The influence of reproductive access restrictions on health behaviors, infant mortality, and physician supply

Abstract

In the past decade, there has been an increasing focus on restriction or elimination of abortion access in the United States. Of particular importance, the Dobbs v. Jackson Women's Health decision in 2022 overturned Roe v. Wade and eliminated the Constitutionally protected right to abortion. After Roe v. Wade became law in 1973, there was an observed decline in maternal mortality with highest impacts in Black maternal mortality, indicating differential impact of both the restriction and removal of reproductive access. It is hypothesized that removal of access will create many impacts and that those impacts may occur in a differential manner. This dissertation has explored the impacts of limiting reproductive care access on people in the United States. Utilizing a background in health policy, law, ethics, maternal mental health advocacy and doula care, I studied how these laws have impacted populations. Trends in out-of-state abortion seekers were analyzed corresponding with state based restrictions and the repeal of the constitutionally protected right to abortion in the Dobbs decision from 2022. Trends in infant mortality were studied to determine whether they are associated with state-level abortion restrictions in both aggregate data and data which has been disaggregated by race, ethnicity, and cause of death. Physician supply was analyzed to determine if there are changes in the overall supply of physicians as well as within the specialty of obstetricians and gynecologists practicing in impacted states. Reproductive care access is an essential component of healthcare, and it is crucial to understand how changes in state and federal law are impacting people's health and well-being.