Targeted Regulations Of Abortion Providers Associated With Significant Decreases In OB-GYN Density, 1993-2021

Area of Science:

• Medical Economics
• Public Health Policy
• Reproductive Health

Background:

• Obstetrician-gynecologists (OB-GYNs) are crucial for women's healthcare, yet shortages exist, particularly in nonmetropolitan areas.
• Targeted Regulation of Abortion Providers (TRAP) laws may influence OB-GYN practice locations, but this impact is not well-studied.
• The period between *Planned Parenthood v. Casey* (1992) and *Dobbs v. Jackson Women's Health Organization* (2022) provides a unique timeframe to assess these effects.

Purpose of the Study:

• To comprehensively analyze the impact of TRAP laws on the practice patterns and geographic distribution of OB-GYNs in the United States.
• To quantify the association between TRAP laws and OB-GYN density.
• To investigate disparities in these effects, particularly in nonmetropolitan counties.

Main Methods:

• Utilized a staggered difference-in-differences research design.
• Employed county-level data spanning from 1993 to 2021.
• Analyzed the density of OB-GYNs per 100,000 women aged 15-44.

Main Results:

• TRAP laws were associated with a 4.67% average reduction in OB-GYN density.
• This reduction affected both general and fellowship-trained OB-GYNs and was observed in counties without abortion facilities.
• Nonmetropolitan counties experienced a persistent decrease in physician density for a decade due to TRAP laws.

Conclusions:

• TRAP laws have a significant negative association with OB-GYN density, contributing to geographic disparities in women's health care access.
• The findings highlight the potential for TRAP laws to exacerbate existing OB-GYN shortages, especially in underserved rural areas.
• Policymakers should consider the long-term consequences of TRAP laws on healthcare access and equity for women across the lifespan.