Today, Rep. Cindy Axne (IA-03) led a letter to Department of Health and Human Services Secretary Xavier Becerra and Director of White House Gender Policy Council Jennifer Klein to express concerns about the negative impact of the decision in Dobbs v. Jackson Women’s Health Organization on access to women’s and reproductive healthcare in states like Iowa that are considering bans on abortion. The Members expressed concern that restrictions on reproductive healthcare will further deter and decrease the availability of healthcare providers, particularly in rural areas that already lack access to care.

Rep. Axne was joined by eight of her colleagues in writing this letter. Together, the group represents several of the U.S. states that are weighing or have already implemented restrictions on abortion and other reproductive healthcare services.

The letter shines light on the threat that abortion restrictions pose to the already dire state of reproductive healthcare and the workforce delivering this care in these states.

With many counties in Iowa and in the other states represented in this letter already qualifying as a maternity care desert, meaning there are no hospitals providing obstetric care, no birth centers, no obstetrician-gynecologists (OB-GYNs) and no certified nurse midwives, the impact of an abortion restriction can be catastrophic.

For example, the letter cites a study from Texas that indicates that the state’s past legislative efforts to restrict abortion access, namely a ban on abortions after detection of embryonic or fetal cardiac activity, doubled the risk of health issues for pregnant patients.

“In midst of the long-standing maternal mortality crisis in the U.S., which causes American women to die at rates higher than any other developed nation, these restrictions are life-threatening and will profoundly impact the reproductive healthcare workforce that is already overburdened and understaffed,” the members continued. “The reproductive healthcare workforce, which includes obstetrician-gynecologists (OB-GYNs), nurses, midwives, doulas, and other professionals, delivers a wide range of services, from preventive care such as Pap smears and STI testing to direct maternal and infant care. Despite their essential service, these providers are in serious short supply.”

As the letter points out, prospective and practicing physicians are expressing concerns over losing their medical licenses and facing legal repercussions for delivering care in states that have criminalized abortion services, making it even more difficult to attract new talent to the profession. In fact, one medical recruitment firm reported that 20 OB-GYNs turned down a position in a state that restricted abortion and that many others won’t even consider roles in such states.

To address these concerns, this coalition of Representatives asks Secretary Becerra and Director Klein to respond to six questions regarding the future of reproductive health care in the U.S., specifically in states where abortion bans are likely to be implemented.

The letter was signed by U.S. Reps. Alma Adams (NC-12), Carolyn Bourdeaux (GA-07), Emanuel Cleaver (MO-05), Veronica Escobar (TX-16), Ruben Gallego (AZ-07), Brenda Lawrence (MI-14), Kathy Manning (NC-06), and Tom O’Halleran (AZ-01).

Read the letter in full here:

Dear ­­­­Secretary Becerra and Director Klein, 

We write to express our concerns and inquire further about the future of reproductive healthcare access and workforce development in our states following the decision in Dobbs v. Jackson Women’s Health Organization.

As the Representatives of the half of states that are weighing or have already implemented restrictions on abortions, we are deeply concerned about the negative impact that these measures will have on the healthcare of women, pregnant people, their families, and the healthcare professionals who provide them care. Most restrictions severely limit abortions to a narrow timeframe in pregnancy, if not ban it entirely with few exceptions. A growing number of states want to remove exceptions for rape or incest, and exceptions for imminently life-threatening/emergent situations are confusing, unclear, and interfere with physicians’ ability to provide care based upon their best medical judgment.

Various studies suggest that unintended pregnancies, pregnancy-related deaths, complicated pregnancies, miscarriages, and unsafe abortions will rise under these new restrictions.

In fact, a study from Texas already indicates that the state’s past legislative efforts to restrict abortion access, namely a ban on abortions after detection of embryonic or fetal cardiac activity and the criminalization of physicians’ delivery of abortion care, doubled the risk of health issues for pregnant patients. In midst of the long-standing maternal mortality crisis in the U.S., which causes American women to die at rates higher than any other developed nation, these restrictions are life-threatening and will profoundly impact the reproductive healthcare workforce that is already overburdened and understaffed.

