A new national JAMA study found a 4% drop in OB-GYN practitioners per 100,000 reproductive-age women in the states with the most restrictions on reproductive healthcare, compared to no decline in states without new restrictions. Since the Dobbs ruling in 2022, increasingly restrictive abortion laws have caused alarming rates of OB-GYNs from affected states to stop practicing medicine in the area, creating maternity care deserts. Maternity care deserts are defined by March of Dimes as “any county without a hospital or birth center offering obstetric care and without any obstetric clinicians.”
Strict restrictions on abortion are changing the places where aspiring doctors choose to receive their training, endangering access to long-term healthcare in areas that are already underprivileged. Abortion-ban states saw a 6.7% decline in OB-GYN residency applications during the 2023–2024 cycle, while states with legal abortion saw a slight 0.4% increase. This decrease is indicative of medical graduates’ increasing hesitancy to practice full-spectrum reproductive care in states with restrictive legislation. “People don’t want to go to a place where evidence-based practice and human rights in general are curtailed,” Beverly Gray, a professor at Duke University School of Medicine told KFF Health News. In addition to limiting training options, this chilling effect exacerbates provider shortages in underserved and rural areas.
In states like Texas, Tennessee, Idaho, and South Carolina, OB-GYNs are leaving their jobs, not just because of political differences, but due to legal threats, professional restrictions, and the moral distress of not being able to provide care they know their patients need. Providers talk about working in a state of constant anxiety because they are afraid that they might be prosecuted for treating a pregnancy emergency or miscarriage. 60 percent say they fear legal retaliation, and almost 40 percent say they limit emergency pregnancy care or miscarriage care.
Due to their inability to provide abortion education on-site, these states’ training programs are having difficulty maintaining their accreditation, forcing residents to travel outside of their state to finish their coursework. In the end, one Tennessee doctor, once one of only eight abortion providers in the state, packed up and left, preferring to safeguard her conscience and her license over continuing to work in a system that penalized her for providing medical care.
States with restrictive abortion laws are experiencing some of the nation’s worst maternal and infant health outcomes. Maternal death rates in these states are 62% higher, and perinatal mortality is 15% higher compared to states where abortion remains accessible. Access to prenatal care is also slipping, in 2023, early and adequate care fell from 77% to 76.1%, while the percentage of people receiving no prenatal care at all rose by 5%. These challenges are especially acute in many Southern and politically conservative red states, such as Mississippi, Georgia, Louisiana, Alabama, and South Carolina; Black people constitute a significantly larger share of the population, with states like Mississippi and Georgia reporting Black populations above 30–37%.
Unfortunately, these same states also lead the nation in maternal mortality. For example, Mississippi’s overall maternal death rate recently reached 82.5 per 100,000 live births, while Louisiana’s stood at around 60.9—both among the highest nationwide. The racial disparities are even more pronounced: Black women across the U.S. face maternal mortality rates approximately 2.6 times higher than those of white women (49.5 vs. 19.0 per 100,000 in 2022), with national metrics showing Black women at 69.9 versus 26.6 for white women. In rural Georgia, the situation is dire, Black women are experiencing maternal mortality rates double that of their rural white counterparts and 30% higher even than urban Black women.
Bans on abortion are not isolated legislative actions; rather, they are disrupting whole systems of reproductive healthcare. These laws are having an impact that goes well beyond abortion care by forcing providers out of states with restrictions, decreasing training opportunities, and undermining patient-clinician trust. Maternal and infant mortality will rise in the states that can least afford it, and the growing provider deficit will worsen already-existing health disparities, especially for communities of color in the South. The survival and dignity of patients nationwide are at risk.