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.

The seven members of the Wisconsin Supreme Court hear oral arguments. (Henry Redman/Wisconsin Examiner)

In a 4-3 decision, Wisconsin Supreme Court ruled Wednesday that the state’s 1849 law banning abortion had been “impliedly repealed” by the Legislature when it passed laws over the past half century “regulating in detail the ‘who, what, where, when, and how’” of abortion. 

The Court’s majority opinion, authored by Justice Rebecca Dallet and joined by Justices Ann Walsh Bradley, Jill Karofsky and Janet Protasiewicz, finds that the Legislature could not have passed laws regulating abortion access if the 1849 statute was believed to remain in effect. 

“This case is about giving effect to 50 years’ worth of laws passed by the Legislature about virtually every aspect of abortion including where, when, and how health-care providers may lawfully perform abortions,” Dallet wrote. “The Legislature, as the peoples’ representatives, remains free to change the laws with respect to abortion in the future. But the only way to give effect to what the Legislature has actually done over the last 50 years is to conclude that it impliedly repealed the 19th century near-total ban on abortion, and that [the statute] therefore does not prohibit abortion in the State of Wisconsin.” 

Dallet wrote that when the Legislature passed laws restricting abortion under narrower circumstances, guiding “where, when and how” health care providers could perform an abortion and outlining how public money could fund abortion providers, it was repealing the 1849 law. 

The ruling comes three years after the U.S. Supreme Court overturned Roe v. Wade, the landmark Court ruling that found there was a constitutional right to abortion access and marks the conclusion of a legal dispute that helped Protasiewicz win election to the Court in 2023 and Susan Crawford win election this April. 

In response, the Court’s three conservative justices filed dissents, accusing the majority of “propaganda,” “smoke-and-mirrors legalese” and “pure policymaking.” 

“The majority’s smoke-and-mirrors legalese is nothing more than ‘painting a mule to resemble a zebra, and then going zebra hunting. But paint does not change the mule into a zebra,’” Justice Annette Ziegler wrote. “Those in the majority know better, but they do so anyway because they like the result and promised to deliver it.” 

In his dissent, Justice Brian Hagedorn wrote that the majority failed to show when the law was presumably repealed by the Legislature, saying that the opinion doesn’t properly address the Legislature’s actions in 2011 and 2015 amending the 1849 law.  

“The majority does not say when over those 40 years the Legislature once and for all repealed [the statute],” he wrote. “Was it when the Legislature passed a postviability ban? A partial-birth abortion ban? A twenty-week ban? A waiting period? A physician licensing requirement? The majority fails to say.”

23AP2362 Mandate

Following the ruling’s release, the state’s Democratic elected officials and abortion access activists celebrated the decision as a “win” for reproductive health care in the state. 

“Thanks to our lawsuit, today’s decision affirms that access to reproductive healthcare will continue to be available, helping ensure Wisconsin women today are not forced to face firsthand what it’s like to live in a state that bans nearly all abortions, even in cases of rape and incest,” Gov. Tony Evers said in a statement. “Today is a win for women and families, a win for healthcare professionals who want to provide medically accurate care to their patients, and a win for basic freedoms in Wisconsin, but our work is not over. I will continue to fight any effort that takes away Wisconsinites’ reproductive freedom or makes reproductive healthcare, whether birth control, abortion, IVF, or fertility treatments, any less accessible in Wisconsin than it is today. That is a promise.”

Attorney General Josh Kaul, who brought the lawsuit against the law, said at a Wednesday morning news conference that the decision was an important step toward ensuring all Wisconsinites have the freedom to access abortion care, but that the Legislature should step up and further clarify the law.

“I thought we were right on the law. The arguments we made have now been vindicated,” Kaul said. “But at a time when the rights of Wisconsinites and Americans are under threat, this case is a stark reminder of how important it is that we fight for our rights, that we advocate for what is in the best interest of the people of our state, and that we stand on the side of freedom. Here today, we were able to achieve a significant victory for the freedom of Wisconsinites.”

Wisconsin’s state and federal Democratic lawmakers responded to the ruling by saying it wasn’t enough, promising to continue working to codify abortion access in law. 

U.S. Sen. Tammy Baldwin said she will continue to work to enact her proposal to ensure women across the country have access to abortion care. 

“Today’s ruling tells women across Wisconsin that we will not go back,” Baldwin said. “Today’s ruling tells women that our government trusts you to make decisions about your own body and your future. Today’s ruling tells women in our state that they are not second-class citizens. But, this fight is not over. Every woman, in every zip code, in every state deserves the same rights and freedoms. I will not stop fighting until we make that a reality and pass my bill to restore the right to abortion nationwide and allow women to make their own health care decisions without interference from judges or politicians.”

State Sen. Lisa Subeck (D-Madison) said the Legislature must now pass a bill guaranteeing the right to an abortion. 

“Now that the courts have made it clear that Wisconsin does not have a total abortion ban, we must go further,” Subeck said. “It’s time to protect reproductive rights not just in practice, but in law. We must pass the Abortion Rights Restoration Act to guarantee the right to abortion and eliminate the medically unjustified, politically motivated restrictions that still exist in our state statutes. The people of Wisconsin deserve nothing less than full access to safe and legal reproductive health care without unnecessary barriers and free from judgement.”

In a concurring opinion, Karofsky wrote that interpreting the 1849 law as banning abortion gives the state the authority to “exert total control” over women and “strips women and pregnant people of the dignity and authority to make intimate and personal choices by exposing medical professionals who perform abortions to 15-year prison terms.” 

In her opinion, Karofsky details the history of abortion access in the U.S. and highlights four women who died because of restrictive abortion bans, including the recent deaths of two Black women in Georgia and a Honduran immigrant in Texas as well as the death of her own great-grandmother in Boston in 1929. 

“I tell the stories of Amber, Candi, Josseli, and my great-grandmother Julia to remind us that severe abortion restrictions operate like death warrants,” Karofsky wrote. “Under such restrictions women, children, and pregnant people are denied life-saving medical care while medical professionals are forced to sit idly at their bedsides, unable to do their jobs. Extreme abortion restrictions revive a time in our history driven by misogyny and racism, divorced from medical science; it is a world that must be left behind.” 

In her dissent, Justice Rebecca Bradley accused Karofsky of rewriting history to achieve a desired outcome in the case. 

“Not content with effacing the law, Chief Justice Jill Karofsky rewrites history, erases and insults women by referring to mothers as ‘pregnant people,’ slanders proponents of the pro-life perspective, and broadcasts dangerously false narratives about laws restricting abortion,” Bradley wrote. “Laden with emotion, steeped in myth, and light on the law, the concurrence reads as a parody of progressive politics rather than the opinion of a jurist.”