Latest news with #DobbsDecision
Medscape
09-07-2025
- Health
- Medscape
Obstetrics in the Time of Dobbs
Catherine Cansino, MD Asked about her reaction to the Supreme Court's ruling in Dobbs v. Jackson Women's Health Organization in 2022 eliminating the federal constitutional right to abortion, Catherine Cansino, MD, replied, 'There's a lot of fear.' In the resulting fallout from the Dobbs decision, 41 states now ban abortion altogether or at varying gestational ages and with varying exceptions. If a patient is having a miscarriage or an ectopic pregnancy, they may wonder whether the treatment is considered an abortion, said Cansino, an obstetrician at an academic center in California. For providers, the question is, 'Even if you are doing the right thing, will something bad happen?' she said. Abortions are legal where she practices, but she often wonders whether there will be legal ramification for caring for out-of-state residents. Despite the increased stress experienced by abortion providers, many are still finding ways to meet demand for vital reproductive health services in the wake of the Dobbs decision. Some, however, are adapting in ways that may reduce the availability of obstetrical care — and healthcare in general — in parts of the US with strict abortion laws. Dana Howard, PhD The Dobbs decision has begun to affect the obstetrical workforce in parts of the US. In a recent research letter published in JAMA , Dana Howard, PhD, an assistant professor in the Department of Bioethics at The Ohio State University College of Medicine, Columbus, Ohio, looked at how Dobbs may have influenced where abortion care providers practice. She and her colleagues surveyed a wide range of clinicians (physicians, advanced practice providers, clinicians, and nurses) who provided abortion care about their practice location the year before Dobbs and again at the time of the survey in 2023. Sixteen percent of the respondents had relocated to a new state to practice: 42% of those previously practicing in a state with an abortion ban had moved to one without a ban compared with only 9% of clinicians from states without bans. 'We were just struck by the difference between clinicians practicing in states that didn't ban abortions vs states that did impose either a full ban or a 6-week ban,' said Howard. 'They're making these changes right now, but in 5-10 years these changes can have much larger effects on the Ob/Gyn workforce that we can't measure yet.' Another clear indicator of the negative impact of Dobbs on the Ob/Gyn workforce is the number of US medical school graduates applying to Ob/Gyn residencies in states with abortion bans. The most recent data from the Association of American Medical Colleges (AAMC) from the 2023-2024 residency match reported a 6.7% drop in applications to programs in states with bans compared with a 0.4% increase in applications to programs in states where abortion was legal. But access to training in abortion care had started to decline before Dobbs . In a 1991-1992 survey of program directors of Ob/Gyn residency programs in the US, the proportion of programs providing routine training in first-trimester abortion was 12% and for second-trimester abortion was 7%. Most of the programs that provided routine training continued to offer optional training, but residents in those programs were less likely to receive training in abortion procedures. In response to these findings, in 1996 the Accreditation Council for Graduate Medical Education implemented a requirement that mandated access to experience with induced abortion as part of residency education, although programs or residents with religious or moral objections could opt out. If residency programs did not have routine training available at their institution, they were expected to support residents in finding training options. In 1999, the Kenneth Ryan Jr Residency Training Program was launched at the Bixby Center for Global Reproductive Health of the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California San Francisco. 'The Ryan Program was founded with the purpose of supporting Ob/Gyn departments to integrate abortion care and improve their training, and part of that includes also improving the care they provide for people with pregnancy loss,' said Jody Steinauer, MD, PhD, a distinguished professor of obstetrics and gynecology at the University of California San Francisco who currently serves as the center's director. Since its inception, the Ryan Program has supported 120 Ob/Gyn departments in improving their capacity to provide training in abortion procedures to their residents. In addition to learning the critical skill of safely evacuating the uterus, Steinauer stressed the importance of additional skills learned by residents at Ryan Programs that go along with learning abortion procedures. 'You learn incredible skills in ultrasound and patient counseling, how to be empathetic and compassionate, how to do the actual procedure, anesthesia, and how to take care of people after their abortion,' said Steinauer. 