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

Abstract

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.

Who Will Save Legal Access to Emergency Abortion?

“…However, as Justice Jackson noted, Idaho’s physicians “will still have to decide whether to provide medical care in the midst of highly charged legal circumstances,” a problem that will remain as long as states continue to interfere in medical decisions best left to pregnant people and their clinicians . Indeed, even before this case, physicians in states with abortion bans have reported distress from uncertainty about what the law permits and having to “choose between standard patient care and their own legal exposure.”…”

Subjective Well-Being and Burnout Among the Maternal and Child Health Workforce

“…27 OBGYNs have also reported mental distress, depression, anxiety, and intentions to leave their jobs as a result of the Dobbs decision. 28 Due to liability concerns and lack of autonomy, approximately 60% of OBGYNs report not wanting to take a job opportunity in a state with heavily restricted access to abortion. 29…”

State Abortion Policy and Moral Distress Among Clinicians Providing Abortion After the Dobbs Decision

“…Since the Dobbs decision, commentaries and qualitative studies have raised concerns about increasing moral distress among clinicians. 6 , 7 , 17 We aimed to quantify moral distress among clinicians providing abortion following the Dobbs decision and to assess differences by state-level abortion policy. We hypothesized that clinicians in states that restrict abortion would report higher moral distress scores compared with clinicians in states that protect abortion.…”