Growing OBGYN shortages are threatening maternal health; abortion bans may make them worse

The U.S. has high rates of preventable maternal morbidity and mortality, particularly for Black Americans. And while new research has called some data collection methods into question, there’s no dispute that poor outcomes and disparities persist.

Addressing the problem will require a host of efforts, and a central one would be to address the ongoing shortage of the OBGYNs. A federal study from 2016 predicted a national shortage of nearly 5,000 providers by 2025. 

Given the challenges of long standing financial difficulties and a declining birth rate, a lack of incoming OBGYNs could be the final straw for some maternal care units. As experienced physicians retire, there is not a sufficient number of trainees coming down the pipeline to replace them. (see “Labor and delivery units are closing across the country. Here are some of the names.”)

Case Study: Idaho

Abortion bans implemented following the 2022 Dobbs decision may be putting increased pressure on the physician supply problem in some states. In the 15 months since Idaho has put some of the most restrictive abortion laws in the nation into effect, the state has lost 22% of its practicing obstetricians, according to a recent report from the Idaho Coalition for Safe Healthcare (ICSH). In addition, two obstetrics programs have closed (with a third set to close on April 1), half of Idaho counties now lack practicing obstetricians, and there are high rates of burnout for those remaining.

All of this is happening in a state that, previous to the Dobbs decision, had already experienced a 121.5% increase in maternal mortality. Compounding the problem is a decision by the state to dissolve the existing maternal mortality review board.

It’s reasonable to expect a similar impact in other states. Evidence shows that some physicians in states where abortion bans have been enacted are choosing to relocate, and some new physicians are choosing to avoid abortion ban states altogether. Mindy Sharon, for example, a student from West Virginia currently heading to medical school told this to the Boston Globe:The way health care has been treated here with this ban and the politics of it all just don’t align with my values. I would love to come back and take care of West Virginians, but for right now, this is not a place that’s going to advance my training.’’

Impact on other types of maternal and reproductive health

A shortage of OBGYNs won’t just affect abortion care. These physicians provide many more healthcare services. Patients seeking contraceptives, screening for cervical cancer, and treatment for endometriosis and other chronic conditions may find themselves struggling for appointments as maternity deserts grow. This is especially true for Black Americans.

It’s clear maternal mortality is a public health and health equity crisis, but recent developments suggest we’re going in the wrong direction. If we want maternal mortality to get better, we need to understand the factors contributing to its decline, so we can implement policies that help instead of hurt.