Things Are About to Get a Lot Worse for Red State Residents

Doctors are fleeing conservative states -- and that impacts far more than just abortion care.

Photo by Luis Melendez on Unsplash

Abortion bans in conservative states are playing out exactly as predicted, curtailing women’s opportunities, landing women in the ICU, forcing raped children to become mothers, nearly killing a lot of women, and probably killing some we haven’t heard about. The Republican politicians who pass these bans, though, are largely unbothered — they knew women’s lives and futures were on the line when they penned this legislation, but that’s a price they’re happy to pay. After all, curtailing women’s opportunities and making us more dependent on men is part of the plan; it’s not a problem, it’s integral to the design.

But it’s not just women seeking abortions who suffer under abortion bans. It’s the health and wellbeing of entire regions. Will conservatives care? Probably not. But they will suffer from their own political decisions. And they’ll make everyone around them suffer, too.

A new study shows just how dire the future looks in abortion-hostile states, with nearly 8 in 10 medical students saying that abortion restrictions will likely shape where they apply for residency programs, and nearly three-quarters of them saying that those same restrictions will shape where they settle and raise a family — and, ostensibly, where they work as doctors.

The US is already facing a doctor shortage, and states that are hostile to abortion are generally the same states with really poor healthcare to begin with: Fewer insured people, lower life expectancy, higher maternal and infant mortality rates. This isn’t a coincidence — it’s a direct result of the conservative politics and policies that dominate in red states. And now, these conservative politicians are doubling down on their failed policies. They’re going to see the predictable results.

Already, abortion bans have meant that far fewer doctors are considering becoming OB/GYNs, and the drop is double in abortion-hostile states — those states have seen more than a 10% decrease in OB/GYN residency applications since the Supreme Court overturned Roe v. Wade and set all of these state abortion bans into motion.

I certainly can’t blame doctors who decide it’s simply too risky to practice medicine in abortion-hostile states. The anti-abortion movement has put a target on their backs, making clear that it sees health workers as Enemy #1. They want to put doctors in jail for abortion; they need a villain, and it’s not politically palatable (yet) for that to be a desperate, pregnant woman.

As doctors know, the human body is complicated. Pregnancies are not all healthy or identical, and abortion bans force doctors to make patients suffer unnecessarily. They force doctors to offer a substandard level of care. Over and again, these bans mean that if a fetus has a heartbeat, no matter what else is happening or going dangerously wrong in the pregnancy, there is nothing doctors can do except tell a woman to wait until she’s about to die before they can provide the most basic care. And before doctors can provide even life-saving emergency care, they have to go through a phalanx of bureaucratic approvals, from lawyers and administrators and sometimes ethics boards, all of which takes time — and time is not typically what you have in an emergency, nor what you want to tolerate as a patient in the midst of a traumatic and devastating pregnancy complication.

This is all unconscionable and intolerable, and a direct violation of the oath doctors take. But it’s the position the anti-abortion movement and Republican politicians have forced doctors into. They have to choose: Provide care and risk losing your career, your home, your savings, and possibly your freedom, or abide by anti-abortion laws and violate the rules of your profession and your own conscience, put women’s lives at risk, do tremendous physical damage to women’s bodies, and potentially kill someone.

Why put yourself in that position?

Of course I wish doctors would simply be brave and break these laws. I am sure some are. But it’s a mighty big ask to say: Please provide abortions and risk bankruptcy, going to jail, losing your license, losing your home, losing your future, losing your freedom, losing your ability to raise kids, losing everything you have built and worked for — to do a single procedure, and then losing your ability to help anyone else going forward.

It’s also the case that, in a hospital setting, doctors simply may not be able to go rogue and offer necessary abortion care. They’ll need support workers (nurses etc), and possibly an appropriate treatment room, a pharmacist willing to fill the necessary prescriptions, maybe an anesthesiologist, maybe particular equipment or medications. Even the most determined doctor may not be able to get her hands on the resources she needs to give pregnant women the options they deserve.

Future doctors are also likely better-versed in the reality of anti-abortion laws than members of the general public, which is why the fact that more than three-quarters of them say they’re unlikely to start families in abortion-hostile states is so telling. Honestly, if I were pregnant, I would reconsider travel to states that ban abortion — if something goes wrong, you are just not going to get the same care in Texas as you would get in New York, and a serious complication may mean being unable to travel while you develop sepsis; in scenarios we’ve already seen play out in Texas specifically, miscarrying women have lost their fallopian tubes and their uteruses and have been put in the ICU because they weren’t able to get the kind of care that would have been standard in any state without an abortion ban. This is part of the reason why it’s so unconscionable for companies to require workers to stay in abortion-hostile states, or for them to require travel to those states; it’s unconscionable that any sports team or performer or artist would host events in abortion-hostile states. Doing so puts pregnant women at unnecessary risk.

The stakes are even higher for reproductive-age people deciding where to live. When you’re considering where to settle down and have kids, why would you do it in a place that might kill or maim you for having a baby? Why would you choose a place where your daughter will be a second-class citizen, and where her life will be at risk if she gets pregnant? Why, as a doctor, would you work in a place that doesn’t allow you to do your job?

I don’t actually expect any of this to matter. After all, all of the right-wing policies that make health and healthcare worse for red state residents do the worst damage to the people Republicans have decided are disposable: Black women, poor women, women seeking abortions. But abortion bans and doctor shortages and substandard care for pregnant women won’t just impact the people Republicans don’t care about. These shortages will hit everyone in conservative states, making health care worse over all, and making red state life generally shorter, nastier, and more brutal. It almost feels like that’s the point.

xx Jill