Document Type

Article

Abstract

Introduction

Intensifying state-level abortion restrictions following the Dobbs v Jackson Women’s Health Organization (2022) decision could lead clinicians to leave states that ban abortion.1 While large-scale changes are not yet apparent among obstetrician-gynecologists, the abortion care workforce may be uniquely at risk.2 We examined the proportion of abortion-providing clinicians who changed primary state of practice, comparing those who left states that banned abortion with those who left states that did not ban abortion after Dobbs, and the ban status of the states to which they relocated.

Methods

This survey study was approved by The Ohio State University institutional review board. From May to December 2023, we disseminated an electronic, purposive survey to national professional listservs for abortion-providing clinicians and through snowball sampling.3 Following AAPOR reporting guidelines, we recruited clinicians (physicians, advanced practice clinicians, and nurses) who provided abortion the year before Dobbs and/or at the time of the survey.4 Surveys queried primary practice state in the year before Dobbs and at the time of the survey. Electronic informed consent was obtained prior to the survey.

We categorized states based on abortion policy. Any state with a near-total abortion ban or 6-week gestational abortion ban in effect at any time following Dobbs (June 2022) and our survey’s close (December 2023) was categorized as a ban state. All other states were categorized as no-ban. If clinicians reported a different primary practice state in the year before Dobbs compared with their primary practice state during the survey, they were categorized as relocating primary practice state.

Finally, we assessed the proportion of clinicians who changed primary practice state from a ban state to a no-ban state. Analyses were conducted in Stata version 18 (StataCorp) in November 2024. The threshold for statistical significance was a 2-sided P <  .05.

Results

Of 388 respondents, 346 (89%) met eligibility and consented. We excluded respondents not practicing before Dobbs (19 respondents) or not reporting primary practice state before and after Dobbs, for an analytic sample of 305 (79%). Most respondents (277 respondents [91%]) reported providing some nonabortion health care (Table 1). Respondents reported primarily practicing in 44 states and Washington DC, with 227 respondents (74%) practicing in no-ban states and 78 (26%) practicing in ban states before Dobbs (Table 1).

This survey study found that after Dobbs, 42% of survey respondents who provided abortions in states banning abortion relocated to another state. Almost all clinicians who relocated from any policy context relocated to states not banning abortion. We document practice relocation rates vastly exceeding those of obstetrician-gynecologists from 2005 to 2015, and among obstetrician gynecologists post-Dobbs. 2,5 Broader reproductive health care workforce patterns can take years to develop. Our findings among clinicians providing abortion give early insights into future workforce shifts. Given that most study respondents provided both abortion and nonabortion health care, these accelerated relocations have implications for abortion access and for the broader maternal health workforce, exacerbating health care deserts and outcome disparities.6 This study has limitations. Our sample is purposive because listservs used for recruitment protect member identities and numbers and our study may have selection bias. These privacy measures are necessary for study participant protection given the sensitive nature of abortion provision.4 Our study reflects abortion-providing clinicians, not the broader reproductive and maternal health care workforce. When clinicians cannot provide the standard of care, they may leave. Patients left behind could lack access to reproductive and maternal health care.

Digital Object Identifier (DOI)

https://doi.org/10.1001/jamanetworkopen.2025.14884

Rights

© 2025 Howard D et al. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.

APA Citation

Howard, D., Bornstein, M., Wascher, J., Norris, A. H., & Rivlin, K. (2025). Relocation post-Dobbs among clinicians providing abortions. JAMA Network Open, 8(6), e2514884. https://doi.org/10.1001/jamanetworkopen.2025.14884

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