Policy Changes as a Context for Moral Injury Development in the Wake of Dobbs v Jackson Women's Health Organization

Desai, Alisha; Holliday, Ryan; Wallis, Marianne; Thornewill, Alice; Bahraini, Nazanin H.; Borges, Lauren M.

doi:10.1097/aog.0000000000005009

Cited by 16 publications

(9 citation statements)

References 26 publications

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“…We fear, however, that this motivation and dedication might not stave off the realities of living and working in an abortion-hostile environment. 20 We urge hospital-level administrators, particularly in restrictive states, to heed the concern of impending "brain drain" of physicians who can safely provide not only abortion care but also evidence-based pregnancy and miscarriage care. Graduate medical education leadership may use these data to inform tailored recruitment methods and to increase support from their medical systems.…”

Section: Discussionmentioning

confidence: 99%

Effects of the Dobbs v Jackson Women's Health Organization Decision on Obstetrics and Gynecology Graduating Residents' Practice Plans

Woodcock,

Carter,

Baayd

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To explore the association of the Dobbs v Jackson Women's Health Organization (Dobbs) decision on future practice locations of graduating obstetrics and gynecology residents. METHODS: This is a mixed-methods survey study of obstetrics and gynecology residents graduating from sites with Ryan Program abortion training programs (109 sites) between March 8, 2023, and April 25, 2023. We conducted both univariate and multivariable logistic regression analyses to identify factors that were associated with post-Dobbs change in career plans, particularly location. We also performed a thematic analysis using responses to the survey's optional, open-ended prompt, “Please describe how the Dobbs v Jackson Women's Health Organization decision impacted your professional plans.” RESULTS: Of an estimated 724 residents graduating from residencies with Ryan Program abortion training programs, 349 participated in the survey (48.2% response rate); 17.6% of residents indicated that the Dobbs decision changed the location of intended future practice or fellowship plans. Residents who before the Dobbs decision intended to practice in abortion-restrictive states were eight times more likely to change their practice plans than those who planned to practice in protected states before the Dobbs decision (odds ratio 8.52, 95% CI 3.81–21.0). In a thematic analysis of open-ended responses, 90 residents wrote responses related to “not living in a state with abortion restrictions.” Of residents pursuing fellowship, 36 indicated that they did not rank or ranked lower programs in restrictive states. CONCLUSION: These findings demonstrate reduced desire of residents in obstetrics and gynecology to practice or pursue fellowship in restrictive states after residency. This reduction in obstetrics and gynecology workforce could significantly exacerbate maternity care deserts.

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Section: Discussionmentioning

confidence: 99%

Effects of the Dobbs v Jackson Women's Health Organization Decision on Obstetrics and Gynecology Graduating Residents' Practice Plans

Woodcock,

Carter,

Baayd

et al. 2023

Obstetrics &Amp; Gynecology

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“…However, the broad nature of post– Dobbs v Jackson abortion bans have potential implications for all OB-GYNs in affected states, not just the 14% who provide abortion care . Commentaries have discussed potential impacts of abortion bans on OB-GYNs, pointing to likely increased documentation burdens, ethical challenges, and heightened stress when treating cases in legal gray areas . Workforce-related impacts also include retention and recruitment difficulties .…”

Section: Introductionmentioning

confidence: 99%

“… 19 Commentaries have discussed potential impacts of abortion bans on OB-GYNs, pointing to likely increased documentation burdens, ethical challenges, and heightened stress when treating cases in legal gray areas. 11 , 20 , 21 , 22 , 23 , 24 Workforce-related impacts also include retention and recruitment difficulties. 25 , 26 , 27 , 28 A May 2023 survey found that 55% of Idaho OB-GYNs were seriously or somewhat considering leaving the state due to the abortion ban.…”

