A National Survey of OBGYNs’ Experiences After Dobbs

Introduction

One year ago, the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade and opened the door for states to ban or severely restrict the availability of abortion care. Today, people seeking abortion in large swaths of the country must travel to other states to get abortion services or obtain medication abortion through self-managed or other means. In many states, abortion is not banned, but laws impose gestational limits and other restrictions that limit access to abortion. This has left large parts of the U.S., particularly in the South and Southeast, without meaningful abortion access. In the states where abortion remains available under most circumstances, abortion providers have had to take on additional patients traveling to their states to get an abortion. Furthermore, the situation in many states remains uncertain, with new bans being implemented that are often followed by legal challenges creating a complicated landscape to navigate for patients and clinicians, particularly those who provide services to pregnant people.

To understand the impact of the changing abortion landscape on clinical care, KFF conducted a nationally representative survey of office-based OBGYNs practicing in the United States who spend the majority of their working hours (60% or more) in direct patient care and provide sexual and reproductive health care to at least 10% of patients. The survey was fielded from March 17 to May 18, 2023, and responses were received from 569 OBGYNs. This survey examines the provision of sexual and reproductive health care provided by OBGYNs before and after the Dobbs decision, comparing the experiences of OBGYNs practicing in states where abortion is fully banned, states with gestational restrictions, and states where abortion remains available under most circumstances. All differences highlighted in the text of this report are statistically significant.

Key Findings

Abortion Access and Constraints on Care Since Dobbs

• Since the Dobbs decision, half of OBGYNs practicing in states where abortion is banned say they have had patients in their practice who were unable to obtain an abortion they sought. This is the case for one in four (24%) office-based OBGYNs nationally.
• Nationally, one in five office-based OBGYNs (20%) report they have personally felt constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies since the Dobbs decision. In states where abortion is banned, this share rises to four in ten OBGYNs (40%).
• Four in ten OBGYNs nationally (44%), and six in ten practicing in states where abortion is banned or where there are gestational limits, say their decision-making autonomy has become worse since the Dobbs ruling. Over a third of OBGYNs nationally (36%), and half practicing in states where abortion is banned (55%) or where there are gestational limits (47%), say their ability to practice within the standard of care has become worse.
• Most OBGYNs (68%) say the ruling has worsened their ability to manage pregnancy-related emergencies. Large shares also believe that the Dobbs decision has worsened pregnancy-related mortality (64%), racial and ethnic inequities in maternal health (70%) and the ability to attract new OBGYNs to the field (55%).

Abortion Policies and Concern About Legal Risk

• Two-thirds of OBGYNs nationally (68%) say they understand the circumstances under which abortion is legal in the state they practice very well. However, among OBGYNs in states where abortion is restricted by gestational limits the share is lower (45%) compared to those practicing in states where abortion is available under most circumstances (79%) or banned (68%).
• Over four in ten (42%) OBGYNs report that they are very or somewhat concerned about their own legal risk when making decisions about patient care and the necessity of abortion. This rises to more than half of OBGYNs practicing in states with gestational limits (59%) and abortion bans (61%).
• Eight in ten OBGYNs approve of a recent policy change from the FDA that allows certified pharmacies to dispense medication abortion pills.

Abortion Services

• Nearly one in five (18%) officed-based OBGYNs nationally say that they are providing abortion services after the Dobbs About three in ten OBGYNs (29%) practicing in states where abortion is available under most circumstances offer abortion care, compared to just 10% in states with gestational restrictions. There were already large differences between states prior to the Supreme Court’s ruling. Many of the states that have abortion restrictions today had these or similar restrictions in place prior to the Dobbs decision.
• Nationally, 14% of OBGYNs say they provide in-person medication abortions, but only 5% say they provide telehealth medication abortions.
• In states where abortion is banned, essentially no OBGYNs offer abortions, except under very limited circumstances. Additionally, nearly half (48%) of OBGYNs in these states only offer information, such as online resources, to help patients seek out abortion services on their own, but 30% do not even offer their patients referrals to another clinician or any information about abortion.

Contraception

• More than half (55%) of OBGYNs nationally say they have seen an increase in the share of patients seeking some form of contraception since the Dobbs ruling, particularly sterilization (43%) and IUDs and implants (47%).
• Nearly all OBGYNs offer their patients some form of contraceptive care, but only 29% make all methods of contraception available to their patients, including all three methods of emergency contraception (copper intrauterine device (IUD), ulipristal acetate/Ella, and levonorgestrel/Plan B).
• Only one-third of OBGYNs (34%) prescribe or provide all three methods of emergency contraception and one in seven (15%) do not provide any methods of emergency contraception to their patients. A quarter of OBGYNS (25%) only prescribe or provide Plan B, which is available over the counter.
• Availability of care via telehealth expanded greatly after the onset of the COVID-19 pandemic. Today, almost seven in ten OBGYNs (69%) nationally say they provide at least some care via telehealth.