doctor, nurse, midwife or medical center specializing in maternity care, impacting more than 2.3 million women of childbearing age.
“We’ve seen people leave states,” said Dr. Stella Dantas, president of the American College of Obstetricians and Gynecologists. “We know that there is maternal distress across the country that is being exacerbated by people leaving.”
As an example, Dantas cited Idaho, where nearly a quarter of practicing midwives have left the state since strict abortion laws went into effect, according to a report from the Idaho Physician Well-Being Action Collaborative.
Dantas said that in addition to practicing physicians leaving the state, restrictive abortion laws also impact training.
“When a medical student applies for residency training, they now look at residency programs and ask questions, ‘What is the abortion training I’m going to get there? Am I going to get enough training to come out feeling competent and confident to to pursue the field I desire?” said Dr. Dantas.
She further explained that OB/GYN residents must undergo training in abortion care to become certified physicians.
“Abortion is reproductive health care, and gynecologists are the people who provide reproductive health care,” Dantas said. “Abortion is the same procedure used to treat miscarriages [and] ectopic pregnancy management. It is used in situations where the pregnancy is highly desired and it cannot continue for the health of the mother. So you do need that training.”
In May, the Association of American Medical Colleges published a revealing set of data on the domino effect of Roe’s overturn and its potential impact on maternal health. In the two years since Dobbs, states with outright bans saw applications for OB-GYN residency drop by 6.7% in one year, compared to a small increase in applications in states without restrictions.
For Smith, the growing gap in women’s health care has made her want to practice medicine in a state like Texas or Georgia after her residency.
“Patients need us there,” she said. “We need midwives in these areas who can provide these procedures, and education and guidance in the cases where we can still do them. And we need the midwives to advocate for change. If there is no one to advocate on our behalf, of these patients, then we may never see some of these laws overturned.”
The video above was produced by Brit McCandless Farmer and edited by Scott Rosann.