'It's just critical to make our next generation really ready to not just provide abortion care, but really just compassionate care in lots of different areas of gynecology and obstetrics.' Despite these successes, the passage of State Bill 8 in Texas prohibiting and criminalizing abortion, followed by the Dobbs decision, posed new challenges. According to Steinauer, there are more than 50 Ob/Gyn programs with over 1000 residents in states with bans. 'Even if you're only having a rotation for them in one of their 4 years, that's still 250 Ob/Gyns residents each year that need training,' said Steinauer. 'So we still have a long way to go.' Rachel Crebessa, MD Rachel Crebessa, MD, whose residency program in a southern state did not offer abortion training even pre- Dobbs , described her struggles to find a place to develop competency in abortion procedures. 'I reached out to no less than 50 different clinics or programs to try and find somewhere that had room and the capacity to take an out-of-state resident. I was met with a dead end every single time,' she said. Fortunately, for residents in Crebessa's position, the Ryan Program based at Oregon Health & Science University (OHSU) in Portland, Oregon, immediately responded to the need to provide training to out-of-state residents. 'When the leaked SCOTUS decision came out, we saw the writing on the wall,' said Alyssa Colwill, MD, an associate professor of obstetrics and gynecology at OHSU. 'Not only were patients going to have restricted access to abortion care, but a large proportion of residents are training in states that were no longer going to be able to access abortion training.' Colwill and her colleagues developed the Complex Family Planning Visiting Resident Elective, which is committed to educating out-of-state Ob/Gyn residents without access to abortion training in their home state. As of June 2025, the OHSU elective hosted 22 residents from 17 programs as well as three out-of-state fellows. 'Residents have left this experience knowing that this is essential, routine healthcare, and without this training, they felt like there was a hole in their education,' explained Colwill. Crebessa participated in the OHSU elective in the fall of 2023. For her, practicing in a state without an abortion ban was a relief. 'There is no reason for me to be ashamed of the care that I was providing there [in Oregon] because it was the right thing to do,' she said. 'I was definitely a lot more confident and open about the kind of care that I wanted to provide.' The Guttmacher Institute reported that 1,037,000 abortions were performed in the US in 2023, the first full calendar year after the Supreme Court overturned Roe v. Wade . This number represented an 11% increase from 2020, the last year in which formal estimates are available. Much of the increase was due to increases in states without bans that border states with bans, which saw a 38% increase in the number of abortions between 2020 and 2023. According to the most recent analysis of Society of Family Planning's WeCount data, another driver is an increasing reliance on telehealth: In the last quarter of 2024, telehealth abortions accounted for 25% of abortions in the US compared with April-June of 2022, when telehealth abortions accounted for just 5%. Although these numbers suggest that efforts by organizations such as the Ryan Program and the OHSU elective can help mitigate the effect of Dobbs , the geography of abortion availability is still daunting. OHSU's Colwill said that Oregon has seen increases in patients from neighboring states seeking abortion services and she worries about the growth of maternity care deserts in other parts of the country. 'We've seen in states like Idaho a large exodus of Ob/Gyns practicing in that state,' she said. 'And since the Dobbs decision, they have closed two labor and delivery units in the state.' Steinauer pointed out that AAMC also reported decreases in applications to residencies in other specialties in states that have abortion bans. Family medicine, pediatrics, internal medicine, and emergency medicine residency programs all saw declines in applicants in the 2023-2024 match. 'I'm very worried that we're going to see programs that don't fill, until there are cities and regions in rural areas that don't have enough doctors who can provide care in general,' she said. But not everyone leaves. 'There's always that pressure of wanting to be close to family, but also there's an internal drive of not wanting to be another statistic of somebody leaving a state just because it's hard,' said Jewel Brown, MD, an associate professor of obstetrics and gynecology at an academic medical center in Florida. She attended medical school and completed her Ob/Gyn residency in Florida in the pre- Dobbs era, when her home state allowed abortions up until 24 weeks gestational age. Brown chose to do a complex family planning fellowship in California as there wasn't one in Florida. She dreamed of coming back to work with her former residency mentor to start the first complex family planning fellowship in Florida. Initially, the passage of Dobbs seemed to deny that goal, but after finishing her fellowship in the summer of 2024, Brown took