Impact of State Abortion Policies on Family Medicine Practice and Training After Dobbs v Jackson Women’s Health Organization

Karen L. Roper; Sarah Jane Robbins; Philip Day; Grace Shih; Neelima Kale

doi:10.1370/afm.3183

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Figure 1.
States’ abortion access classification.
Note: Rankings at end date of survey administration (February 2022). Source. The Guttmacher Institute. https://states.guttmacher.org/policies/methodology.html

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Table 1.

Study Participant Characteristics (N = 1,216)

Characteristics	Values
Age, mean (SD), y	48.3 (12.3)
Missing, No. (%)	110 (9.0)
Gender, No. (%)
Female	759 (62.4)
Male	435 (35.8)
Gender non-conforming	4 (0.3)
Non-binary	2 (0.2)
Chose not to disclose	12 (1.0)
Missing	4 (0.3)
Race, No. (%)
American Indian or Alaska Native	3 (0.2)
Asian	112 (9.2)
Black or African American	58 (4.8)
Middle Eastern or North African	7 (0.6)
Native Hawaiian or Pacific Islander	1 (0.1)
White	915 (75.2)
Chose not to disclose	33 (2.7)
Missing	87 (7.2)
Ethnicity, No. (%)
Non-Hispanic	1144 (94.1)
Hispanic	72 (5.9)
Missing	0 (0.0)
Degree earned, No. (%)
EdD	11 (0.9)
DNP	0 (0.0)
DO	115 (9.5)
MD	793 (65.2)
MD/PhD or DO/PhD	51 (4.2)
PhD	132 (10.9)
Other doctoral level	33 (2.7)
Other nursing degree	0 (0.0)
Masters	60 (4.9)
Bachelors	15 (1.2)
Missing	6 (0.5)
Year graduated, median (IQR)	2005 (1994-2013)
Missing, No. (%)	11 (0.9)
Region (states), No. (%)
New England (NH, MA, ME, VT, RI, CT)	76 (6.3)
Middle Atlantic (NY, PA, NJ)	134 (11.0)
South Atlantic (PR, FL, GA, SC, NC, VA, DC, WV, DE, MD)	204 (16.8)
East South Central (KY, TN, MS, AL)	42 (3.5)
East North Central (WI, MI, OH, IN, IL)	229 (18.8)
West South Central (OK, AR, LA, TX)	86 (7.1)
West North Central (ND, MN, SD, IA, NE, KS, MO)	139 (11.4)
Mountain (MT, ID, WY, NV, UT, AZ, CO, NM)	106 (8.7)
Pacific (WA, OR, CA, AK, HI)	182 (15.0)
Missing^{^a}	18 (1.5)
Guttmacher Institute Classifications on abortion access, No. (%)^{^b}
Very restrictive	228 (18.8)
Restrictive	366 (30.1)
Some restrictions/protections	162 (13.3)
Protective	251 (20.6)
Very Protective	189 (15.5)
Not grouped^{^c}	3 (0.2)
Missing	17 (1.4)
Institution type, No. (%)
Allopathic medical school	644 (53.0)
Osteopathic medical school	59 (4.9)
Not at a medical school	506 (41.6)
Missing	7 (0.6)
Institution residency program, No. (%)
Multiple residencies including family medicine	853 (70.1)
Multiple residencies not including family medicine	18 (1.5)
Only a family medicine residency	278 (22.9)
No residency education	58 (4.8)
Missing	9 (0.7)
Practice population density, No. (%)
Urban	641 (52.7)
Suburban	382 (31.4)
Rural	185 (15.2)
Missing	8 (0.7)
Underserved area, No. (%)
Yes	342 (28.1)
No	752 (61.8)
Unsure	105 (8.6)
Missing	17 (1.4)
Role, No. (%)
Administrator or manager	44 (3.6)
Behavioral or social science specialist	75 (6.2)
Chair or vice chair	64 (5.3)
Clerkship director	24 (2.0)
Coordinator	16 (1.3)
Faculty	555 (45.6)
Fellow	13 (1.1)
Nurse	1 (0.1)
Pharmacist	14 (1.2)
Practicing physician	80 (6.6)
Researcher	59 (4.9)
Residency director or associate director	207 (17.0)
Other	61 (5.0)
Missing	3 (0.2)

DNP = doctor of nursing practice; DO = doctor of osteopathy; EdD = doctor of education; IQR = interquartile range; MD = doctor of medicine; PhD = doctor of philosophy
↵a Includes responses from outside of the United States.
↵b Using Guttmacher Institute’s Ranking as of February 2023.
↵c Includes responses from Puerto Rico and responses from outside of the United States.

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Table 2.

