Dr. Becky Uranga, an OB-GYN in the Boise area of Idaho, holds one of many babies she has delivered over her 14 years of practice. As OB-GYNs and specialists have left Idaho after the implementation of a near-total abortion ban, Uranga said she is shouldering more work and feeling unable to give as much of her attention to some patients as she used to. (Courtesy of Dr. Becky Uranga)

Before Dr. Harmony Schroeder left her OB-GYN practice in Idaho last year for Washington, she’d had many conversations with legislators and others about how to feel safe practicing in a state with a near-total abortion ban that includes criminal and civil liabilities for violating the law.

Schroeder wanted to stay. She’d practiced in Idaho for nearly 30 years, with a patient list of about 3,000 and a group of doctors she loved. She thought once elected officials understood that a ban would mean poorer medical care and more negative outcomes, things would improve.

Instead, they got even worse, as women were airlifted out of state during a period without protection for emergency abortion care under federal law.

Schroeder felt like she was either compromising care for women or compromising herself by risking jail time.

Providers convicted of breaking the law face up to five years in prison, revocation of their medical license and at least $20,000 in civil penalties.

“People said, ‘Oh, we would never really put you in jail,’” she said. “Sometimes it felt like the legislature was giving us a pinky swear.”

Schroeder is one of 114 OB-GYNs who left Idaho or stopped practicing obstetrics between August 2022 and December 2024, according to data from a peer-reviewed study published in JAMA Open Network, a division of the Journal of the American Medical Association. That number represents 43% of the 268 physicians practicing obstetrics statewide, a higher figure than previous reports indicated.

The study showed 20 new OB-GYNs moved to Idaho during that same period, for a net loss of 94 physicians.

It’s not the only state with a ban experiencing shifts in numbers of obstetrics providers, but it is one of the most acute. Physicians in Texas, Tennessee, Oklahoma and other ban states have spoken to the media and researchers to say they are leaving the state or retiring from the practice because of bans, and while the numbers may not always be statistically significant, the departures are often in states that already have maternal health care shortages. 

The states with the highest percentage of maternity care deserts as of 2024 were North Dakota, South Dakota, Oklahoma, Missouri, Nebraska and Arkansas, according to March of Dimes. With the exceptions of North Dakota and Nebraska, every state in that list has a near-total abortion ban in place.

Out of the 55 OB-GYN physicians Idaho lost just in 2024, 23 moved out of the state, 12 retired, and 16 either shifted their practice to gynecology only or moved from a rural to urban practice site. The remaining moved elsewhere in state. All of those who moved away moved to a state that did not have abortion restrictions similar to Idaho’s.

As of 2018, four years before the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision that ended federally protected access to abortion, Idaho needed 20 more OB-GYNs to meet demand, according to a report from the U.S. Department of Health and Human Services.

Schroeder likes her new practice in Washington, but she is still sad about the realities that forced her to leave.

“I wish it didn’t have to be this way,” she said. 

Study proves ‘what we feared was happening’

Susie Keller, CEO of the Idaho Medical Association, said the losses feel worse because Idaho already consistently ranked at the bottom of nationwide rankings for physician-to-patient ratios even while the population has exploded in recent years.

The Centers for Disease Control and Prevention ranked Idaho lowest in 2019 for overall patient-to-doctor ratios, and the conservative Cicero Institute ranked it 50th in 2024. According to a report from the Idaho Coalition for Safe Healthcare, the ratio of patients to obstetricians increased from 1 per 6,668 Idahoans to 1 for every 8,510 Idahoans between August 2022 and November 2023.

Keller said the medical association has tried hard to find solutions that would help retain physicians, including failed efforts over the past two years to add a health exception in the abortion law.

“Every time there’s been some sort of event that sustained this difficult environment or made it worse, we heard about folks leaving,” Keller said.

The study, which was led by Dr. J. Edward McEachern, is a clear demonstration of what Keller said the medical association already knew anecdotally. It’s also proof, she said, for the elected officials who have accused them of fabricating stories or data and exaggerating the situation. Idaho Attorney General Raúl Labrador said in June 2024 that Idaho doctors who left were doing so because they made “the vast majority of their money” from performing abortions, but he did not provide evidence for that claim. Republican Rep. Brent Crane, who is chairman of the committee where abortion-related legislation would be considered, said in April 2024 that hospital legal counsel was being disingenuous with providers about the vagueness of the law because they want to undermine and ultimately repeal it.

“This kind of dialed-in study really gives us a very clear picture of what we had feared was happening,” Keller said.

Among clinics, not everyone is in agreement about the problems. Scott Tucker, practice administrator for Women’s Health Associates in Boise, said the providers they have lost over the past three years were mostly due to other factors. Increases in clinic wait times are up across the valley because of population growth, he said, and there is a national shortage of OB-GYNs and primary care providers.

“(Idaho’s abortion ban) really hasn’t impacted us much, other than we get a lot of questions and a lot of requests for contraception counseling,” Tucker said.

He added that while it’s never easy to recruit new physicians, and the ban has created extra challenges, they’ve onboarded a new physician once every nine months for the past four years and have two candidates slated to start in 2026. Much of the interest comes from candidates in the Midwest and the East, he said, and “much of what they’re hearing is hyperbole.”

