In the Wake of Dobbs, are Community Health Centers Prepared to Respond to Rising Maternal and Infant Care Needs?

Peter Shin, Sara Rosenbaum, Rebecca Morris, Kay Johnson, and Feygele Jacobs

Executive Summary

The Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization will have a dramatic impact on access to abortion services. Thirteen states have abortion bans on the books that are designed to immediately go into effect (trigger bans), while another 13 states are expected to enact bans in the near future. Community health centers are a major source of health care to communities that will experience the harshest effects of the bans because of poverty and underservice. Health center patients are disproportionately people of color, who face the most serious health inequities and are likely to be most adversely affected. Federal data show that in 2020, health centers nationwide served over 7.4 million women of reproductive health age and 636,000 infants under age one. Nationally, health centers provided contraceptive management to 1.5 million patients that year. Among children cared for by health centers nationwide, over half a million showed signs of developmental delay. More than 3 million women of reproductive age, 274,000 infants, and 156,000 children with developmental conditions received care at a community health center in one of the 26 states that have either banned abortion or are likely to do so. In the wake of a ban, these figures can be expected to rise. Community health centers in ban or likely-to-ban states care for a significant percentage of all pregnancies in their state. These states tend to have higher levels of poverty and a greater percentage of Black and Latino women who are uninsured. The health centers in these states currently face a critical shortage of obstetrical providers.

• In 9 states (AL, AR, ID, MT, NE, ND, SD, UT, WY), the state’s health centers have fewer than 5 OB/GYN physicians in total.

• In 11 states (AL, AR, ID, LA, MS, MO, MT, ND, SD, UT, WY), the state’s health centers have fewer than 3 full-time equivalent (FTE) certified nurse midwives (CNM).

Federal data measuring maternity care shortages show that 9 trigger ban or likely-to-ban states (AL, AR, ID, LA, MO, MT, ND, UT, WY) have the most severe shortages, as measured by federal guidelines—fewer than 1 OB/GYN physician and/or CNM per 6,000 women aged 15-44 or alternatively, no CNMs or OB-GYNs and a population of at least 500 women ages 15-44. In Montana, where community health centers served 26,140 women of reproductive age in 2020, health centers had only 1 CNM, far exceeding the severe shortage threshold. None of the 26 ban or likely-to-ban states meets the provider-population ratio for adequate maternity care staffing of 1-to-1,500.

The full-text issue brief is available here. The accompanying infographic is available below.

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