OB/GYNs feel effect of US abortion bans on workforce, personal health, patient care

Key takeaways:

• OB/GYNs in states with abortion restrictions reported both clinical and personal impacts.
• Reported impacts included care delays, counseling restrictions, moral distress, depression and anxiety symptoms.

Based on interviews with 54 self-selected OB/GYNs, researchers reported in JAMA Network Open that OB/GYNs experienced “deep and pervasive” impacts from state abortion bans on workforce sustainability, physician health and patient outcomes.

“Prior to Dobbs v. Jackson, many studies documented how state-level abortion restrictions imposed stressful burdens on clinicians who provide abortion care, amplifying abortion stigma and interfering with patient-clinician rapport, thereby contributing to occupational stress, compassion fatigue and burnout,” Erika L. Sabbath, ScD, associate professor at the School of Social Work at Boston College and the Center for Work, Health, & Well-Being at Harvard T.H. Chan School of Public Health, and colleagues wrote. “However, the broad nature of post-Dobbs v. Jackson abortion bans has potential implications for all OB/GYNs in affected states, not just the 14% who provide abortion care.”

Sabbath and colleagues conducted a qualitative study using semi-structured, remote interviews with 54 obstetricians and gynecologists (mean age, 42 years; 81% women) from 14 states with abortion bans as of March 2023. Researchers identified and recruited interviewees using announcements made on OB/GYN listservs and social media groups, professional networks, direct email recruitment and snowball sampling.

The interview covered professional backgrounds, perspectives on abortion bans, any impact of bans on clinical practice and experiences of moral distress, personal health and well-being, and institutional practices and policies.

Researchers used responses to characterize perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health and turnover intention for OB/GYNs in the U.S.

Of study participants, 72% practiced in general obstetrics and gynecology, 13% practiced in maternal-fetal medicine and 15% practiced in complex family planning. Researchers identified the following as major domains in which abortion laws affected OB/GYNs:

• clinical impacts, including delays in care, pregnancy counseling restrictions and ability to provide appropriate care or make referrals for care; and
• personal impacts, including moral distress, fears and perceived consequences of breaking the law, intentions to leave the state and depressive and anxiety symptoms.

According to researchers, many respondents reported needing to delay medically necessary care until their patients were at risk for death or permanent impairment or the fetal heart spontaneously stopped. In addition, researchers noted that respondents also reported being unable to provide abortion referrals or discuss abortion as an option with patients and, therefore, were unable to provide appropriate care to those in need.

Regarding personal impacts, 93% of respondents reported experiencing situations in which they or a colleague could not follow clinical standards due to legal constraints, which led to moral distress, and 87% of respondents reported fears about practicing in such a climate. Eleven percent of respondents reported moving their practices to states with stronger protections for abortion. Finally, 70% of respondents reported feeling anxiety and depressive symptoms directly attributable to Dobbs.

Study limitations included possible selection bias due to the use of non-probabilistic sampling strategies and the limited sample of OB/GYN specialties rather than inclusion of family medicine physicians, nurse midwives and others.

“Given that states with the most restrictive laws were already among the states with highest rates of pregnancy-related mortality prior to the Dobbs v. Jackson ruling, loss of clinicians in these states could further exacerbate geographic disparities in pregnancy outcomes,” the researchers wrote. “Supporting the OB/GYN workforce in the current policy environment is essential for preserving timely and accessible reproductive health care in the U.S.”