Four Years After Dobbs, Women’s Healthcare Is a Scarce Resource

Four years ago, the Supreme Court set women’s health—not just abortion rights—back decades.

Originally published by The Contrarian, June 24, “On the Dobbs Anniversary, Taking Stock of Women’s Health.”

Wednesday, June 24, marks four years since the Supreme Court, in Dobbs v. Jackson Women’s Health Organization, revoked the federal right to abortion, catapulting the nation into an era of state-sanctioned deprivation of bodily autonomy for American women. In total, 41 states now restrict abortion, including 13 with a total ban.

But Dobbs hasn’t had quite the desired effect. The number of abortions in the United States has not plummeted—it has actually increased, due to a combination of widespread access to telehealth, the availability of abortion pills, and state shield laws that enable doctors to prescribe them.

Still, it’s a tenuous status quo for women, whose lives are not considered important in this state-sponsored focus on fetus-first.

And predictably, there are now relentless attacks on mifepristone by an incensed antiabortion movement that feels frustrated by its failure to achieve long sought results, even after it thought the Court had ruled in its favor.

That fight is now being waged in the courts, as well as by federal regulatory agencies, including a so-called safety review currently underway at the Food and Drug Administration.

Continued access to medication abortion (at least for now) shouldn’t obscure the full accounting of damage to real people’s lives that Dobbs has done.

• For those who choose or require in-person abortion care, travel costs and delays have increased steadily over the past few years, according to a study published by the American Journal of Public Health.
• Surveillance of pregnancy outcomes and outright criminalization for miscarriages and stillbirths—long a reality for women of color in this country—are also escalating, as prosecutors in antiabortion states intimidate people by leveraging unrelated statutes for child endangerment, homicide or abuse of a corpse in the context of pregnancy and reproductive healthcare.
• Women with nonviable pregnancies are forced to wait to receive care, as their health deteriorates, because medical professionals fear that their judgment will be second guessed.

The Rise of Medical Deserts

On this anniversary, we write to take stock of one of the underreported outcomes directly linked to Dobbs, one you may be unaware of and may not have expected: It’s the growing number of individuals and families for whom access to healthcare is diminishing because of a rise in medical deserts.

Medical deserts, defined as areas with insufficient supply to meet demand, can be caused by hospitals shuttering; a shortage of doctors and other health professionals, leading to appointment wait times that are prohibitively long; or too few pharmacies.

In abortion-ban states, deserts are also produced by a climate of fear, as reported by TIME magazine: “Doctors, nurses, and pharmacists fear they will be arrested, jailed, fined, or lose their licenses for providing care, and patients fear getting in trouble and hesitating to share everything with doctors.”

Dobbs Piles on to Existing Doctor Shortage

To be sure, the United States has been headed toward a clinician shortage for years: By 2030, we can expect to be down more than 5,000 OB-GYNs nationwide, in part because of early retirement and burnout alone.

Experts posit that Dobbs accelerated and exacerbated this trend—and that it is no accident that states with the most restrictive abortion laws most acutely feel the imminent effects of the emerging shortage. According to the Journal of the American Medical Association, 42 percent of surveyed clinicians who provide abortions in states with near-total or six-week bans relocated to another state, nearly all of whom went to states with no ban; just 9 percent of those who practiced in a state that allowed abortion relocated.

That’s just common sense. There is no reason for highly mobile professionals to remain in places where they find themselves (increasingly) facing the prospect of personal risk for practicing medicine.

Not surprisingly, medical deserts are prevalent in conservative and rural states; the downstream pressure suggests it soon will become an issue for blue states, too.

Doctors, nurses, and pharmacists fear they will be arrested, jailed, fined, or lose their licenses for providing care …

Chantelle Lee, TIME

Dobbs Impacts Ripple Far Beyond Abortion

The impact on America’s unconscionable maternal and infant mortality rates cannot be overstated. The United States has the highest maternal mortality rate of any wealthy country; as rates continue to drop worldwide, they climb higher here, with Black women more than three times more likely than white women to die in childbirth. Infant mortality has risen specifically in states that enacted abortion restrictions since 2022, again with impacts worse among Black infants.

A 2024 report by March of Dimes found that over 5 million women now live in U.S. counties with limited or zero access to maternity resources such as hospitals, birthing centers or obstetric care; Alaska, Oklahoma, Nebraska, North Dakota and South Dakota are the most impacted states with no maternity care. Women in maternity deserts have an increased risk of preterm birth.

The crisis extends to midlife and older patients, too, who often contend with complicated pregnancies, attributed to factors such as heightened susceptibility to hypertension, diabetes and cardiovascular disease. And 100 percent will need cancer and other preventive screenings that may no longer be accessible, as well as support for perimenopause and menopause, which is already hard enough to come by (though state legislatures are working hard to change that). These are scarcely niche concerns: Women’s long-term health and longevity depends on proactive treatment and care.

The end game conservatives envisioned when they took on choice and fought for a result like the one in Dobbs wasn’t intended to be limited to abortion. The rollback of fundamental rights and freedoms, control over one’s own body, on the basis of gender, is and always has been about amassing power and exerting control. It’s about assigning second-class citizenship to the people being told what they can and cannot do.

And though the affront to democracy that is Dobbs is real—now, on its fourth anniversary, it has become apparent that it has a dangerous synergy with the calamity that is America’s crumbling healthcare infrastructure.

The harm extends to us all.

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A note from Ms. editors: We want to hear from you for The Majority, a new campaign collecting stories about how reproductive freedom has enabled readers to build the lives they want and need. Poll after poll shows a majority of Americans support reproductive healthcare access. Yet public debate overlooks the lives shaped by abortion access, contraception, IVF, miscarriage care, maternal healthcare or comprehensive sex education—countless women who chose to pursue an education, have children, not have children, protect their health and chart their own future. Add your voice and complete the sentence: “Access to reproductive choices gave me the freedom to….” Together, these stories will help show not only why reproductive freedom remains a majority value, but also what it makes possible. 

Look to these trusted groups if you or a loved one needs to know more about reliable abortion care:

• A one-stop-shop for abortion seekers: I Need An A
• Safe websites to buy abortion medication: Aid Access, Plan C Pills, Abortion Finder
• If you need help affording abortion care, contact an abortion fund near you.
• To protect your digital privacy when planning your abortion, click here.
• For free legal help as a patient or doctor, call If/When/How’s Repro Helpline: 844-868-2812
• For medical advice, contact the Miscarriage & Abortion Hotline: 833-246-2632
• If you need to know the abortion law in your state, look to the Center for Reproductive Rights.