a position in Florida anyway. She was 'slightly optimistic' about the passage of Florida Amendment 4, which would have overturned the restriction on abortions performed before fetal viability. Although it received nearly 58% of the vote later that fall, it failed to reach the 60% threshold required in Florida. Brown admits some disappointment about not being able to work as a full-time specialist in complex family planning like her colleagues in California. Instead, she works 1 day a week in the local Planned Parenthood clinic and 1 day a week at her academic institution doing complex contraception visits and managing patients with early pregnancy loss. The rest of her week is spent doing routine Ob/Gyn care, where she doesn't use the full spectrum of skills acquired in fellowship. But Brown's skillset is critical to the region. She often receives referrals from providers unwilling to jump through the regulatory hoops needed to perform an abortion on woman with a valid medical indication. 'Frankly, a lot of physicians really just don't have those skills of knowing how to do second trimester abortions or even second trimester procedures for fetal losses,' she said. For her, satisfaction comes from being able to provide care to the patient with a fetal demise who drove 5 hours from south Florida to her hospital, or the experience she can pass along to students and residents who would not have any exposure to the procedures they need to learn for many obstetric emergencies. She knows that if she leaves Florida, many trainees won't learn to provide emergency care that requires mastery of the procedures used to perform abortions. 'I think just teaching them in general is probably what keeps me going,' said Brown. Brown, Cansino, Colwill, Crebessa, Howard, and Steinauer reported no financial conflicts of interest.
Washington Post
28-06-2025
- Politics
- Washington Post
Justice Kavanaugh explains what the injunctions ruling won't change
Landmark Supreme Court decisions sometimes don't have the results partisans fear or hope for. The 2010 Citizens United decision loosening restrictions on campaign spending was expected to help Republicans, but now Democrats spend more on political ads. The 2022 Dobbs decision finding that there is no constitutional right to abortion has not reduced the number of abortions.
Bloomberg
25-06-2025
- Politics
- Bloomberg
Bloomberg Law: War Powers & Abortion Rights
Joshua Kastenberg, a professor at the University of New Mexico Law School and a former prosecutor and judge in the US Air Force, discusses whether the President Trump's strikes on Iranian nuclear sites, required consultation with Congress. Healthcare attorney Harry Nelson, a partner at Leech Tishman Nelson Hardiman, discusses the third anniversary of the Dobbs decision which took away the constitutional right to abortion. June Grasso hosts.
Yahoo
25-06-2025
- Politics
- Yahoo
Abortion in America: 3 years after Roe's repeal, in 7 charts
Three years ago, the Supreme Court issued a bombshell ruling that overturned Roe v. Wade, ending nearly 50 years of precedent that had protected abortion rights throughout the United States. 'The Constitution does not confer a right to abortion … and the authority to regulate abortion is returned to the people and their elected representatives,' Justice Samuel Alito wrote for the majority in Dobbs v. Jackson Women's Health Organization. That decision marked a huge victory for the anti-abortion movement, which had worked for decades to reverse the 1973 ruling in Roe that had required all states to allow abortions at least up to the point of fetal viability — roughly 24 weeks into pregnancy. It also sparked a political and legislative frenzy as states and voters reckoned with having the power to fully regulate abortion on their own for the first time in half a century. Three years later, America is in a fundamentally different place than it was before the Dobbs decision. Beyond its direct impact on reproductive health care, the ruling also had major political implications across the country. Here are some of the things that have changed — and a few that surprisingly haven't — since Roe was repealed. The most obvious and immediate effect of Dobbs was the roll back of abortion rights in dozens of states. Thirteen states had 'trigger laws' in place that were designed to instantly impose strict new restrictions or outright bans the moment Roe was repealed. Some others had dormant anti-abortion measures still on the books that became active again once nationwide protections disappeared. Today, abortion is essentially banned, with limited exceptions, in 12 states. Another 10 states ban abortions earlier in pregnancy than the standard established under Roe. Laws in the remaining half of states either mirror Roe's fetal viability standard or have no gestational limits on abortions. We're only now beginning to understand the impact that these new bans have had. Somewhat unexpectedly, they don't appear to have reduced the number of abortions in the U.S. The best evidence we have suggests that the total has gone up since Roe was overturned. There were just over 1 million