IVF under threat and an OB/GYN exodus: What’s next for reproductive healthcare post Dobbs

This story is part of an investigative series and new documentary, The A-Word, by The Independent examining the state of abortion access and reproductive care in the US after the fall of Roe v Wade.

All three justices Donald Trump appointed to the Supreme Court ruled in favor of reversing Roe v Wade in 2022, handing a major victory to activists and their Republican allies who had fought for decades to overturn the constitutional right to an abortion.

It was a watershed moment in the battle over reproductive rights, and the two years since have demonstrated how the landmark decision’s consequences extend far beyond abortion itself, altering the landscape of women’s healthcare in the US.

Access to contraception and IVF treatments are under threat. The number of OBGYNs and abortion clinics are shrinking. Maternal mortality rates are on the rise. Physicians in some states are at risk of criminal penalties should they provide abortions. And murky laws are preventing pregnant women suffering medical emergencies from getting proper care.

While abortion remains legal in many states, a potential Trump-Vance administration could see a federal ban on the table. Trump has claimed he would veto such a ban — insisting he’ll leave the issue to the states — but his messaging on the issue has been wishy-washy. Even without a federal ban, the existing state-level laws have already damaged reproductive care across the board.

Since the Dobbs v. Jackson Women’s Health decision, 41 states have enacted some limits on when women can get an abortion; 13 of those states have total bans. Many women have suffered painful complications, some have lost their fertility, others have died as doctors try to navigate these new laws.

The laws may have been crafted to target abortion solely, but their murkiness has had an impact on miscarriage treatment as well. If one tragedy — losing a child — wasn’t hard enough, some women have wound up facing criminal charges after taking medication abortion, a two-pill regimen. One of those pills — mifepristone — was at risk of being restricted, but the Supreme Court unanimously ruled to preserve its access in a June decision.

The pills are still not in the clear.

JD Vance signed onto a January 2023 letter — along with dozens of other Congress members — urging the Justice Department to enforce the Comstock Act, an 1873 law originally aimed to promote sexual purity and prohibit obscenity and abortion drugs, in the hopes of blocking the mailing of mifepristone. Project 2025, a rightwing think tank’s blueprint for a second Trump term, also threatens to resurrect the vestigial law.

Supreme Court Justices Clarence Thomas and Samuel Alito even discreetly referenced the 19th-century law in oral arguments over mifepristone last term.

On the state level, in October, a Louisiana law reclassified the pair of pills as “controlled dangerous substances,” potentially delaying care. There’s a fear that the first-in-the-nation law could serve as a blueprint for other states; for now, though, the two-pill regimen remains widely available, accounting for more than 63 percent of all abortions in 2023, according to Guttmacher Institute.

Women in the 14 states with near-total bans on medication abortion now have to travel for care. More than 171,000 patients fled their home states to obtain abortion care in 2023 alone.

But patients aren’t the only ones who feel forced to travel; some doctors facing strict regulations in their states have opted to move their practices entirely.

Dr Kylie Cooper, a maternal-fetal medicine specialist who was working in Idaho, has moved her practice to Minnesota in the wake of the 2022 Supreme Court decision.

Before that, she’d regularly treated women whose fetuses had been diagnosed with lethal conditions. Then “Dobbs came and changed everything,” she told The Independent.

She’d tried to remain hopeful when a six-week ban went into effect but broke down in tears days later after treating a woman whose fetus had a “major anomaly.”

“It was the first time in my career that I was unable to provide care,” Dr Cooper said.

Dr Cooper was far from the only provider to leave. In the first 15 months after Idaho’s ban went into effect, the state lost 22 percent of OBGYNs — and the trend extends beyond Idaho.

The US is set to experience a shortage of 5,000 OB-GYNs by 2030, according to a 2021 report from the Department of Health and Human Services. The report adds that there are already too few practicing OB-GYNs to meet rising demand.

That will only make the problem of maternal care “deserts” across the country worse. More than 35 percent of counties in the US fall within that desert category, and 52 percent of counties lack a hospital that provides obstetric care, according to a March of Dimes report.