Responses to Nonclinical Questions

Questions	No. of Responses	Very Restrictive (n = 228) No. (%)	Restrictive (n = 366) No. (%)	Some Restrictions or Protections (n = 162) No. (%)	Protective (n = 251) No. (%)	Very Protective (n = 189) No. (%)	Overall^{^a} (n = 1,196) No. (%)	P Value^{^b}
Reproductive health care more limited?	1,134							<.001
Yes		166 (72.8)	180 (49.2)	11 (6.8)	10 (4.8)	9 (4.0)	376 (31.4)
No		42 (18.4)	172 (47.0)	145 (89.5)	230 (91.6)	169 (89.4)	758 (63.4)
Missing		12 (6.7)	4 (1.4)	6 (4.3)	6 (3.0)	4 (2.5)	32 (3.3)
Confidence in training residents	1,130							<.001
A lot less confident		75 (32.9)	77 (21.0)	11 (6.8)	8 (3.2)	6 (3.2)	177 (14.8)
A little less confident		66 (28.9)	141 (38.5)	38 (23.5)	61 (24.3)	37 (19.6)	343 (28.7)
No change		63 (27.6)	121 (33.1)	79 (48.8)	140 (55.8)	103 (54.5)	506 (42.3)
A little more confident		2 (0.9)	7 (1.9)	22 (13.6)	24 (9.6)	26 (13.8)	81 (6.8)
A lot more confident		1 (0.4)	4 (1.1)	4 (2.5)	6 (2.4)	8 (4.2)	23 (1.9)
Missing		11 (6.1)	4 (1.4)	6 (4.3)	7 (3.5)	3 (1.9)	31 (3.2)
Change in program desirability	1,125							<.001
I anticipate programs in my state will become less desirable to applicants		105 (46.1)	115 (31.4)	10 (6.2)	3 (1.2)	3 (1.6)	236 (19.7)
I do not anticipate a change in the desirability of programs in my state to applicants		99 (43.4)	204 (55.7)	89 (54.9)	110 (43.8)	71 (37.6)	573 (47.9)
I anticipate programs in my state will become more desirable to applicants		3 (1.3)	29 (7.9)	55 (34.0)	126 (50.2)	103 (54.5)	316 (26.4)
Missing		11 (6.1)	5 (1.7)	6 (4.3)	7 (3.5)	6 (3.7)	35 (3.6)

↵a From Guttmacher Institute’s ranking as of February 2023. Respondents without state identification were excluded (n = 20).
↵b P values <0.05 considered significant.

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Table 3.

Responses to Clinical Questions

Questions	No. of Responses	Very Restrictive (n = 228) No. (%)	Restrictive (n = 366) No. (%)	Some Restrictions or Protections (n = 162) No. (%)	Protective (n = 251) No. (%)	Very Protective (n = 189) No. (%)	Overall^{^a} (n = 1,196) No. (%)	P Value^{^b}
Patients of childbearing age, %	1,179							.295
0 to 20		20 (8.8)	38 (10.4)	15 (9.3)	19 (7.6)	17 (9.0)	109 (9.1)
21 to 40		70 (30.7)	98 (26.8)	50 (30.9)	62 (24.7)	53 (28.0)	333 (27.8)
41 to 60		66 (28.9)	106 (29.0)	59 (36.4)	79 (31.5)	55 (29.1)	365 (30.5)
61 to 80		19 (8.3)	45 (12.3)	15 (9.3)	33 (13.1)	29 (15.3)	141 (11.8)
81 to 100		4 (1.8)	8 (2.2)	0 (0.0)	7 (2.8)	7 (3.7)	26 (2.2)
Does not see patients in a clinical setting^{^c}		46 (20.2)	63 (17.2)	23 (14.2)	49 (19.5)	24 (12.7)	205 (17.1)
Missing^{^c}		3 (1.3)	8 (2.2)	0 (0.0)	2 (0.8)	4 (2.1)	17 (1.4)
Received new recommendations	948							.003
Yes		80 (35.1)	141 (38.5)	52 (32.1)	65 (25.9)	55 (29.1)	393 (32.9)
No		92 (40.4)	150 (41.0)	82 (50.6)	127 (50.6)	104 (55.0)	555 (46.4)
Missing		7 (3.9)	5 (1.7)	5 (3.6)	8 (4.0)	2 (1.2)	27 (2.8)
Change in patient counseling	946							<.001
Yes		86 (37.7)	106 (29.0)	28 (17.3)	23 (9.2)	18 (9.5)	261 (21.8)
No		85 (37.3)	182 (49.7)	106 (65.4)	171 (68.1)	141 (74.6)	685 (57.3)
Missing		8 (4.5)	8 (2.7)	5 (3.6)	6 (3.0)	2 (1.2)	29 (3.0)
Change in clinical decision making	946							<.001
Yes		53 (23.2)	71 (19.4)	19 (11.7)	29 (11.6)	18 (9.5)	190 (15.9)
No		118 (51.8)	217 (59.3)	115 (71.0)	165 (65.7)	141 (74.6)	756 (63.2)
Missing		8 (4.5)	8 (2.7)	5 (3.6)	6 (3.0)	2 (1.2)	29 (3.0)
Trust in patient self-reported history^{^d}	947							.029
My level of trust has decreased		18 (7.9)	24 (6.6)	7 (4.3)	8 (3.2)	12 (6.3)	69 (5.8)
No change		153 (67.1)	260 (71.0)	127 (78.4)	185 (73.7)	142 (75.1)	867 (72.5)
My level of trust has increased		0 (0.0)	5 (1.4)	0 (0.0)	1 (0.4)	5 (2.6)	11 (0.9)
Missing		8 (4.5)	7 (2.4)	5 (3.6)	6 (3.0)	2 (1.2)	28 (2.9)
Change in patient trust toward physicians	945							.172
I perceive that patients are less trusting		29 (12.7)	35 (9.6)	12 (7.4)	17 (6.8)	17 (9.0)	110 (9.2)
No change		139 (61.0)	243 (66.4)	118 (72.8)	171 (68.1)	138 (73.0)	809 (67.6)
I perceive that patients are more trusting		1 (0.4)	11 (3.0)	4 (2.5)	6 (2.4)	4 (2.1)	26 (2.2)
Missing		10 (5.6)	7 (2.4)	5 (3.6)	6 (3.0)	2 (1.2)	30 (3.1)
Worry of legal risk^{^d}	946							<.001
A lot more worried		27 (11.8)	31 (8.5)	7 (4.3)	11 (4.4)	6 (3.2)	82 (6.9)
A little more worried		71 (31.1)	104 (28.4)	49 (30.2)	61 (24.3)	40 (21.2)	325 (27.2)
No change		72 (31.6)	149 (40.7)	75 (46.3)	120 (47.8)	107 (56.6)	523 (43.7)
A little less worried		1 (0.4)	3 (0.8)	1 (0.6)	1 (0.4)	3 (1.6)	9 (0.8)
A lot less worried		0 (0.0)	2 (0.5)	2 (1.2)	1 (0.4)	2 (1.1)	7 (0.6)
Missing		8 (4.5)	7 (2.4)	5 (3.6)	6 (3.0)	3 (1.9)	29 (3.0)