Section: Introductionmentioning

confidence: 99%

US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans

Sabbath,

McKetchnie,

Arora

et al. 2024

JAMA Netw Open

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ImportanceFollowing the Dobbs v Jackson Women’s Health Organization decision in June 2022, 17 US states have functionally banned abortion except in narrow circumstances, and physicians found in violation of these laws face felony charges, loss of their medical license, fines, and prison sentences. Patient impacts are being studied closely, but less research has focused on the consequences for obstetrician-gynecologists (OB-GYNs), for whom medically necessary care provision may now carry serious personal and professional consequences.ObjectiveTo characterize perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health, and turnover intention among US OB-GYNs practicing in states with functional bans on abortion.Design, Setting, and ParticipantsThis qualitative study included semistructured, remote interviews with OB-GYNs from 13 US states with abortion bans. Volunteer sample of 54 OB-GYNs practicing in states that had banned abortion as of March 2023.ExposureState abortion bans enacted between June 2022 and March 2023.Main Outcomes and MeasuresOB-GYNs’ perceptions of clinical and personal impacts of abortion bans.ResultsThis study included 54 OB-GYNs (mean [SD] age, 42 [7] years; 44 [81%] female participants; 3 [6%] non-Hispanic Black or African American participants; 45 [83%] White participants) who practiced in general obstetrics and gynecology (39 [72%]), maternal-fetal medicine (7 [13%]), and complex family planning (8 [15%]). Two major domains were identified in which the laws affected OB-GYNs: (1) clinical impacts (eg, delays in care until patients became more sick or legal sign-off on a medical exception to the ban was obtained; restrictions on counseling patients on pregnancy options; inability to provide appropriate care oneself or make referrals for such care); and (2) personal impacts (eg, moral distress; fears and perceived consequences of law violation; intention to leave the state; symptoms of depression and anxiety).Conclusions and relevanceIn this qualitative study of OB-GYNs practicing under abortion bans, participants reported deep and pervasive impacts of state laws, with implications for workforce sustainability, physician health, and patient outcomes. In the context of public policies that restrict physicians’ clinical autonomy, organization-level supports for physicians are essential to maintain workforce sustainability, clinician health and well-being, and availability of timely and accessible health care throughout the US.

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“…Finally, the Dobbs ruling is also likely to affect healthcare providers and trainees providing abortion care and reproductive health services. Anticipated challenges for healthcare professionals may include navigating the uncertainty of rapidly evolving legal restrictions on abortion care, the fear of prosecution or potential loss of medical licenses, facing stigma in the medical field, and more [14,15]. Moreover, the potential conflicts between healthcare providers' personal beliefs and their professional responsibilities surrounding issues such as bodily autonomy and reproductive rights may increase the risk of emotional distress, moral injury, and burnout [14,15].…”

Section: Introductionmentioning

confidence: 99%

Public health and clinical implications of Dobbs v. Jackson for patients and healthcare providers: A scoping review

Zhu,

Zhao,

Alzoubi

et al. 2024

PLoS ONE

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Introduction On June 24, 2022, the U.S. Supreme Court’s decision in Dobbs v. Jackson reversed the precedent set forth by Roe v. Wade, empowering individual states to regulate abortion care. This aftermath of this ruling has given rise to widespread bans, limiting the accessibility of abortion services for patients and impeding providers’ ability to deliver a comprehensive spectrum of reproductive health services. Of particular concern is the disproportionate impact on medically underserved groups, further heightening existing social and structural disparities in reproductive health. Methods We conducted a scoping review to broadly evaluate the clinical and public health impact of Dobbs on patients’ access to abortion care and related reproductive health services, in addition to the training and clinical practice of healthcare providers. We searched eight bibliographic databases (PubMed, Scopus, Embase, PsycINFO, Google Scholar, Science Direct, JSTOR, and Web of Science) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) using various combinations of keywords related to ‘abortion’, ‘Dobbs’, and ‘Roe’ on March 22, 2023. Four reviewers independently screened the studies based on pre-specified eligibility criteria and one reviewer performed data extraction for pre-identified themes. The search was conducted based on PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guidelines. Results Eighteen studies, comprising 12 peer-reviewed articles and 6 study abstracts, met the inclusion criteria. The studies demonstrated that Dobbs increased demand for contraception, magnified existing travel- and cost-related barriers to access, further polarized views on abortion and complex family planning on social media (e.g., Twitter), and evoked substantial concerns among medical trainees regarding their scope of practice and potential legal repercussions for providing abortion care. Conclusion In the wake of Dobbs v. Jackson, further public health and clinical interventions are urgently needed to bridge disparities in abortion care and reproductive health, mitigating the deleterious consequences of this emerging public health crisis.

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Policy Changes as a Context for Moral Injury Development in the Wake of Dobbs v Jackson Women's Health Organization

Abstract: The views expressed are those of the authors and do not necessarily represent the views or policy of their institutions.

Cited by 16 publications

References 26 publications

Effects of the Dobbs v Jackson Women's Health Organization Decision on Obstetrics and Gynecology Graduating Residents' Practice Plans

Effects of the Dobbs v Jackson Women's Health Organization Decision on Obstetrics and Gynecology Graduating Residents' Practice Plans

US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans

Public health and clinical implications of Dobbs v. Jackson for patients and healthcare providers: A scoping review

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