When Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health, was completing her medical training to become a doctor in the 2000s, she delayed becoming pregnant and having kids—like many other medical students and residents—amid her strenuous workload. In the final year of her residency, Perritt became pregnant with her first child, and this development was a crucial factor in her decision on where to live after her residency. “I had to know where I moved that I could get the care I needed during my pregnancy, that I would be safe,” she told Jezebel.
Per a new report published in Obstetrics & Gynecology, the official journal of the American College of Obstetricians and Gynecologists (ACOG), the spread of state abortion bans since the Supreme Court overturned Roe v. Wade is impacting where new OBGYNs are choosing to work. The report, which surveyed 350 graduating OBGYNs, found residents who previously planned to practice in abortion-restrictive states were eight times more likely to change their plans to practice in states that currently protect abortion rights. “That’s a critical factor for a lot of folks,” Perritt said, noting the vast majority of U.S. OBGYNs (about 85%) are women, many of whom can become pregnant and may find themselves needing pregnancy-related care.
The report similarly found that 17% of residents changed their practice and fellowship plans after Roe fell. Earlier this year, one survey of third and fourth-year medical students found 58% said they were “unlikely or very unlikely to apply to a single residency program in a state with abortion restrictions.” Perritt ultimately chose to practice medicine in Washington, D.C., where she’s remained to this day.
The new research comes around the same time as a weekend report from NBC on the increasingly dire state of maternal care in the state of Idaho, which adopted a stringent abortion ban after Roe fell. The ban threatens providers with criminal charges and prison and has spurred a mass exodus of reproductive and maternal health care providers from the state. This prompted Bonner General Health in Sandpoint, Idaho, to shutter its entire labor and delivery department in the absence of enough people to staff it in March—consequently leaving Bonner County without any OBGYNs. In a press release at the time, Bonner General cited the criminal threats against providers and noted that as a result, “highly respected, talented physicians are leaving” the state and “recruiting replacements will be extraordinarily difficult.”
We’re seeing outcomes like this, Perritt says, because the “costs and impacts” of abortion bans “expand beyond abortion.” Abortion is often the sole treatment for pregnancy complications that might include ectopic pregnancies, life-threatening fetal anomalies, or miscarriage and stillbirth. Anyone who provides this care in a state like Idaho could be threatened with prison. Perritt said Idaho is just the start.
Abortion bans can also dissuade healthcare providers from returning home to their own communities to provide care, Perritt says. It’s a shift that could worsen the ongoing issue of racial bias and lacking cultural competency in the medical system, where the maternal mortality rate for Black people sharply outpaces the rate for white people. A study published in December showed that, even before Roe fell, in 2020, maternal morbidity rates were 62% higher in abortion-restrictive states. Obviously, the end of Roe can only continue to exacerbate this crisis, especially in states that reproductive health care providers are avoiding, leading to maternal care deserts.
In the months since Bonner General closed its labor and delivery department, NBC spoke to Bonner County residents who have since been forced to drive to Spokane, Washington, for maternal care, including one mom who previously delivered her twins at Bonner General—only to deliver her third child in Spokane in August. “To go into labor at home and arrive at the hospital five minutes later was a blessing that I didn’t know was a blessing,” she said. Pregnant residents in Bonner County can drive to Spokane, drive 40 miles away to Kootenai Health in Coeur d’Alenehe (the closest in-state hospital with OB-GYNs), or deliver at home with a midwife.
Idaho state Rep. John Vander Woude, chair of the House Health and Welfare Committee and a co-sponsor of the state’s ban, told NBC he and his colleagues didn’t predict the varying ripple effects of their law. He admitted that “It’s really hard, I think, right now, under the current language to recruit or try to keep them [OBGYNS]” and said, “there needs to be clearer guidelines on what becomes criminalized.” Of course, with or without “clearer guidelines” regarding criminalization, abortion bans will always threaten patients’ safety and impede physicians’ ability to provide care.
At the end of the day, providers are people and “members of the community,” Perritt says, meaning fears for their own health and safety as well as their families will shape their personal choices. But she’s afraid for those who aren’t in a position to make these decisions: “The idea that you can just simply move away is not reasonable or realistic for many folks, for people who want to be around family, to be grounded in the community that they grew up in,” Perritt said. “[Abortion bans] just are not sustainable.”