Geography, Policy, and System Strain in U.S. Obstetric and Gynecologic Care

Area of Science:

• Reproductive Health
• Health Policy
• Obstetrics and Gynecology (OBGYN)

Background:

• Abortion policy environments and geographic context significantly influence reproductive health outcomes.
• Understanding these associations is crucial for assessing implications for obstetrics and gynecology (OBGYN) care delivery and access.

Purpose of the Study:

• To examine the association between abortion policy environments and geographic context with reproductive health outcomes.
• To characterize the implications of these factors for obstetrics and gynecology (OBGYN) care.

Main Methods:

• Cross-sectional analysis using the 2024 Commonwealth Fund State Scorecard and Guttmacher abortion policy categories (restrictive, middle-ground, protective).
• Statistical analysis included Kruskal-Wallis tests, Dunn post hoc comparisons, and Spearman correlations to assess relationships with 32 reproductive health outcomes.
• Examined associations with U.S. Census regions and rural population percentages.

Main Results:

• Southern states exhibited poorer overall reproductive health rankings compared to other regions (p < 0.001).
• States with restrictive abortion policies showed worse outcomes across all domains of OBGYN care and access (p < 0.01).
• Higher rural populations correlated with increased infant mortality (r = 0.31, p = 0.028), preterm birth (r = 0.36, p = 0.010), prenatal depression (r = 0.71, p < 0.001), and poor mental health (r = 0.44, p = 0.001).

Conclusions:

• Health disparities linked to restrictive abortion policies and geographic inequities highlight regional variations in OBGYN workforce strain.
• System-level, context-aware strategies are essential for supporting OBGYN workforce retention and sustainability.
• Addressing these disparities requires tailored approaches considering both policy and geographic factors.