The Supreme Court’s landmark 2022 overturning of Roe v. Wade has had an impact on women’s health beyond abortion, accelerating a gap in obstetrics and gynecological care in some states across the country.

In Texas, the first state to implement more restrictive abortion laws, a fear of discussing abortion has impacted doctors practicing there and the medical students and OB-GYN residents looking to learn there.

“We asked for [abortion care] in our curriculum they’re like, ‘Oh, well, it’s a state-funded school. And since the state doesn’t support it, then we probably shouldn’t teach it,'” said Dr. Dani Mathisen, who received her medical degree in Texas but relocated to Hawaii to complete her OB-GYN residency.

Mathisen said she had discovered that education on anything to do with abortion was so limited, she and her fellow students had to teach themselves. They rented classrooms, where abortion providers came in to teach about abortion care and students practiced on papayas and dragon fruit.

“It’s actually really common,” Mathisen said. “[Fruit] is a really great model for a uterus.”

OB-GYN resident Dr. Adrianne Smith began her residency in Texas but transferred to a hospital in New Mexico. Like Mathisen, Smith saw how abortion laws were impacting her education and said limits on education lead to restrictions on care — and not just in pregnancy.

“We’re seeing now with these new restrictions, more OB-GYNs are leaving these states,” Smith said. “You need OB-GYNs for pap smears, for birth control, for mammograms. And then not to mention routine pregnancy care. You need OB-GYNs staffing the hospitals and staffing those labor and deliveries, which in rural areas are already struggling to stay open. And so people are having to travel further for care — pregnancy or other care — and then waiting even longer to be able to be seen.”

These vacancies are contributing to what a recent report by the March of Dimes calls a “maternity care access crisis.” According to the report, more than one-third of counties in America are considered maternity care deserts. That means they don’t have a single doctor, nurse, midwife, or medical center that specializes in maternity care, impacting more than 2.3 million women of reproductive age.

“We’ve seen people leave states,” said Dr. Stella Dantas, the president of the American College of Obstetricians and Gynecologists. “We know we have maternal care deserts around the country that are being worsened by people leaving.”

As an example, Dantas pointed to Idaho, where nearly one quarter of practicing obstetricians have left the state since its strict abortion laws took effect, according to a report by the Idaho Physician Well-Being Action Collaborative. 

Dantas said that, in addition to practicing physicians leaving the state, restrictive abortion laws are also impacting training.

“When a medical student is applying to train for residency, they’re now looking at residency programs and asking questions, ‘What is the abortion training I’m going to get there? Am I going to get enough training to come out and feel competent and confident to practice the field that I desire?'” Dr. Dantas said.

She went on to explain that OB-GYN residents are required to have training in abortion care to become licensed physicians.  

“Abortion is reproductive health care, and OB-GYNs are the people that provide reproductive health care,” Dantas said. “Abortion is the same procedure that’s used in miscarriage management [and] ectopic pregnancy management. It is used in … situations where the pregnancy’s highly desired and it cannot go on for the health of the mom. So, you do need that training.”

In May, the Association of American Medical Colleges released a revealing set of data on the domino effect of the overturning of Roe and its potential impact on maternal health. In the two years since Dobbs, states with complete bans saw OB-GYN residency applications drop 6.7% in one year, compared to a small increase of applications in states without restrictions.

For Smith, the growing gap in women’s health care has made her want to practice medicine in a state like Texas or Georgia after she completes her residency.

“Patients need us there,” she said. “We need OB-GYNs in these areas that can provide these procedures, and the education and counseling in the cases where we can still do them. And we need the OB-GYNs to advocate for changes. If no one is there advocating on behalf of these patients, then we may not ever see some of these laws get overturned.”