abortions in the U.S. last year, about 100,000 more than there were in 2020, according to estimates by the Guttmacher Institute, a pro-reproductive rights research organization. That increase represents a break from a long-standing trend that had seen the total number of abortions per year cut nearly in half from their peak in the early 1990s. How can the implementation of strict bans in large swaths of the country not cause the number of abortions to fall? Part of the answer is that abortion access in some red states was quite limited even when Roe was in place. But the main reason is a massive surge in abortion-related travel out of highly-restrictive areas to states with more permissive laws. Last year, more than 155,000 patients crossed state lines in order to obtain an abortion, according to Guttmacher Institute estimates. That's nearly twice as many as in 2020. Roughly 70% of the abortions in New Mexico and Kansas last year were performed on out-of-state patients, mostly from Texas. There were 35,000 abortions performed on out-of-state patients in Illinois, which borders several states with strict bans. Two trends that were already in motion when the Dobbs decision came down may have also reduced the ruling's impact. The first is the growing importance of medications like mifepristone and misoprostol, which allow patients to have an abortion without undergoing a medical procedure. Medications had been an increasingly common alternative to traditional in-clinic abortions (alternatively known as procedural or surgical abortions) for years, but their use has accelerated even more since Roe was repealed. Last year, 63% of abortions were performed via medication, according to the Guttmacher Institute. The second trend is the telemedicine revolution that was spawned by the COVID-19 pandemic two years before Dobbs was decided. Like nearly all types of doctor's visits, the share of abortion-related appointments that happen virtually has skyrocketed over the past five years. By the end of 2024, a quarter of all abortions were provided by telehealth, according to the Society of Family Planning. Roe's repeal didn't just affect the total number of abortions, but its broader affects on health and fertility are still coming into focus. The limited data available does offer some hints. Research released earlier this year found that strict abortion bans do appear to have resulted in more than 20,000 more babies being born than would otherwise be expected in restrictive states, particularly among Black and Hispanic mothers and people with low incomes. But that same research found a troubling increase in infant mortality within those same groups. A separate study by the Gender Equity Policy Institute estimated that mothers in restrictive states are twice as likely to die due to pregnancy-related complications as those in more 'supportive' states. Dobbs was decided just four months before the 2022 midterm elections, instantly moving abortion up the list of most important issues in races across the country. Blowback over the ruling is credited with helping Democrats hold off a widely expected 'red wave' and maintain control of the Senate. With the status quo on abortion suddenly upended, states also had to decide what their own policies on the issue would be. That led to a wave of ballot initiatives that allowed voters, for the first time, to decide how accessible abortion should be in their states. Since 2022, there have been 14 separate state ballot measures to either protect or expand abortion access. Eleven were approved, including initiatives that repealed highly restrictive laws in Missouri and Ohio that went into effect when Roe was repealed. Several initiatives that would have rolled back abortion protections and granted lawmakers more power to restrict abortion have failed. It hasn't been a clean sweep for pro-abortion initiatives, however. Last year, voters in Florida, Nebraska and South Dakota had a chance to significantly expand abortion rights in their states. All three measures came up short. The most glaring example of the limits of abortion as a political issue came in the 2024 presidential election, which saw Donald Trump win a second term even though his three Supreme Court picks provided the decisive votes to overturn Roe. The Dobbs decision clearly had an impact on American's views about abortion, but polls show that the shift has been relatively small. In a nation where elections are often decided by the slimmest of margins, that can matter a lot. But public opinion on abortion appears to have been deeply entrenched after decades of heated debate over the issue. Even after such a dramatic change in the nation's laws, polls only moved a few percentage points, leaving overall sentiment roughly where it has stood for 50 years. Three years is too short of a time period to fully understand the impact of something as monumental as Roe's repeal. Abortion opponents are continuing to push for even more restrictions, as reproductive rights supporters fight to make abortion more accessible. No doubt that the courts will have plenty of say in how those battles are decided.
