On The Dobbs Anniversary, Taking Stock of Women's Health

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

Today 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. For the moment, the number of abortions in the United States has not plummeted — it has actually increased. That’s thanks to the availability of medication abortion: a combination of widespread access to telehealth, the availability of abortion pills, and state shield laws that enable doctors to prescribe them.

Photo by Colin Lloyd on Unsplash

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 anti-abortion 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 anti-abortion states intimidate people by leveraging unrelated statutes for child endangerment, homicide, or abuse of a corpse in the context of pregnancy and reproductive health care. 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.

On this anniversary, we write to take stock of one of the under-reported 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.”

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.

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.

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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 still as real as can be, 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. In a word, the harm extends to us all.

Jennifer Weiss-Wolf is executive director of the Birnbaum Women’s Leadership Center at NYU School of Law. She also leads strategy and partnerships at Ms. Magazine. Joyce Vance, a former federal prosecutor, is an MSNBC legal contributor, law professor, and author of Giving Up Is Unforgivable: A Manual For Keeping A Democracy and the Civil Discourse Substack.

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