The reproductive healthcare workforce, which includes obstetrician-gynecologists (OB-GYNs), nurses, midwives, doulas, and other professionals, delivers a wide range of services, from preventative care such as Pap smears and STI testing to direct maternal and infant care. Despite their essential service, these providers are in serious short supply. Prior to the Dobbs decision, the Health Resources and Services Administration projected that the number of OB-GYNs will fall almost 7% by 2030, leaving a gap of 5,170 providers between supply and demand for OB-GYNs. Today, these shortages acutely affect the 34.9% of U.S. counties that qualify as a maternity care desert, meaning there are no hospitals providing obstetric care, no birth centers, no OB/GYN and no certified nurse midwives. Many of these counties are located in rural areas where only 8% of obstetric providers practice.[3] Post-Dobbs, a significant portion of these counties will also be located in states that are considering or have implemented abortion restrictions, presenting additional barriers to healthcare access and potentially serious challenges to the development of the future reproductive healthcare workforce in these areas.

For instance, many articles have documented cases of disinterest among medical students, OB-GYN residents, and practicing providers in pursuing training and careers in states that have or are considering abortion restrictions. Some concerned medical students, particularly those interested in OB-GYN practice, have reported feeling discouraged from pursuing residencies in states like ours that are unable to teach them the full spectrum of reproductive healthcare and/or limit their scope of practice. Given that providers are more likely to practice where they complete their residency, these concerns point to a potential major challenge in future physician recruitment.

Relatedly, many practicing physicians express concern over losing their medical license and liability in delivering care in states that have criminalized abortion services. Often the criteria for abortion in cases of “medical emergency,” which are typically excluded from these restrictions, are unclear and place physicians in impossible positions. In fact, the impact of abortion restrictions on recruitment is already starting to be felt. Hospital administrators and medical recruitment firms are raising alarm over the challenges they are facing in bringing physicians to practice in our states post-Dobbs. One firm reported that 20 OB-GYNs turned down a position in a state that restricted abortion and that many others won’t even consider roles in our states.

Even where doctors can be recruited, there are also serious concerns with the education and preparation of the future reproductive healthcare workforce. A recent UCLA study found that, of 286 accredited OB-GYN residency programs with current residents, 44.8% are in states certain or likely to ban abortions. Consequently, of 6,007 current obstetrics and gynecology residents, 2,638 (43.9%) are certain or likely to lack access to in-state training on abortion-related procedures that are also critical to other reproductive care services. For example, technical procedures that are used in providing an abortion like dilation and evacuation may also be used to manage miscarriages, treat excessive bleeding, or take a biopsy from the uterus. Additionally, training in abortion care remains critical for the ability to manage life-threatening complications such as placental abruption, infection, and eclampsia, and the same skills are often utilized in the delivery of non-abortion services, such as early gestational ultrasonography, pain management, and cervical dilation. This could mean that in addition to a lack of medical providers in our states, those providers that remain may be unable to provide a full spectrum of reproductive care to their patients. This hurts people seeking care across our states who given our legal circumstances are also more likely to have elevated and complicated care needs.

The future of the reproductive healthcare is in jeopardy nationwide. We appreciate the steps that the Administration has already taken to secure to access to reproductive and other health care services. We hope to support such efforts by bringing to light and addressing workforce challenges that we expect to worsen, particularly in states like ours that have or are considering implementing restrictions to abortion and reproductive healthcare. For these reasons, we respectfully ask the Task Force on Reproductive Healthcare Access to respond to the following questions by October 15, 2022.

• How does the Administration plan to monitor reproductive health and workforce trends following the Dobbs decision?
• How can the Administration support recruitment efforts in communities that are facing an increasing demand for reproductive healthcare providers following the Dobbs decision?
• How can the Administration support efforts to protect access to comprehensive reproductive healthcare training in OB-GYN residency programs across states that have implemented or are considering implementing abortion restrictions?
• Similarly, how can the Administration help ensure that medical school students have adequate exposure to comprehensive reproductive healthcare training and service delivery within their clinical rotations?
• As a result of the Dobbs decision, and barriers to care, there is likely going to be an uptick in patients that are experiencing complicated pregnancies necessitating rapid and elevated levels of care, including abortion care. Are there contingency plans for the delivery of care for such individuals, particularly in areas with a shortage of OB-GYN providers? What about for patients who are seeking immediate or follow up care for other reproductive healthcare needs, including but not limited to abortion care?
• What additional steps can the Administration take, both in the short and long term, to ensure that people in states like ours do not lose access to essential health care?

We look forward to hearing from you and thank you for your prompt attention to this matter and service to our country.

Original source can be found here.