In a new study, co-authors Dr. Justin H. Markowski and Aline Vandenbroeck, both from the UIC School of Public Health, show that laws that impose additional requirements on abortion clinics and providers have decreased the availability of obstetricians and gynecologists overall. (Photo: Jenny Fontaine/UIC).
Nearly half the counties in the United States do not have obstetricians and gynecologists — physicians who provide essential health care to women of all ages. Research findings from the University of Illinois Chicago suggest that three decades of laws targeting abortion providers have resulted in this shortage and that these laws have obstructed access to women’s health care, especially in rural communities.
In a new study in Health Affairs, co-authors Aline Vandenbroeck, a PhD candidate in health policy and administration, and Justin Markowski, assistant professor in the UIC School of Public Health, show that laws that impose additional requirements on abortion clinics and providers have decreased the availability of obstetricians and gynecologists overall.
These laws, also known as targeted regulation of abortion providers, or TRAP laws, stem from the U.S. Supreme Court decision in Planned Parenthood v. Casey. That 1992 decision reaffirmed the right to abortion established in Roe v. Wade but introduced the “undue burden” standard: states can regulate abortions as long as those regulations don’t put an undue burden on a woman seeking an abortion.
In their study, Vandenbroeck and Markowski report data indicating these laws influence OB-GYNs’ decisions about where to practice medicine and whether to practice at all.
“There’s both a shortage situation and maldistribution and equity issues at play here, because rural communities are disproportionately affected by the shortage of providers despite, on average, having higher birth rates,” Vandenbroeck said. “So we wanted to understand whether these laws enacted over three decades may have played a role in shaping these disparities in access to obstetricians and gynecologists.”
The researchers say their study is the first known investigation into the causal relationship between these laws and access to OB-GYNs over the three-decade period before the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in 2022, which ended the constitutional right to an abortion.
After the Planned Parenthood v. Casey decision in 1992, states passed laws that required facility upgrades, specific staffing levels or other changes that can be difficult and costly for clinics to meet, potentially forcing them to close, the researchers said.
“These laws are telling clinics, if you provide abortions, you need to have a corridor of a certain width, or you need to comply with ambulatory surgical center requirements. So what happens to providers when clinics close?” Vandenbroeck said. “What we find is that not only do they affect abortion access, but they also affect the broader access to women’s health care, because gynecologists and obstetricians provide other types of care beyond abortion.”
Markowski said their findings reveal these laws have caused a loss of 1 in 20 providers serving 100,000 women of reproductive age.
The study also found significant decreases in providers who were 45 and older and had no evidence that they had relocated. That suggests OB-GYNs, when faced with targeted regulation of abortion provider laws, were more likely to retire early or leave the workforce altogether than to continue working.
“They are essential for the training of the future women’s health care workforce, and so it may impact the mentorship and skills that are passed from one generation of providers to the next and also disrupt existing patient-physician relationships,” Vandenbroeck said of veteran health care providers. “When you lose older providers, you lose those that are rooted in their community.”
Laws regulating abortion providers are in effect in 24 states, 14 of which do not have a total abortion ban in place.
“In states with total abortion bans post-Dobbs, TRAP laws may not be relevant or enforced anymore, as abortion is illegal in most cases. But these laws are still at play in states without full bans, and therefore still enforced and restricting abortion access in the U.S. today,” Vandenbroeck said.
Vandenbroeck and Markowski hope policymakers consider their findings when deciding whether to enact further abortion restrictions or keep such laws on the books.
“We would hope for policymakers in states where TRAP laws are still in place to reflect on these findings and weigh their policy goals, the intent of these laws against the fact that they have spillover effects on the broader health care workforce,” Vandenbroeck said.
