It’s been two years since the United States Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade, which for nearly 50 years had legally protected the ability to have an abortion. Since then, many states have passed extreme restrictions on abortion care, with 14 states banning abortion completely. Yet the number of abortions in the United States has risen, and remains consistently elevated compared with pre-Dobbs levels.
Oregon Health & Science University’s Center for Women’s Health continues to see a rise in patients seeking abortion care from out-of-state — a trend reflected nationwide. The latest data from the Society of Family Planning’s #WeCount — a national abortion reporting effort that includes OHSU and aims to capture the shifts in abortion access by state — show that abortion volume was higher in 2023 than in 2022. Oregon has experienced a nearly 40% increase since 2020.
Clinicians note that these individuals are often extensively delayed in accessing care due to financial constraints, managing time off work and childcare, travel logistics and health care system barriers.
“What the numbers continue to tell us is that restrictions don’t eliminate the need for abortion care, they make care unsafe and inaccessible. This is especially true for people who already face barriers to the health care system, including people of color, immigrants, low-income individuals and LGBTQ+ people,” said Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Reproductive Health Equity. “It’s heartbreaking to see the obstacles patients face to receive what should be basic health care.”
In the face of restrictive laws and painfully difficult circumstances for patients, OHSU has been steadfast in its position that, as an academic health center guided by a mission firmly rooted in health, science and a commitment to the well-being of all people, it will provide reproductive health care — including abortion — to all patients who seek it. And the Center for Women’s Health has been a leader in rising to the challenge: improving access to care, educating clinicians on the full spectrum of reproductive health care, and generating important research to inform health care policy.
Expanding access with telehealth
Following the Dobbs decision, providers and health systems have explored alternative methods to deliver safe and legal abortion care, including telehealth. Telehealth now makes up a larger proportion of the abortion care landscape than ever before, accounting for nearly 20% of all abortions.
In response to increased demand, OHSU launched a telehealth program, which effectively doubled clinical visit capacity and significantly increased service for many of Oregon’s most rural counties.
“For many patients, especially those living in rural areas, access to abortion services can be hours away,” said Alison Edelman, M.D., M.P.H., professor of obstetrics and gynecology and division director of Complex Family Planning in the OHSU School of Medicine. “We don’t want anyone to be delayed in receiving care because of where they live or their personal circumstances. By expanding our telehealth services, we can provide a more efficient, lower-barrier option for patients.”
Training the next generation of providers
Abortion bans and restrictions mean that there are fewer opportunities for providers to train in the state where they live, presenting difficult decisions for medical students and residents. New data from the Association of American Medical Colleges show that fewer medical school graduates applied to residency training programs in states that banned or restricted access to abortion than to residency programs in states where abortion remained legal, accelerating a growing shortage of reproductive health care providers.
To bridge gaps in training and education, OHSU continues to offer abortion training for medical residents who don’t have access to clinical experience with abortion care as part of their family planning training. Supported by the Abortion Care and Training Fund, or ACT Fund, the program has trained two fellows and 13 residents since the overturn of Roe, and plans to host an additional 10 residents in the 2024 – 25 academic year.
Additionally, OHSU partnered with the ECHO Network to launch a reproductive health training course, which equips clinicians of all backgrounds — not just OB/GYN — with skills and knowledge to provide more comprehensive, compassionate reproductive health care. The program has now trained more than 70 clinicians across the state and Southwest Washington.
“Providers want to learn in an environment where they’re able to offer comprehensive, evidence-based care, but in many places, providers now fear legal retribution for offering basic and essential health care,” said Alyssa Colwill, M.D., MCR, assistant professor of obstetrics and gynecology in the OHSU School of Medicine, who leads the OB/GYN Ryan Residency Program at OHSU. “Without those skills, they won’t be able to properly care for patients, which is a threat to women’s health care everywhere.”
Research to inform evidence-based policy
By the numbers
- Nearly 40% increase in abortions in Oregon since 2020.
- New telehealth program doubled OHSU clinical visit capacity.
- ACT Fund has trained 15 providers in abortion services.
- Reproductive health ECHO program has trained 70 clinicians in the region.
Poor and worsening maternal health outcomes in the U.S. are driven in part by limited access to evidence-based reproductive health services — in particular, contraception and abortion. In efforts to combat the maternal health crisis, OHSU’s Center for Reproductive Health Equity continues to investigate key disparities affecting reproductive health and clinical care. Recent research efforts investigated how insurance coverage mitigates or perpetuates reproductive health disparities among marginalized groups, including low-income immigrants.
“In the face of continued attacks on reproductive rights, it’s critical to advance policies that will preserve access to full-scope reproductive health care, including maternity and newborn care, contraceptive access, abortion services and fertility treatment,” Rodriguez said.
“The ability to make decisions about our reproductive health, including when or whether to bear a child, is a fundamental right that must be protected.”