Anti-abortion laws are likely not the cause of a decline in the number of obstetricians and gynecologists or the number of labor and delivery wards in the United States, according to a new study published by the Charlotte Lozier Institute that instead pins the blame on a lack of training opportunities and declining birth rates.
The finding stands in contrast with predictions from abortion-rights advocates that the 2022 Dobbs v. Jackson Women’s Health Organization ruling, which found that there is no federal right to abortion, would lead to a dearth of OB-GYN medical students in states with limits on abortion and the closure of medical centers able to provide OB-GYN care.
Democrats running in the 2024 elections have highlighted abortion bans in 24 states as the reason women lack access to OB-GYN care, even in emergency situations such as miscarriage or ectopic pregnancy.
But a new study published recently from the CLI, the think tank arm of the anti-abortion advocacy group SBA Pro-Life America, notes that structural problems with medical education have contributed to this problem for more than the past two years since Dobbs.
Between 2011 and 2023, more than 217 hospital labor and delivery wards closed nationwide, creating so-called “maternity deserts,” or areas where women lack access to essential labor and delivery services.
The Dobbs decision has also raised awareness of maternal mortality in the U.S., which is among the highest in the developed world. Maternal mortality is still higher for minority women and women in rural areas who live in maternity deserts.
However, data from both medical school enrollment and clinical training programs show little evidence that the Dobbs decision contributed to this trend, according to the CLI study.
The authors of the study posit instead that medical school enrollment is up, even in the 24 states with abortion bans, and that there are not enough training spots for OB-GYN physicians nationwide.
Medical school enrollment is up
Medical school enrollment data from the Association of American Medical Colleges shows that more students are applying for medical programs over the past five years, including in states with abortion bans.
For the 2023-2024 academic year, medical school enrollment was up 6.6% compared to the 2019-2020 school year enrollment in the 14 states that have passed laws prohibiting elective abortion during the entire period of pregnancy.
States with other abortion bans at anywhere between six and 15 weeks gestation experienced a 7% enrollment increase during the same time period.
By comparison, medical school enrollment in states without abortion restrictions only rose 4.6%.
Osteopathic medical school enrollment has also increased by 77% in the last decade, with more than half of these types of medical schools in states with abortion restrictions. On average, 1 in 4 doctors received medical training from an osteopathic school.
On top of this, 25 new OB-GYN programs have been accredited within medical schools over the past five years, including 56% in states with abortion bans.
Dearth of OB-GYN residencies
Although the number of medical school graduates, including OB-GYNs, is up overall, there are not enough residency program spots available for doctors post-graduation.
Following medical school, doctors train in residency programs that can last three to seven years depending on the specialty in a program, and they tend to stay in the state or area where they completed their final stage of training.
While the number of OB-GYN residency applications for states with abortion bans fell by 2% from 2022 to the 2023 match cycle, virtually all OB-GYN residency spots were filled the year immediately following the Dobbs decision.
According to data from the National Resident Matching Program, 2,143 applicants applied for 1,539 OB-GYN residency positions nationwide in 2024.
The CLI study authors note the example of Nebraska, which has a prohibition on elective abortions after 12 weeks gestation. In 2024, the number of applications for OB-GYN residencies in Nebraska fell from 253 to 191. However, there are only nine OB-GYN spots available in the state, split between the University of Nebraska-Lincoln and Creighton University.
The number of residency spots for each institution is largely dependent on Medicare funding, but academic hospitals must also follow requirements from the states and from academic accrediting institutions.
Falling birth rate has a role in the crisis
The fact that fewer women are having children also naturally influences the number of maternity ward closures, contributing to the effects of maternity deserts.
The total fertility rate, or the average number of children a woman will have in her lifetime, fell to 1.62 births per woman in 2023, a 2% decline from 2022 and the lowest number recorded since the federal government began recording the statistic in the 1930s.
Last year, there were only 3.6 million babies born in the U.S., according to the Centers for Disease Control and Prevention, and the number of babies born each year has been on a downward trend since its peak of about 4.14 million live births in 2005.
Labor and delivery wards in rural hospitals, in particular, are at a higher risk of closure due to the decline in the number of births in their regions and the general population decline in rural areas.
For example, politicians and commentators were quick to highlight Idaho‘s abortion ban as the cause for the closure of the labor and delivery ward at Bonner General Health in the northern part of the state.
However, the hospital itself cited “low patient volume” as a reason for the difficulty of hiring pediatricians and OB-GYNs, and the number of babies delivered “continued to decrease yearly,” making the ward unprofitable to operate.
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Even when there are labor and delivery facilities within an urban county, making an area not a statistical maternity desert, the travel time and distance can still add an additional burden to accessing care, particularly for lower-income and minority mothers.
Neither the American College of Obstetrics and Gynecology nor the American Medical Association, both of which oppose gestational age limits on abortion, responded to the Washington Examiner’s request for comment on the study from the CLI.