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A Public Review of OBGYNs' Encounters After Dobbs

A Public Review of OBGYNs' Encounters After Dobbs
Source: kff.org

Introduction: Dobbs v. Jackson The Women's Health Organization, one year ago, overturned Roe v. Wade and made it possible for states to prohibit or severely restrict the provision of abortion services. Today, people in large parts of the country who want an abortion either have to travel to other states to get services or self-abort with medication. While gestational limits and other restrictions limit access to abortion, abortion is not illegal in many states. As a result, significant access to abortion has been denied to a large portion of the United States, particularly in the Southeast and South. Abortion providers have had to take on more patients traveling to their states to get an abortion in the states where abortion is still generally legal. In addition, the situation in many states remains uncertain, with new prohibitions frequently followed by legal challenges, making it difficult for patients and clinicians, particularly those who provide services to pregnant patients, to navigate the landscape.


KFF conducted a nationally representative survey of office-based OBGYNs practicing in the United States who provide sexual and reproductive health care to at least 10% of their patients and spend the majority of their working hours providing direct patient care (60 percent or more). 569 OBGYNs responded to the survey, which was conducted from March 17 to May 18, 2023. This survey compares the experiences of OBGYNs practicing in states where abortion is completely illegal, states with restrictions on gestation, and states where abortion is generally legal to provide sexual and reproductive health care before and after the Dobbs decision. This report's text highlights all statistically significant differences.


Key Results

Access to abortion and restrictions on medical care since Dobbs

  • Half of OBGYNs who work in states where abortion is illegal say they have seen patients who were unable to get the abortion they wanted since the Dobbs decision. This is the situation for one in four office-based OBGYNs nationwide (24 percent).
  • One in five office-based OBGYNs (20%) say that since the Dobbs decision, they have personally experienced limitations in their ability to treat miscarriages and other medical emergencies related to pregnancy. This percentage rises to four out of ten OBGYNs in states where abortion is illegal (40 percent).
  • Six out of ten OBGYNs practicing in states where abortion is illegal or where gestational limits are set say that their decision-making autonomy has decreased since the Dobbs ruling, compared to four out of ten nationally (44%). Over a third of OBGYNs nationwide (36%) and half of those practicing in states with gestational limits or prohibitions on abortion (47%) claim that their ability to practice within the standard of care has deteriorated.
  • The ruling, according to the majority of OBGYNs (68%), has hindered their ability to manage pregnancy-related emergencies. Sixty-four percent of respondents also believe that the Dobbs decision has exacerbated pregnancy-related mortality, racial and ethnic disparities in maternal health, and the ability to recruit new OBGYNs.


Policies Regarding Abortion and Concerns About Legal Risk

  • Nationally, two-thirds of OBGYNs (68%) say they are very familiar with the conditions under which abortion is legal in the state in which they practice. However, the percentage of OBGYNs practicing in states where abortion is generally available (79%) or prohibited is lower (45%) than the percentage of OBGYNs practicing in states where abortion is legal.
  • When deciding whether or not an abortion is necessary or not for a patient, over four out of ten (42 percent) OBGYNs say that they are very or somewhat concerned about their own legal risk. This means that more than half of OBGYNs (59%) work in states with restrictions on gestational age and abortion prohibitions.
  • A recent FDA policy change that allows certified pharmacies to dispense medication for abortion pills is supported by eight out of ten OBGYNs.


SERVICES FOR ABORTIES

  • After the Dobbs, only 10% of office-based OBGYNs in states with gestational restrictions offer abortion care, compared to 39% of OBGYNs practicing in states where abortion is generally available. Nearly one in five (18%) office-based OBGYNs nationwide report providing abortion services. Prior to the decision by the Supreme Court, there were already significant differences between states. Prior to the Dobbs decision, these or similar restrictions were in place in many states that currently prohibit abortion.
  • Only 5% of OBGYNs say they perform telehealth medication abortions, while 14% of OBGYNs nationwide say they perform in-person medication abortions.
  • Except in extremely rare instances, there are virtually no OBGYNs who provide abortion services in states where it is illegal to do so. In addition, while 30% of OBGYNs in these states do not even provide their patients with any information about abortion or referrals to another clinician, nearly half (48%) of them only provide information, such as online resources, to assist patients in independently locating abortion services.


CONTRACEPTION

  • Since the Dobbs decision, more than half (55 percent) of OBGYNs in the country say they have seen an increase in the number of patients seeking some form of contraception, particularly sterilization (43 percent) and IUDs and implants (47 percent).
  • Although nearly all OBGYNs provide their patients with some form of contraceptive care, only 29% provide all methods of contraception, including all three emergency contraceptive methods (copper intrauterine device (IUD), ulipristal acetate (Ella), and levonorgestrel (Plan B)).
  • One in seven OBGYNs (15%) do not offer any emergency contraception to their patients, and only one third of OBGYNs (34%) prescribe or provide all three methods. Twenty-five percent of OBGYNs only prescribe or provide Plan B, which can be purchased over the counter.
  • After the COVID-19 pandemic started, telehealth care became much easier to get. Today, 69 percent of OBGYNs nationwide say they use telehealth to provide at least some care.

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