One major effect of the Supreme Court’s decision to overturn Roe v. Wade will be on the reproductive healthcare workforce, particularly people who work for abortion clinics.
“We know that half of the states already have bans or severely restrict abortion or will do so soon,” says Julia Strasser, DrPH, assistant research professor in health policy and management at the Milken Institute School of Public Health at George Washington University. “When we think about the [abortion] workforce, that means the workforce will be reduced, potentially, by half. What will providers do in states where it’s banned? Will they continue practicing in those states, doing primary care, but stopping abortion services?”
Primary care providers (PCPs) and OB/GYNs who provide abortion care may move out of state to a place where abortion is legal. Some may drop out of the workforce, retiring earlier than planned.
“We know this will cause a dramatic decrease in the workforce,” Strasser says. “That’s something we have to study as states implement legislation.”
Investigators are trying to construct a large national database that studies insurance claims of mostly OB/GYNs, but also primary care providers, who offer abortion care.
“We find that primary care providers can and do provide abortions, but the numbers that do provide them is pretty low,” Strasser says. “If we’re interested in increasing the workforce of abortion providers, one way is to increase the number of PCPs who can provide these services.”
One major problem pregnant patients likely will face in coming years as abortion-ban states experience the full effect of their laws will be that fewer physicians will know how to perform surgical abortions.
“Because the procedures and medication used to terminate a pregnancy are the same for management of miscarriage and [other situations], doctors won’t have the skills to provide care if someone presents to their ER or practice when experiencing a miscarriage or having significant blood loss,” Strasser says. “If the provider isn’t trained in abortion care, then patients won’t be able to get care under those circumstances.”
In states with abortion bans, medical students, interns, and residents may not have access to abortion training. “It will be a problem next month, next year, and 10 years from now if there aren’t current clinicians who can pass along those skills,” Strasser says.
Another workforce issue is violence against staff at abortion clinics. “We know that physical violence against abortion providers has increased in recent years,” Strasser notes. “The fear of physical violence for providers is a real fear that may increase as providers are identified against their will.”
Violence against abortion clinics increased 600% in 2021, according to data from the National Abortion Federation. This includes stalking, blockades, hoax devices and suspicious packages, invasions, assault and battery, and bomb threats. There also is an increase in vandalism and intimidation tactics.1
Extremists sometimes even threaten abortion providers’ families. An example is the case of the 10-year-old rape victim from Ohio who sought an abortion at an Indiana clinic. The clinic’s physician, Caitlin Bernard, MD, mentioned the case to a reporter, and news of this spread as President Biden also referred to the tragedy of a child rape victim having to travel out of state for medical care. Bernard was threatened with a state investigation, but she had experienced worse threats in the past.2,3 As the media focused on Bernard, some outlets reported that Bernard received kidnapping threats against her daughter because of her abortion care work.3
Threats of legal investigations and threats of violence have a profound chilling effect on the abortion care workforce. “If you’re a provider that offers some abortion care, but it’s not your regular practice — maybe just a couple of abortion services a month — and you see abortion providers being identified in the news, then you may stop abortion services altogether,” Strasser explains. “Even if their state says it’s legal, they may not want to touch it, and may drop out of the abortion workforce.”
One way to alleviate this is for states to allow nurses to be trained as abortion providers, which some states have done. This could face resistance among physicians, but anecdotal evidence from the use of nurse practitioners in federally qualified health centers or safety net clinics shows there is value in having nurses involved in care that traditionally was performed by physicians, Strasser notes.
As the Turnaway Study showed, people who wanted an abortion but were unable to obtain one experienced long-lasting health problems, poverty, and even were more likely to stay in a life-or-death situation with a violent partner. The researchers found that women denied a wanted abortion have four times greater odds of living below the federal poverty level and are more likely to suffer anxiety and loss of self-esteem.4
“There also are other health and quality of life consequences that come from people not getting the abortion care they need,” Strasser says.
REFERENCES
- National Abortion Federation. National Abortion Federation releases 2021 Violence & Disruption Report. June 24, 2022.
- Alfaro M. Biden decries case of 10-year-old rape victim forced to travel for abortion. The Washington Post. July 8, 2022.
- Roche D. Dr. Caitlin Bernard’s daughter faced kidnap threat over abortions. Newsweek. July 16, 2022.
- Advancing New Standards in Reproductive Health. The Turnaway Study. 2020.