↵a From Guttmacher Institute’s ranking as of February 2023. Respondents without state identification were excluded (n = 20).
↵b P values <0.05 considered significant.
↵c Respondents who selected “I do not see patients in a clinical setting” or who did not answer the question (Missing) were excluded from answering the remaining questions in this Table.
↵d P value was computed with Monte Carlo simulations (10,000 iterations) of Fisher’s exact estimates.

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SUPPLEMENTAL MATERIALS IN PDF FILE BELOW

Supplemental Appendix 1. CERA Survey. 2022 Administration "Family Medicine After Dobbs Ruling" Subsection

RoperSuppApp.pdf
VISUAL ABSTRACT IN PDF FILE BELOW

Roper_VA.pdf
PLAIN-LANGUAGE ARTICLE SUMMARY AND VISUAL ABSTRACT

Original Research

Restrictive Abortion Laws Drive Changes in Counseling, Increase Legal Concerns, and Weaken Training Confidence Among Family Medicine Professionals

Background and Goal:The 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization removed federal protections for abortion, allowing individual states to establish their own laws. This shift has created significant legal uncertainty, especially in states with highly restrictive abortion laws. Family medicine clinicians, who often provide comprehensive reproductive care, are now navigating new challenges related to clinical practice and training. This study evaluated perceived impacts of state abortion legislation on clinical practice and medical education regarding reproductive health care within the discipline of family medicine.

Study Approach:The study utilized data from a national survey conducted by the Council of Academic Family Medicine, a joint initiative of four major academic family medicine organizations to support the leadership, research and education of the discipline. The survey gathered responses from family medicine clinicians, educators, and other professionals across states with varying abortion restrictions. States were classified based on their abortion policies according to the Guttmacher Institute, ranging from very restrictive to very protective. The survey measured changes in clinical practice, legal concerns, patient-clinician trust, and medical training since the Dobbs decision.

Main Results: Data from 1,196 respondents was analyzed.

Of the 1,196 respondents, 49.7% reported working in states with very restrictive or restrictive abortion policies.

Among the 991 respondents with clinical responsibilities, significant differences were observed in counseling practices, clinical decision-making, worry about legal risks, and trust in patients’ self-reported reproductive medical history compared to peers in unrestricted states.

Perceived trust from patients toward clinicians remained unchanged.

Respondents in states with restrictive abortion policies also reported significantly reduced confidence in resident training programs and a decrease in program desirability.

Why It Matters:The findings highlight that restrictive state abortion laws are already influencing how family medicine clinicians practice and how they train future health care professionals. Without clear guidelines, clinicians face legal uncertainties, which may affect their ability to provide comprehensive reproductive care. These challenges, particularly in states with restrictive abortion policies, could limit access to essential health care services and disrupt medical education.

Impact of State Abortion Policies on Family Medicine Practice and Training and Training After Dobbs v Jackson Women’s Health Organization

Karen L.Roper, PhD, et al

Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky

Visual Abstract