This Expert Column is part of a series that will explore the effects of the Dobbs decision on obstetrician gynecologists’ (OB-GYNs) mental health and emotional well-being, with a particular focus on groups of OB-GYNs who are uniquely or disproportionately affected by it. The pieces that follow will consider the experiences of Black OB-GYNs and OB-GYNs in rural settings, respectively.
More than a year has passed since the Supreme Court overturned Roe v. Wade in Dobbs v. Jackson Women’s Health Organization and eliminated the constitutional right to abortion, leaving regulation to states. Abortion is currently banned in fourteen states, while seven states have restrictive gestational limits in place. Courts have blocked bans adopted by legislators in other states, preventing them from going into effect. The consequences of criminalizing the provision of essential reproductive health services are far-reaching and felt by both physicians and their patients.
Threats of Criminalization
In states that have adopted or implemented bans or restrictions, physicians potentially face civil penalties, criminal liability, or loss of their licenses in the event of an unlawful abortion. Abortion bans in many states contain broad language that leaves OB-GYNs confused about when they can provide care without legal repercussions, particularly in cases of obstetric emergencies. Though some bans make exceptions for medical emergencies, they do so with vague or narrow language. As a result, providers in those states are often hesitant to act in emergency situations given the possible repercussions — placing patients’ health and lives at risk.
For example, in some cases of patients experiencing a miscarriage, emergency medical intervention may become necessary to prevent serious complications. Miscarriage management and abortion services are often clinically similar and treated by similar medications and procedures. As a result, some physicians are unsurprisingly apprehensive about treating miscarriages and other complications that may arise during pregnancy.
Additionally, Black physicians may be disproportionately and uniquely affected by the threats of criminalization that have arisen in the wake of the Dobbs decision. Black physicians tend to face increased scrutiny in the workplace and feel less supported by their employers compared to their white counterparts, even in the absence of potential civil or criminal penalties. Given these experiences, Black OB-GYNs are likely to face heightened surveillance but receive less institutional support in states where abortion is now criminalized.
Mental Health and Emotional Well-Being
The practice of medicine is demanding, and physicians are no strangers to stress, burnout, and mental illness. This is particularly true for OB-GYNs. A recent survey revealed that OB-GYNs experience some of the highest rates of burnout among the various specialties, which can be attributed to long working hours, unpredictable schedules, and complexity of surgical interventions involved. These and other factors contribute to the stress that leads to burnout for OB-GYNs, which can in turn lead to increased medical errors, decreased work effort, and lower patient satisfaction. As of 2020, 15% of OB-GYNs reported having suicidal thoughts, and 1% reported past suicide attempts. The continually changing legal landscape post-Dobbs is likely to exacerbate these troubling trends.
Shortages in the Workforce
Physicians are caught between threats of criminalization and ethical obligations to provide their patients with evidence-based care, and have begun to leave states that ban abortion to practice in less restrictive contexts. Training in abortion care has similarly become scarce in states with sweeping bans, exacerbating the OB-GYN workforce shortage already looming prior to Dobbs. As a result, individuals in more restrictive states are now left with drastically reduced access to essential reproductive health services, and physicians in less restrictive states are overwhelmed by an influx of patients, who are unable to access care where they live. In states where abortion remains legal, some clinics are seeing double the number of patients they were seeing prior to the Dobbs decision.
These increased pressures are especially pertinent for rural parts of the country, where shortages of OB-GYNs exist and physicians are already treating patients who travel long distances to access care. Additionally, due to the unique nature of physician-patient relationships within rural settings, rural physicians often feel compelled to work beyond their areas of expertise in order to meet their patients’ needs. The changing legal landscape post-Dobbs will only worsen preexisting workforce shortages and strains on rural OB-GYNs’ capacity to provide care.
A Path Forward
Now is the time to document and raise awareness on how the post-Dobbs legal landscape further exacerbates trends that ultimately undermine OB-GYNs’ mental health and emotional well-being. We can start this important work by elevating the voices of OB-GYNs who are disproportionately and uniquely affected by the bans that have come into effect in the last year — such as OB-GYNs of color and rural OB-GYNs. Both groups of physicians care for some of our country’s most marginalized patients, and it is imperative that we understand their concerns and ensure they are better equipped to provide quality health services to women and pregnant people throughout the country.