Family Planning Clinicians Say Dobbs Decision Affected Their Work
December 1, 2025
By Melinda Young
A qualitative, interview-based study shows that family planning clinicians across the United States say their work was affected by the U.S. Supreme Court’s decision to allow states to ban abortion in the Dobbs v. Jackson Women’s Health Organization decision.1 “We reached out to participants in a survey at clinics that provide comprehensive services,” says Alicia VandeVusse, PhD, a senior research scientist at the Guttmacher Institute of New York, NY.
“We were trying to get fairly equal representation from staff in states where abortion was restricted post-Dobbs and in less restrictive states,” she explains. “Among the clinics that provide contraceptive services, how is their work impacted by the Dobbs decision?”
Researchers anticipated differential effects, and they found that clinicians in both types of states — restrictive and not restrictive — reported issues, but their difficulties were different. For example, clinics in states with abortion restrictions had stopped providing abortions or were struggling to provide abortions in a landscape with various restrictive policies. Clinics in less restrictive states also faced difficulties, such as having to adjust their patient care schedules because of an increase in patients seeking abortion care.1
One year after Dobbs, there was an 11% increase in the number of clinician-provided abortions in the United States, despite reductions in abortion access in many states. This meant that family planning clinics that provide abortion services in states that allow this saw a large increase in demand from inside and outside of their states.1 “We found in less restrictive or protective states, there were efforts to expand access to medical abortion and telemedicine services for medical abortion and to increase abortion service appointments,” VandeVusse says.
Clinicians in restrictive states struggled with how to manage patients experiencing a miscarriage. They worried about facing legal repercussions if they provided an abortion or if they referred patients to a clinic where they could obtain one, she adds.“ To be clear, the vast majority of clinics that provide contraceptive services are not abortion providers,” VandeVusse says.
“They have to provide counseling care about patients’ options, and we heard about how hamstrung they felt about not being able to give full information to their patients,” she adds. “In some cases, they felt they were not able to give comprehensive counseling to patients, and this contradicted their medical training and makes them unable to provide comprehensive care for patients.”
There were a few reasons why clinicians felt they were unable to provide all of the information they would want their patients to have, and one was that some states had post-Dobbs restrictions on providers telling patients about abortion and how to access it, VandeVusse explains. “We had participants who referenced regulations that came before Dobbs like the federal Title X gag rule from 2019-2021,” she says. “So, in some cases, folks are just scared whether or not they’re allowed to tell patients how to access abortion.”
Burnout and moral distress were common themes. “We heard from providers about burnout and the stress of feeling like you might be running afoul of legal restrictions and that it could have repercussions for their medical license,” VandeVusse says. “One person described it as being stuck between a rock and a hard place — you want to give information about abortion, but you felt you were not allowed to.”
Some clinicians found a workaround strategy. For example, one provider in an abortion-restrictive state said they could offer patients a list of providers of prenatal care, and if those providers also happened to offer abortions, then they can be on the list but the list would not say they offer abortion, she says. “They can point people in the right direction,” VandeVusse adds. “If you live in a city near a border, it might be common to cross the border to get care for any service.”
Clinicians in abortion-protective states reported expanding access to abortion where they could. “We heard about expanded training for handling patients experiencing miscarriage or thinking about where to refer patients experiencing miscarriage,” she says. “They talked about how to handle the demand of out-of-state patients needing abortion care.”
The logistics of handling out-of-state patients are difficult, she notes. “We heard about wait times for other sexual reproductive health services and that they had a large influx of out-of-state patients,” VandeVusse explains. “This increased wait times for contraception, implant, IUD [intrauterine device], and for people who want to come in for counseling about birth control or for a Pap smear.” These clinics provide a range of sexual and reproductive health services, and their other work was log-jammed by the influx of more people seeking an abortion, she adds.
“Across the board in states, we heard about clinics needing to address the ripple effects of this,” she says. “We heard about their trying to increase their navigation services.” For example, clinics might use patient navigators to connect patients to care and provide more support for them.
“We heard about folks trying to strengthen their confidentiality for patients,” VandeVusse says. “If they’re seeking care out of state and their medical record follows them, it could potentially be used against them.” Clinicians said they were exploring whether they could protect their medical records from being used to harm patients, she adds.
The study included participants who completed the 2022-2023 Survey of Clinics Providing Contraceptive Services. So, clinicians’ answers were early in the post-Dobbs period — before there were examples of states using surveillance technologies like license plate-scanning to track women seeking abortions out of state. “We didn’t hear from folks about surveillance technologies,” VandeVusse says. “We did hear they wanted to make patients understand what they can do to maintain confidentiality, but that was the extent of it.”
Another concern from providers involved the rise of misinformation and disinformation about abortion.1 Providers had to expend their resources to counter misinformation both from social media and also from crisis pregnancy centers that often present themselves as helping patients but will not inform them of all their options or connect them to appropriate care, VandeVusse notes.
“One participant said a coalition of providers work together to promote accurate information,” she adds. “We heard from folks about trying to address misinformation in individual appointments if patients [mention misinformation] and countering [inaccurate information] one-on-one,” she says. “It’s a growing concern.”
Clinics need to educate their staff as much as they can about what is legal and what is not legal in their state because clinicians often will comply in advance or self-censor when the state law does not require that, VandeVusse says.
“There is a lot of data at this point, showing Dobbs is having real harms and ripple effects to providers and to patients, and it looks like they are going to continue to attack reproductive healthcare,” she says. “But we need to promote and center the importance of patient autonomy, which is the best thing we can do; we have to lead with our values and keep leading with our values in the midst of these attacks.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
Reference
1. Mueller J, Cech S, Mulhern O, VandeVusse A. Effects of the Dobbs decision on abortion and related service provision among sexual and reproductive health clinics in the United States: Results from a qualitative study. Sex Reprod Health Matters. 2025;33:2557074.