Delivering Reproductive Care to Women After Dobbs

The 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which concluded that the Constitution does not protect the right to an abortion, reshaped reproductive care access in the U.S. Three years after the Court’s decision, evidence is emerging as to the impacts manifesting across the states. This article offers updates from our and provides insights on how physicians and training programs are coping with restrictions, migration patterns and health outcome disparities.

1. What has the impact of Dobbs been on women’s health overall and in underserved communities so far?

The Dobbs decision’s impact has been most severe in underserved and rural communities. According to the , within one month of the Dobbs ruling, 43 clinics in 11 states stopped providing abortion care, increasing to 66 clinics in 15 states after 100 days. These closures have not only eliminated abortion services but also reduced access to preventive health care such as contraception, prenatal visits, and routine screenings for conditions like cervical cancer.

Post-Dobbs travel data show a significant increase in patient burden. The Society of Family Planning that the number of patients traveling out of state for abortion care more than doubled, from around 81,000 in 2020 to 170,000 in 2023. —especially for those in the Southeast and Midwest—add financial strain, time delays, and health risks, with delays linked to higher complication rates.

Health disparities are among low-income women and women of color, as confirmed by the National Association of Social Workers. face some of the steepest barriers: with higher rates of chronic disease, lower preventive care use, and maternal mortality rates double those in urban areas. Emerging research also indicates a in OB/GYN preventive visits in ban states as providers depart or shift services away from reproductive health.

2. How has the decision affected the OB/GYN workforce and training pipeline?

Market responses to the Dobbs decision on OB/GYN workforce distribution have been than initially anticipated and conflicting studies have been published showing the impacts on the workforce. Nationwide, found that over 94% of OB/GYNs remained in their pre‑Dobbs state regardless of abortion policy environment, with no significant difference in relocations between ban and non-‑ban states. However, studies at the state level have suggested dramatic shifts in their OB/GYN workforce. , a recent study found that 114 OB/GYNs stopped practicing or from 2022–2024. This outmigration has affected urban and rural areas in the state alike but has left only 23 practicing obstetricians serving the state’s 37 most rural counties.

Given that many women rely on their OB/GYN both for primary care needs and as the first line of defense in identifying conditions such as cardiovascular disease, cancer, and autoimmune disorders, restrictions on the OB/GYN workforce to essential health care well beyond reproductive health. This is particularly true in growing women’s and general healthcare deserts, especially in rural areas, as noted above.

The decision has also affected the training pipeline: of all U.S. OB/GYN residency programs no longer have access to local abortion training post-Dobbs. Meanwhile, residency applicants highly value abortion training and consider access to such training when selecting their residency program. The 2023 and 2024 show an in graduating M.D. students applying to OB/GYN residency programs, with a notably larger decrease in applicants to states enforcing abortion bans. While OB/GYN training slots , the number of applicants to OB/GYN residencies in abortion-ban states by 6.7% in 2024 compared to the prior year, contrasting with a slight 0.4% increase in states maintaining legal abortion access.

Residency directors in ban states face stark choices: or risk losing accreditation under The Accreditation Council for Graduate Medical Education's (ACGME) mandate that abortion training be available. These partnerships are often costly and logistically challenging, forcing some programs to cut other reproductive health training components to make room for required rotations. Meanwhile, the influx of abortion trainees to residency programs in permissive states of reducing the breadth of surgical and family planning training, given the limits on faculty, clinic space, and patient volume.

3. What role are accrediting and regulatory bodies playing in the current environment?

The ACGME has in maintaining abortion training requirements for OB/GYN residency accreditation. In a reaffirmation statement, the body emphasized that residents must receive in-person clinical experience with abortion care, whether in their home state or via external rotations. This position has effectively placed accreditation compliance at the center of the post-Dobbs battlefield.

While accrediting standards have not weakened, regulatory bodies face capacity-management challenges. As of 2024, only 19% of OB/GYN residency programs in states with total abortion bans (11 of 57) had established training partnerships with programs in states where abortion remains legal. The to 17% (14 of 84) among states with a six-week ban. Meanwhile, the into permissive states has led to extended waitlists for certain procedural training modules and competition for clinical slots. As of mid‑2025, federal funding agencies such as HRSA have not yet created dedicated subsidies to offset increased hosting costs for these programs, despite advocacy from ACOG and the Association of American Medical Colleges (AAMC). Without such support, some host programs may scale back participation.

4. To what extent are we seeing policy, funding, or market responses at the state or federal level?

As of August 2025, there has been no enacted specifically addressing OB/GYN training access or mitigating post-Dobbs service loss, though multiple bills have been introduced in Congress to fund cross-state training and incentivize OB/GYN practice in high-shortage areas. Some permissive states—such as , , and —have enacted state-level policies to provide grants to medical schools hosting displaced trainees.

While show that providers who performed abortions in banned states were more likely to move to states without bans, this group represents a subset of the overall OB/GYN workforce, which includes many clinicians who do not provide abortion services. Therefore, largescale net workforce gains of 5–9% in permissive states or equivalent losses in ban states are not supported by currently . Instead, workforce shifts , with many in communities despite regulatory changes due to personal, professional, and logistical factors. Nevertheless, remain about potential exacerbation of local shortages in highly underserved rural areas within restricted states where outmigration, however modest, may deepen existing disparities.

5. What are the most critical unknowns and risks moving forward?

Several unknowns outlined in our original study are now partly quantifiable:

• Education bottlenecks are real and worsening, with some residency programs unable to place all residents in compliant rotations.
• Geographic maldistribution of OB/GYN providers is accelerating, risking further erosion of maternal health infrastructure in large swaths of the South and Midwest.
• The financial sustainability of out-of-state rotation partnerships for GME programs remains uncertain without targeted funding.
• The long-term impact on reproductive health outcomes is still unfolding, pointing to increased maternal morbidity in restrictive.

If unaddressed through coordinated policy, these trends may lead to structural shortages in the OB/GYN workforce and a dual-tier reproductive health system: robust in urban centers of permissive states, fragile or absent elsewhere.