The Independent
25-06-2025
- Health
- The Independent
Tens of thousands of women forced to travel out of state for abortion care after Roe v Wade was overturned in 2022
Tens of thousands abortion patients have been forced to leave their home states to seek abortion care three years after the end of constitutionally protected abortion access in America. One out of every seven abortion patients, or roughly 155,000 people, left their home state for abortion care last year, according to the Guttmacher Institute, a reproductive health research group. That total is slightly fewer than the 170,000 people who traveled for abortion care in 2023, but it remains a remarkable spike in abortion-related travel compared to the years before the Supreme Court's June 2022 decision in Dobbs v Jackson Women's Health Organization, which overturned Roe v Wade and allowed states to criminalize abortion care and implement outright bans. Out-of-state travel for abortion care has virtually doubled since that ruling. Since the Dobbs decision, 13 states have outlawed abortions in virtually all circumstances, creating a patchwork of abortion access across the country, and balkanized legal constraints for patients and providers, who are shielded in some states and criminalized in others. The total number of abortions each year has also steadily increased in the wake of that decision. In 2024, 1.14 million abortions occurred in the United States, according to the Society for Family Planning. Roughly one in four abortions were performed through telehealth last year, with an average of 12,330 abortions per month performed through medication abortion, which typically requires a two-drug protocol that a patient can take at home. That's up from one in five in 2023 and one in every 20 in 2022. Medication abortion has accounted for the vast majority of abortions in recent years. Roughly 63 percent of all abortions are now medication abortions, according to Guttmacher. Mifepristone, one of two prescription drugs used in medication abortions, is approved for use by the FDA up to 10 weeks of pregnancy. From 2019 through 2020, nearly 93 percent of all abortions were performed before the 13th week, according to the Centers for Disease Control and Prevention. But the drug is at the center of legal challenges fueled by right-wing anti-abortion activist groups who have sought to strip the government's approval and implement sweeping federal bans on abortion care. President Donald Trump's administration has also pledged to revisit the drug's approval, using spurious reporting and junk science, in an apparent attempt to undermine the basis for the government's approval. Nearly half of patients who traveled for an abortion last year came from states where abortion is outlawed — including more than 28,000 Texas residents, more than any other state, Guttmacher found. 'While these findings show us where and how far patients are traveling, they are not able to capture the numerous financial, logistical, social and emotional obstacles people face,' according to Guttmacher Institute data scientist and study lead Isaac Maddow-Zimet. In the months after the Dobbs decision, sweeping anti-abortion restrictions across the deep South and neighboring states have effectively forced abortion patients to travel hundreds of miles to reach the nearest state where abortion access was legal. Florida, surrounded by anti-abortion states, was initially a key point of abortion access in the South within the first two years after the Dobbs decision. In 2023, more than 9,000 people traveled from other states to get an abortion there, according to Guttmacher. Roughly one in every two abortions nationwide and one in three abortions in the South were performed in Florida at that time. Last year, Florida banned abortion beyond six weeks of pregnancy, before many women know they are even pregnant, and the number of patients traveling to the state for abortion care was virtually cut in half. Another 8,000 people left the state to get an abortion elsewhere, often crossing as many as three states to get there, Guttmacher found. 'It was not just Floridians who were impacted, but also the thousands of out-of-state patients who would have traveled there for care,' according to Candace Gibson, Guttmacher Institute Director of State Policy. 'The most extreme abortion bans are concentrated in the South, which makes it disproportionately difficult for people living in that region to exercise their fundamental right to bodily autonomy,' she added.
