Data shows minimal changes to OB-GYN workforce following abortion bans, but that could change

Across the country there is evidence that abortion restrictions have made it harder on reproductive health care workers, and that many have left their practice because of those restrictions. 

But there is no one perfect database to show how the Supreme Court decision in Dobbs v. Jackson’s Women’s Health Organization has changed the health care workforce overall, said Julia Strasser, a professor and researcher of health policy and public health at George Washington University. 

For one, many databases that include physicians often don’t require that people update them if those physicians moved or stopped practicing. 

But Strasser also said that while the Dobbs decision clearly caused a “shock to the system” and likely will have repercussions on the availability of reproductive care, that doesn’t mean data at this point shows the whole story. 

“We're going to have to look at it over time, because I think well, if there is a change, it will take a while to unroll,” Strasser said.

What Strasser and her colleagues have found, through an analysis of a national workforce database, is that over the past two years there were minimal changes in the OB-GYN workforce in both states with strict or total abortion bans and without. That includes Georgia, which actually saw a small bump in the workforce relative to the state's population. 

Though these changes weren't statistically significant, that doesn't mean anecdotal evidence doesn't hold value too, said Strasser. 

“I know that there are OB-GYNs who are leaving because we've seen stories about them,” Strasser said. 

And that can be especially devastating in rural areas already facing poor access to care.

There are historical factors to consider, too. States with strict laws around abortion now have generally had a smaller OB-GYN workforce. These are states such as Georgia, Texas, Iowa and Louisiana, among others. 

“Going back to 2017 … those are the states that have fewer OB-GYN enrollments per population compared to the states that don't have bans,” Strasser said. 

That points to longstanding issues with retention. 

As of 2022, there were just over 1,200 physicians practicing obstetrics and gynecology actively licensed with the Georgia Composite Medical Board. Licenses last for two years, so updated counts for 2024 are expected “in the coming weeks,” said Leanne Greenwood with the Georgia Board of Health Care Workforce 

Meanwhile, another group that could indicate changes in the workforce are medical residents. 

In 2023, the Association of American Medical Colleges recorded a decrease in applications to OB-GYN programs in states that had enacted stricter abortion laws. Yet, all the programs included in the survey still filled every residency spot. 

Again, that points to a need for more analysis, and likely more waiting too, Strasser said. 

“I think finding a lower number of OB-GYN applicants is important to document,” Strasser said. “But at the moment, I don't know that that is translating yet into fewer OB-GYNs that are in practice.

The law in Georgia

Reports show some medical providers, including those in the emergency room, have struggled with interpreting abortion laws that were largely created without their input. 

Abortion in Georgia is illegal past the detection of a so-called “fetal heartbeat,” detected by ultrasounds around six weeks of pregnancy. 

In September, state public health agencies sent providers a one-pager pointed at addressing “misinformation” regarding Georgia’s abortion law, specifically around medical emergencies. The notice came just days after reporting by ProPublica into the death of two Georgia women who experienced pregnancy-related medical complications. 

“Physicians are reminded that Georgia law requires life-saving medical care to a mother without delay when necessary,” reads the notice. In addition, it says that medical providers are protected from legal action if they perform an abortion “at any stage of pregnancy to save the life and health of the mother.”

In the case of both Amber Nicole Thurman and Candi Miller, medical records showed tissue left over from incomplete abortions after six weeks of pregnancy. That tissue would typically be removed through a procedure called a dilation and curettage. While Thurman tried to get one at a hospital, Miller did not. Both deaths were deemed preventable by the state.