It’s been three years since Indiana’s near total abortion ban took effect, even though a majority of Hoosiers believe the ban is too extreme. Patients who need to terminate a pregnancy are routinely forced to travel to neighboring states or carry their pregnancies to term. But the impacts of anti-abortion policies are not limited to those who need to terminate a pregnancy, or even those who become pregnant. In a state already characterized by poor maternal and child health outcomes, abortion bans simply make matters worse – for everyone.
Since 2020, at least 16 hospitals across Indiana have closed their obstetrics department and around 25% of counties in Indiana lack access to maternity care. While this trend was in motion before Roe was overturned in 2022, it’s important to understand that abortion bans are weakening an already fragile health care infrastructure across Indiana.
And the problem isn’t just the loss of physical health care infrastructure. Indiana also needs a strong and sustainable health care workforce to staff the hospitals and provide care in the communities that still have access to it. Yet there are growing signs that the state’s abortion ban is making that challenge even harder.
A declining health care workforce
Like much of the country, Indiana faces a declining health care workforce, with a shortage of primary care providers, nurses, mental health care professionals, and OB-GYNs. In December 2025, the Health Resources and Services Administration (HRSA) designated 169 primary care Health Professional Shortage Areas across the state. While millions of Hoosiers are already impacted by these shortages, they are only expected to increase in coming years. Forty percent of Indiana’s nursing workforce are aged 55 or older, and it’s not clear who will replace them when they retire.
But Indiana’s workforce challenges aren’t happening in a vacuum. Increasingly, there is evidence that the state’s abortion ban is also influencing where medical professionals choose to train and practice.
Across specialties, medical students appear to be factoring abortion bans into where they choose to train. Data from the 2023 and 2024 residency application cycles show that while the overall pool of graduating MD applicants shrank, the drop-off was sharper in states with abortion bans. OB-GYN programs in ban states saw applications fall 6.7% during the 2024 cycle, compared to a slight 0.4% increase in states where abortion remains legal.
The same pattern emerged in family medicine applications during the 2023 cycle, which also saw a shift in applications away from states with abortion bans. This is consistent with what students themselves report: surveys show that both access to abortion training and abortion access more broadly rank among the top factors applicants weigh when deciding where to apply.
Taken together, these trends suggest that abortion bans may be making it harder for Indiana to build and maintain the health care workforce it needs. But the impact isn’t only a future concern. Our recent research suggests that the ban is already changing how care is delivered and who is willing and able to provide it.
Workforce pressures are reshaping the provision of care
Abortion bans are not just impacting the future of the health care workforce; they are reshaping the provision of care for patients now. In our recent study, we learned that Indiana’s abortion ban has had several harmful impacts:
- A climate of fear and confusion: Legislation that singles out abortion contributed to a sense among doctors that managing or just talking about abortion was risky. Emergency medicine physicians we interviewed explained that they weren’t sure they understood the law well enough to stay out of jail. They feared being prosecuted for offering abortion medications or treatment—even when treating miscarriage. This sapped not just their confidence, but also their ability to provide routine counseling and care. When routine care for pregnancy becomes considered too risky to touch because of its potential association with abortion, will doctors in the ED simply lose fluency in providing it? This question is even more urgent as Indiana has lost infrastructure for pregnancy care in the last six years.
- Increased burden on OBGYNs: A small group of obstetrician/gynecologists (OBs) became “hyperspecialists” on cases involving potential abortion care. Emergency medicine physicians were quick to refer to their OB colleagues, even for simple things that they would have handled on their own in the past. They trusted only their OB consults to know the exact language and protocols to keep doctors safe from abortion-hostile prosecutors. Emergency medicine physicians frequently called in OBs just to speak with the ED patients about what was and was not available in Indiana. As a byproduct, certain OB clinicians accumulated expertise spanning clinical management, legal interpretation, institutional policy, and patient counseling.
- Higher risk of health care failures: The OB-GYNs that we talked with typically welcomed the role for increased consultation, recognizing that they have expertise that can be helpful for patients. They continue to provide a high quality of care. Yet, three years into the ban, the long-term sustainability of this approach is concerning. The risk of health care failures grows as the burden of care shifts onto an increasingly dwindling number of OB-GYNs in the state.
- Many more unknowns: Our research offered a glimpse into a highly supportive, resourced hospital setting. We don’t yet know what is happening in emergency departments in rural areas where there isn’t an option to refer to OBs.
Anti-abortion policies are hollowing out the workforce meant to care for everyone who gets sick, gives birth, or needs a doctor nearby.
Legislators owe the state an honest reckoning with the impacts on our communities. Rather than continuing to enact policies that drive health care professionals away, Indiana must reverse course and start investing in the workforce it depends on. It is essential that the state tries to recruit and retain quality health care providers and to create opportunities for physicians to maintain their existing skillsets.
About the Authors: Kathryn LaRoche, PhD, is a women’s health educator and researcher in Indiana. Her work centers on improving reproductive health care with a particular focus on abortion and pregnancy. Lori Freedman, PhD, is a sociologist and bioethicist who conducts primarily qualitative research about how the politics of abortion shape obstetric and reproductive medical care in the United States. Freedman is a Professor at the University of California, San Francisco’s Advancing New Standards In Reproductive Health.
