It’s the second anniversary of the Dobbs decision. As a physician, here’s how I’ve seen the landscape change since.  

Two years ago today, the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization to overturn Roe v. Wade. This decision stripped abortion care of its federal protection and left it to individual states to decide.  

Since 1994, over 60 countries have expanded the grounds under which abortion is legal. By contrast, the U.S. is 1 out of only 4 countries to remove legal grounds for abortion during the same timeframe.  

While Roe was the law of the land, my field of work was no stranger to states enacting abortion bans and barriers. From the Hyde Amendment to far more reaching restrictions, not only have we long faced political interference in this care, but Roe also never truly lived up to its promise.  

Unfortunately, the crises created by Roe’s failings have been exasperated in the wake of Dobbs.  

As of this moment, 21 states across the nation have eliminated all or some access to abortion.

Over the last two years, I have watched patients suffer at the hands of government so far removed from what essential medical care is and what happens in patient exam rooms and hospitals.

Here are the outcomes of the Dobbs decision those of us in the medical community forced to stand by and witness, and what the public can do to help.

1. Increase in maternal deaths and infant mortality rates. 

The Dobbs decision and the resulting states with abortion bans have seen a threefold increase in maternal deaths compared to states with abortion protections. This is especially true for Black women, who are already three times more likely to experience death or trauma due to pregnancy and childbirth than white counterparts.  

Additionally, Research reported in the American Journal of Preventive Medicine provides evidence that states with the most restrictive abortion laws saw sixteen percent increase more infant deaths in 2014–2018 than in states offering access to comprehensive reproductive healthcare 

2. Increase in harm to our most vulnerable pregnancy-capable people.  

Abortion bans and restrictions disproportionately impact communities already facing barriers to health care, including Black, Indigenous, and other people of color, people living on low incomes and in poverty, people who are disabled, undocumented people, people in rural areas, and young people.  

Since Dobbs, we have seen first-hand the horrific circumstances that could result in people needing abortion care, from the 10-year-old rape victim denied care in Ohio, to the 64,000 people that gave birth because of rape in states with total abortion bans. 

Additionally, we know that people denied abortion care are three-times as likely to live below the federal poverty line.  

3. Chilling effect on hospitals, ERs and maternity wards. 

As a result of Dobbs, people with wanted pregnancies are being turned away from hospitals and emergency rooms when they need care, and hospitals and ERs have stopped or slowed down miscarriage management and childbirth care because of legal concerns. There is also a lack of labor and delivery services at rural hospitals.  

In states where abortion remains legal, available resources are strained, clinic appointments are taking longer to schedule, and patients must travel longer distances and incur greater expenses for transportation, childcare, and lodging.

4. Chilling effect on basic pregnancy care, causing adverse health outcomes.

(source) 

Preliminary results of a study from Advancing New Standards in Reproductive Health (ANSIRH) shows that abortion bans are forcing medical professionals to deviate from the standard of care they were trained to provide in reproductive emergencies for fear of legal or criminal retribution, leading to delays in care and adverse health outcomes.  

In another recent study, 68% of OBGYNs said that Dobbs made it more difficult to manage pregnancy-related emergencies, and 64% said it has increased maternal mortality.  

Pregnant patients have been denied timely and vital care until they develop severe, life-threatening complications that would have been prevented by early interventions. Some women have even had to undergo hysterectomies and c-sections because of dangerous pregnancies where they were denied health-preserving abortion care. 

5. Reproductive physician training obstacles.

(source) 

The education and training of residents and fellows in Obstetrics and Gynecology (OB GYN) have been challenged by the variation in state laws restricting reproductive health care.  

Fellows in Complex Family Planning, Gynecologic Oncology, Maternal-Fetal Medicine, and Reproductive Endocrinology and Infertility have faced challenges to learning advanced knowledge and skills in their subspecialties. In the last year, residents of these programs in states with abortion bans or restrictions have been forced to travel to other cities and states to learn to provide competent reproductive health care, miscarriage management, and abortion care.   

6. Endangerment of IVF and other fetal personhood laws.

Some women in Alabama no longer have access to in vitro fertilization (IVF) services after the state supreme court ruled that extrauterine embryos have full rights of personhood. The Alabama legislature passed a bill to allow IVF services in the state, but at least one hospital stopped these services out of continuing legal concerns. 

We are seeing similar fetal personhood bills spread like wildfire, with organizations like the Southern Baptist Convention just voting to endorse a ban on IVF.  

7. Rising abortion rates – and falling birth rates.

According to the Guttmacher Institute, the abortion rate in 2023 was 10% higher than in 2020 – the highest number and rate in more than a decade. By contrast, the US birth rate dropped to a record low in 2023.   

We’ve said it before and we’ll say it again: abortion bans DO NOT work, and people need care now more than ever. 

8. Extremist push to criminalize and prosecute doctors and pregnant people.

The Dobbs decision has empowered anti-abortion advocates to criminalize essential health care and those who seek and provide such services. In the past year, we have seen the introduction of federal abortion and contraceptive bans, two that made it all the way to the Supreme Court.  

Abortion bans have also resulted in people being targeted, arrested and jailed for disposing of miscarried embryos, driving a minor to an abortion clinic out of state, or involvement in a loved one’s abortion in any way.   

The World Health Organization recognizes that criminalization of abortion has a chilling effect on the provision of legal abortion services, can delay access to life-saving care, and disproportionately impacts marginalized populations, which are more likely to face prosecution for seeking abortion care. (source)