Interested Parties Memo: Reproductive Health in Kentucky and Indiana Two Years Post Dobbs

TO: Interested Parties

FROM: Nicole Erwin, Planned Parenthood Alliance Advocates 

DATE: Friday, June 21, 2024

RE: Reproductive Health in Kentucky and Indiana Two Years Post Dobbs

As we approach nearly two years without federal protections for abortion access following the Supreme Court's decision to overturn Roe v. Wade, growing evidence shows that abortion bans not only impact abortion access but also increasingly block most forms of health care in restricted states. Devastatingly, the Dobbs decision has impacted maternal health, contraceptive care, providers, patients, health centers, and support networks and has created a patchwork of policies where zip codes largely determine a person’s ability to access care. Both Kentucky and Indiana have near-total abortion bans in place. 

Below is a breakdown of how restrictive reproductive health policies impact the health and well-being of communities in Indiana and Kentucky and what trends we see now which may further impact care in the future. 

See more on the specifics of Kentucky’s abortion ban here and Indiana’s here. 

Crossing Borders for Care
Patients traveling to other states to obtain abortion care has doubled in recent years, reaching nearly one in five in the first half of 2023, compared with one in 10 in 2020. 

• 171,000 people traveled out of state for abortions in 2023.
• The Carbondale Planned Parenthood Health Center in Illinois has become a key access point for abortion care in the region, as over 90% of its abortion patients have traveled from 16 different states, with the top 7 being Tennessee, Kentucky, Mississippi, Indiana, Arkansas, Alabama, and Missouri. 

Abortion Exemptions Aren’t Effective
Abortion bans have created a public health crisis, leaving patients scared and confused about where to turn for care and what conditions allow for that care. Reports indicate that many hospitals in Indiana, especially religiously-affiliated ones, are unwilling to provide abortion care even in legally permissible cases of rape or incest. The Supreme Court's ruling on the upcoming EMTALA case could leave Kentucky in a similarly worse situation, with the remaining hospitals potentially turning patients away due to uncertainty around the legal implications when providing abortion care related to serious health risks. 

• 65 000  pregnancies resulted from rape in states with abortion bans. An estimated 3,000 pregnancies have been the product of rape in Kentucky since the abortion ban went into effect. 
• Studies show at least a third of pregnancies involve ER visits, and up to 15% include potentially life-threatening conditions. Abortion bans make pregnancy less safe, period. In fact, carrying a pregnancy to term is significantly riskier for the pregnant person than having an abortion.
• A recent poll from the Kaiser Family Foundation found that 88% of all women support protecting access to abortions for patients who are experiencing miscarriage or other pregnancy-related emergencies.

Birth Control and IVF
Anti-abortion legislators are spreading misinformation about birth control methods in an attempt to limit access. Laws and policies that define personhood to start at fertilization may similarly be used to limit access to contraceptives. So far, in 2024, eight states have enacted or proposed attacks on contraceptive access.

• Indiana: Due to an anti-abortion groups' false claims that IUDs cause abortions, a new Indiana law that provides long-acting contraceptives to Medicaid recipients after birth was amended before passage to include only subdermal contraceptives, preventing IUDs the most common LARC method from being included in the bill. 
• Through its endorsement process, an anti-abortion group in Kentucky is peddling the lie that equates contraceptives like the “morning after pill,” and standard birth control pills with abortion. 
• Redefining contraception like IUDs as abortion is a clear strategy that could be used to restrict access. By doing this, states won’t have to pass an outright ban. The existing bans may be enough.  
• During the last legislative session, lawmakers in both Indiana and Kentucky introduced bills attempting to grant fetal personhood, which could lead to states losing IVF access under existing abortion bans. 
• After the Alabama Supreme Court’s ruling that led to a temporary halt in IVF, Kentucky lawmakers introduced several bills to protect access to IVF. Not a single one received a hearing. 
• One in five Americans say they believe access to birth control is under threat, according to a March Kaiser Family Foundation poll.
• A 2023 poll by the Kaiser Family Foundation shows many Americans don’t know the difference between abortion pills, which end a pregnancy, and emergency contraception, which prevents it. Nearly three-quarters of Americans incorrectly think that emergency contraceptive pills can end a pregnancy in its early stages.
• The Dobbs decision led to a surge in demand for contraception, including permanent contraception and emergency contraception. This was evidenced by increased Google searches and higher consultation rates for vasectomies and other contraceptive methods.

Impact on Health Care Workforce 
Restrictive abortion policies reduce training opportunities, impacting clinical skills and patient care. Physicians report delays in necessary care, legal fears, and moral distress. About 60% considered leaving their state, with 11% actually relocating. A recent survey found many physicians in states with bans are afraid to speak out due to hospital restrictions. 

Residency Program Declines:

• Fewer graduates from U.S. medical schools are applying to residencies in states with abortion bans, with a 10% drop in applicants to residency programs since Dobbs.
• Kentucky: 15% decrease, a 25% drop in OB/GYN applicants over two years.
• Indiana: Indiana University Medical School saw a significant drop in residents staying post-residency (from 3 to 5 out of 10 residents to 1 in 10).

Projected Shortages:

The United States is already suffering from provider shortages, particularly in rural communities that experience major health disparities.

• Researchers predict a nationwide shortage of 86,000 physicians by 2036.
• On top of these physician shortages, Indiana currently has 4,300 nursing job openings, with an additional 5,000 expected by 2031
• Kentucky expects a shortage of 2,926 doctors by 2030 and will need 16,000 more nurses by 2024.

Impact on Maternal Health 
As providers leave states with restrictive policies, pregnant patients may suffer, and regions with little-to-no access to health care will be impacted most, expanding existing maternal health care deserts.

Treatment for pregnancy emergencies is at risk:

• The Kaiser Family Foundation found, among other critical findings, that 20% of providers feel constrained in managing pregnancy emergencies. The number rose to 40% in abortion-ban states.
• Recent polling shows that people are postponing pregnancy out of concern about managing pregnancy-related medical emergencies. 

Maternal mortality will continue to worsen:
Kentucky and Indiana already have some of the worst pregnancy outcomes in the country, with the 2nd and 10th highest rates of maternal mortality in the country, respectively. 

• Both states have severe maternal health care deserts. In 2023, Parkview closed two birthing centers in the Northeast portion of Indiana, further narrowing options for care for Hoosiers. In Kentucky, 76 of 120 counties lack an OB-GYN.

• Research predicts that abortion bans will lead to a 21% increase in pregnancy-related deaths, 33% among Black women. And just like medical students are opting out of abortion-banned states for residency programs, younger people are opting not to relocate or live in these states–driving away up to half of young talent.

Mental Health
Contrary to anti-abortion rhetoric, abortion does not lead to poor mental health outcomes. In fact, quite the opposite: being denied a needed abortion actually undermines mental health and leads to higher rates of anxiety and lower self-esteem. Restricting access to safe, legal abortion is what causes harm. Data show that already marginalized communities within the health care system experienced worsening mental health during this time. The mental health of health care providers, including obstetricians and emergency room physicians, is suffering because they can't practice as they were trained, and could play a part in whether or not providers decide to stay in restricted states. 

Summary 
The impact of these bans is profound and far-reaching, affecting all aspects of health care. Research supports the need to reverse these bans to ensure comprehensive and equitable access to care. There is only one path forward: reverse the bans.

If you have additional questions about abortion access, please reach out to [email protected]