{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T08:36:42Z","timestamp":1792917402128,"version":"4.5.0"},"reference-count":21,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"\n Objective:<\/jats:title>\n To examine how abortion policy environments and geographic context are associated with reproductive health outcomes, and to characterize implications for obstetrics and gynecology (OBGYN) care.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We conducted a cross-sectional analysis exploring associations between outcomes of health care quality and access ranked in the 2024 Commonwealth Fund State Scorecard to Guttmacher abortion policy categories (restrictive, middle-ground, and protective) and U.S. Census regions. Kruskal\u2013Wallis rank-sum tests with Dunn\n post hoc<\/jats:italic>\n comparisons and Spearman correlations assessed the relationship of these environmental factors with 32 outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Southern states had worse overall reproductive health rankings than other regions (\n p<\/jats:italic>\n < 0.001). Restrictive abortion policy states had poorer outcomes across all domains of OBGYN care and access (\n p<\/jats:italic>\n < 0.01). Higher rural population correlated with higher infant mortality (\n r<\/jats:italic>\n = 0.31,\n p<\/jats:italic>\n = 0.028), preterm birth (\n r<\/jats:italic>\n = 0.36,\n p<\/jats:italic>\n = 0.010), depression before\/during pregnancy (\n r<\/jats:italic>\n = 0.71,\n p<\/jats:italic>\n < 0.001), and poor mental health (\n r<\/jats:italic>\n = 0.44,\n p<\/jats:italic>\n = 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Health disparities associated with restrictive abortion policies and geographic inequities signal regional variation in OBGYN workforce strain, reinforcing the need for systems-level, context-aware strategies to support retention and sustainability.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/15409996261478009","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:53:56Z","timestamp":1786686836000},"page":"1121-1130","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Geography, Policy, and System Strain in U.S. Obstetric and Gynecologic Care"],"prefix":"10.1177","volume":"35","author":[{"given":"Abigail Ford","family":"Winkel","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Park","sequence":"additional","affiliation":[{"name":"Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0940-4004","authenticated-orcid":false,"given":"Julia","family":"Rossi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Strasser","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Milken Institute School of Public Health, Washington, District of Columbia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille A.","family":"Clare","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Women\u2019s Health, Albert Einstein College of Medicine, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen K.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-06535-7"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000006069"},{"key":"e_1_3_5_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005976"},{"key":"e_1_3_5_5_1","unstructured":"4.Surgo Health. U.S. Maternal Vulnerability Index (MVI). Surgo health website. Available from: https:\/\/mvi.surgohealth.com\/ [Last accessed: December31 2025]."},{"key":"e_1_3_5_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000452"},{"key":"e_1_3_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogc.2020.11.008"},{"key":"e_1_3_5_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.52109"},{"key":"e_1_3_5_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000006079"},{"key":"e_1_3_5_10_1","unstructured":"9.American College of Obstetricians and Gynecologists. Position statement on institutional support for Ob-Gyns. ACOG website; 2025. Available from: https:\/\/www.acog.org\/clinical-information\/policy-and-position-statements\/position-statements\/2024\/position-statement-on-institutional-support-for-ob-gyns [Last accessed: February6 2026]."},{"key":"e_1_3_5_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/acrefore\/9780190632366.013.466"},{"key":"e_1_3_5_12_1","unstructured":"11.Abortion Care Network. Communities need clinics: 2024 report\u2014There is no access without independent abortion care providers. Abortion Care Network website; 2024. Available from: https:\/\/abortioncarenetwork.org\/wp-content\/uploads\/2024\/12\/CommunitiesNeedClinics2024_WEB-FINAL.pdf [Last accessed: December31 2025]."},{"key":"e_1_3_5_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxae162"},{"key":"e_1_3_5_14_1","unstructured":"13.Stoneburner A Lucas R Fontenot J et al. Nowhere to go: Maternity care deserts across the US. March of Dimes website; 2024. Available from: https:\/\/www.marchofdimes.org\/peristats\/assets\/s3\/reports\/2024-Maternity-Care-Report.pdf. [Last accessed: December31 2025]."},{"key":"e_1_3_5_15_1","unstructured":"14.Collins SR Radley DC Roy S et al. 2024 state scorecard on women\u2019s health and reproductive care. Commonwealth Fund website; 2024. Available from: https:\/\/www.commonwealthfund.org\/publications\/scorecard\/2024\/jul\/2024-state-scorecard-womens-health-and-reproductive-care. [Last accessed: December31 2025]."},{"key":"e_1_3_5_16_1","unstructured":"15.Guttmacher Institute. Interactive map: US abortion policies and access after Roe. Guttmacher Institute website; 2025. Available from: https:\/\/states.guttmacher.org\/policies\/ [Last accessed: December31 2025]."},{"key":"e_1_3_5_17_1","unstructured":"16.U.S. Census Bureau. Census regions and divisions of the United States. U.S. Department of Commerce website. Available from: https:\/\/www2.census.gov\/geo\/pdfs\/maps-data\/maps\/reference\/us_regdiv.pdf [Last accessed: August2025]."},{"key":"e_1_3_5_18_1","unstructured":"17.U.S. Census Bureau. Urban and rural population data. Census.gov website; 2024. Available from: https:\/\/www.census.gov\/programs-surveys\/geography\/guidance\/geo-areas\/urban-rural.html [Last accessed: August2025]."},{"key":"e_1_3_5_19_1","unstructured":"18.Brigham T Barden C Dopp AL et al. A journey to construct an all-encompassing conceptual model of factors affecting clinician well-being and resilience. NAM Perspect; 2018. Available from: https:\/\/nam.edu\/wp-content\/uploads\/2018\/01\/Journey-to-Construct-Conceptual-Model.pdf. [Last accessed: December31 2025]."},{"key":"e_1_3_5_20_1","unstructured":"19.National Center for Health Statistics. Births: National vital statistics system. Centers for Disease Control and Prevention website; 2025. Available from: https:\/\/www.cdc.gov\/nchs\/nvss\/births.htm [Last accessed: December31 2025]."},{"key":"e_1_3_5_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-019-01368-3"},{"key":"e_1_3_5_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000006148"}],"container-title":["Journal of Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15409996261478009","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15409996261478009","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15409996261478009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T07:56:30Z","timestamp":1792914990000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15409996261478009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":21,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026,12,1]]}},"alternative-id":["10.1177\/15409996261478009"],"URL":"https:\/\/doi.org\/10.1177\/15409996261478009","relation":{},"ISSN":["1540-9996","1931-843X"],"issn-type":[{"value":"1540-9996","type":"print"},{"value":"1931-843X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]}}}