‘I don’t know if it’s fair to the public for them to never feel like this is a problem’

Dr. Becky Uranga practiced with Schroeder for 14 years at OGA, a physician-owned OB-GYN clinic in the Boise area. She watched Schroeder leave, along with another doctor at OGA who went into a different medical field and one who retired.

In June, another longtime OB-GYN announced his departure. Dr. Scott Armstrong, who had practiced in the area for 26 years, sent a letter to patients saying his last day at OGA will be on Oct. 17, when he will move back to the Midwest “to help care for my aging parents and embark on a new chapter in my life.”

Uranga said the practice will have eight practicing OB-GYNs by October — down from 12 a few years ago. And the closure of other labor and delivery units in the area, which is the most populous in the state, has increased workloads for clinics like OGA as well. Uranga’s practice provides the full spectrum of obstetrics and gynecological care for women of all ages, including surgeries and labor and delivery.

“All those people (from the closed clinics) then came to us,” Uranga said.

What used to be two or four deliveries on average in a 24-hour shift is now five to six.

“That’s a lot, and it’s a really special moment that you want to be all in, present and available for whatever could happen … and it doesn’t feel like that anymore,” she said.

When a physician leaves, especially ones that have been practicing for a long time, Uranga said it leaves a hole. Schroeder had 3,000 patients, and many of them were receiving care for menopause, which she specialized in. Uranga sought out extra training to become board certified in menopause care to fill that gap.

While they juggled the transition with fewer physicians, OGA temporarily limited new patients for certain services, including some Medicaid patients. Uranga also isn’t traveling to a rural area of Idaho anymore to provide surgeries, something she and Schroeder used to do together.

When she’s not doing clinic visits, patient calls, surgeries or deliveries, she’s helping with organizing and fundraising efforts for the reproductive rights ballot initiative that would restore abortion access in Idaho. And in between all that, she’s scheduling recruiting calls with potential physicians.

She recently had to tell a recruitment coordinator that they need to be transparent up front about Idaho’s abortion laws, because she wasted too much time talking to candidates who responded with a hard no after learning about the medical environment.

“My nurse will tell you that I am fitting people in before, during, and after (hours) all the time, which isn’t fair to my family, it’s not fair to my nurse, and I don’t know if it’s fair to the public for them to never feel like this is a problem,” Uranga said.

This story has been updated.

Clinicians are providing medication abortion through telehealth services even to people in states where abortion is banned, thanks in part to shield laws in states where abortion is still legal. (Natalie Behring/Getty Images)

As conservative lawmakers work to restrict online access to abortion medication, a new report shows how popular it has become for women who live in states that have outlawed abortion.

Researchers from the University of Texas at Austin led a team that analyzed 15 months of prescription data from Aid Access, one of the largest online abortion telemedicine providers.

They found 84% of Aid Access’s more than 118,000 online prescriptions went to patients living in abortion-ban states.

The South and Midwest had the highest rates of patients accessing telemedicine abortion. Rates were also greater in high-poverty areas or where people would have to travel more than 100 miles to reach an abortion clinic, according to the report, which published this month.

Aid Access is able to mail abortion medications to residents in all 50 states — even those in states with abortion bans — thanks to shield laws in Democratic-led states. Shield laws are designed to minimize the legal risks for people who provide or access abortions across state lines.

Currently, 22 states and Washington, D.C., have reproductive care shield laws, either through legislation or by executive order, according to a report from University of California, Los Angeles School of Law.

Eight of those states — California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont and Washington — specifically protect telehealth abortion providers regardless of where their patient is located.

Shield laws, along with difficulty accessing in-person abortion services in abortion-ban states, have contributed to a rise in medication and telehealth abortions since the U.S. Supreme Court overturned the federal right to abortion in 2022, clearing the way for state bans. With telehealth abortion, patients have a virtual appointment with a clinician who can prescribe abortion medication, which is then filled by a licensed pharmacy and mailed to the patient.

Research has shown telehealth medication abortion is effective and safe, and comparable to in-person medication abortion.

Medication abortion accounted for nearly two-thirds of all clinician-provided abortions in states without bans in 2023, the most recent data available from the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights.

But as abortion medication use rises, so have conservative efforts to ban it.

This year, more than a dozen states introduced bills to bar access to medication abortion by criminalizing its sale, purchase or distribution, according to Guttmacher.

One such bill in Texas, which could have been a blueprint for medication abortion restriction in other states, was specifically aimed at groups like Aid Access. It would have allowed private citizens to sue for at least $100,000 anyone who provided abortion pills in Texas. The bill passed the Texas Senate but died in the House in May.

Earlier this year, the state of Louisiana criminally charged a New York physician under its abortion ban law for allegedly providing abortion pills to a Louisiana teen via telehealth. New York, which passed a shield law in 2023, refused Louisiana’s request to extradite the doctor.

Last month marked the first federal test of shield laws, when a Texas man sued a California doctor for allegedly mailing abortion pills to his partner.

This week, a Texas woman filed a federal lawsuit against Aid Access and against a man who she said impregnated her, then spiked her drink with abortion pills. She is also suing the Dutch doctor who founded Aid Access, alleging Aid Access and its founder mailed abortion-inducing drugs in violation of Texas and federal law.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.