Abortion Clinic Laws Linked to Loss of 2+ OB/GYNs Per 100,000 Women
Laws designed to regulate abortion clinics have had a measurable effect on a much broader population: the women who need obstetricians and gynecologists for reasons entirely unrelated to abortion.
A study published in Health Economics tracked the physician workforce in U.S. states that enacted Targeted Regulation of Abortion Providers (TRAP) laws between 2010 and 2021. TRAP laws impose facility requirements on abortion clinics - building standards, equipment mandates, transfer agreements with nearby hospitals - that critics have long described as medically unnecessary and primarily designed to force clinic closures.
What the data shows
The analysis found that enacting TRAP laws was associated with a reduction of more than two obstetrician-gynecologists per 100,000 females aged 15 to 44. The effect was particularly pronounced among two groups: older physicians, who may have chosen retirement over the costs of compliance or the professional environment such regulations created, and newly trained doctors, who may have selected training programs and practice locations in states with fewer restrictions.
Critically, this decline in OB/GYN supply was not offset by increases in alternative providers of women's healthcare. Midwives, nurse practitioners, and physician assistants practicing in women's health did not expand to fill the gap left by departing or never-arriving physicians.
"These findings reveal that abortion restrictions can have much broader effects on maternal healthcare access, raising important considerations for policymakers and healthcare systems nationwide," said corresponding author Quan Qi, a postdoctoral fellow at Johns Hopkins University.
The mechanism
The study does not directly observe physicians leaving states or choosing not to practice in them because of TRAP laws. What it observes is an association between law enactment and workforce outcomes at the population level. The mechanism is an inference, though a plausible one given other research on physician location decisions and the documented effects of political and regulatory environment on where medical professionals choose to train and practice.
Several pathways could account for the finding. Physicians who perform or are willing to perform abortions may relocate to avoid legal risk or professional hostility. Medical students selecting training locations may choose states with less restrictive environments. The professional climate surrounding reproductive healthcare in TRAP law states may affect recruitment and retention of OB/GYN physicians across the board, not just those directly involved in abortion provision.
Women most affected
The women most directly harmed by reduced OB/GYN supply are those in areas already underserved - rural counties, lower-income communities, and regions with fewer large health systems capable of recruiting specialists. These are also frequently the populations with the highest rates of maternal mortality and the greatest need for prenatal and gynecological care.
The study covers 2010 to 2021, a period that predates the Supreme Court's 2022 decision in Dobbs v. Jackson Women's Health Organization. Whether the workforce effects identified have intensified, moderated, or followed different patterns in the post-Dobbs period would require updated data.