Women and women’s health advocates breathed a sigh of relief this week as the Better Health Reconciliation Act died a quiet death in the Senate.

Their relief was short-lived. Not long after the bill’s collapse, Senate Majority Leader Mitch McConnell announced that his caucus would vote to go ahead and repeal Obamacare anyway and just hope that Jesus or the Keebler Elves figure out what will replace it.

The Congressional Budget Office predicted the Senate’s now-dead plan would throw 22 million people off insurance. The current “eh, fuck it” plan would toss 32 million until a less terrible solution is found.

But if past is prelude, whatever theoretical new plan that the collective right-leaning nincompoopery of Washington can conjure will likely target health care that women rely on: abortion access, birth control, cancer screenings.

It’s going to be a rough forever for women’s health in the United States. It’s a great time to live in a constant state of existential dread, as though one’s reproductive anatomy is a biological game of russian roulette that comes pre-installed in the female body. It’s a great time for nail biting.

Even if the bumbling masses of Washington were able to craft a new health care bill that didn’t treat women’s health care like a fun activity gals do together on weekends, like pedicures, the state of women’s health care is precarious.

That’s because America is facing an imminent OB-GYN shortage. It’s difficult for a woman to get access to health care if there simply aren’t any doctors to provide it.

Previous research suggests such a looming shortage, that the average age of a working OB-GYN is older than in other medical specialities and that OB-GYNs are frequently overburdened and undercompensated compared to their peers. Med students simply don’t want to spend their working years in a field that leads medicine in burnout.

But new analysis by Doximity, a social networking site for health care professionals, paints a much more dire picture of how that shortage will be distributed.

First, Doximity analyzed the workloads of OB-GYNs in the 50 largest U.S. metropolitan areas by the number of births per doctor per year. Nationwide, the average OB-GYN assists in 105 childbirths per year. In the country’s most overburdened metropolitan areas—Riverside, California, and St. Louis, Missouri—OB-GYNs must attend to more than twice that number.

Next, Doximity assessed the average age of a working OB-GYN in those cities. Nationwide, the average OB-GYN is 51 years old. Many will retire at 59. Cities with large numbers of older OB-GYNs and high workloads will likely be more burdened during the coming shortage than cities with lesser workloads. The site next examined how many young OB-GYNs were entering the 50 markets.

All in, the cities with the grim combination of current overload, a future wave of retirements, and few young doctors to replace them are the ones that will feel the strain most acutely. Doximity determined that those cities are Las Vegas, Orlando, Los Angeles, Miami, and Riverside, California. Rounding out the top ten are Detroit, Memphis, Salt Lake City, St. Louis, and Buffalo, New York.

The Doximity analysis didn’t look at why young doctors don’t choose to go into the OB-GYN speciality, nor did it set out to trace whether the legal environment facing OB-GYNs is a factor.

Right now, in Wisconsin, a Republican state rep named Andre Jacque has introduced a measure that would prevent medical students at the state’s flagship public university in Madison from training OB-GYNs to perform abortions. Medical schools that do not at least offer training in how to perform abortions to their students could lose their national accreditation in the specialty, which would cause students interested in becoming OB-GYNs to choose another medical school. The state is already facing its own shortage; 20 of the state’s 72 counties don’t have an OB-GYN, according to the AP.

The bill could theoretically cut med students off from a path to OB-GYN certification by requiring they receive abortion training at hospitals rather than facilities like Planned Parenthood, which is where students currently learn (law requires that no tax money be used to fund abortion services, and the Planned Parenthood partnership allows OB-GYNs to train while obeying these requirements).

The only hospitals in Madison, Wisconsin, that could possibly train students on abortion care are University of Wisconsin hospitals, which means they’re already barred from receiving state funds, which means students who wanted to learn how would have to choose a different medical school. Which means Wisconsin’s women would have even fewer options when it came to their prenatal, postnatal, and reproductive health care. It’s a veritable Mobius strip of anti-women’s health logic cloaked in pro-life sanctimony.

In the age of Trump, hyperbole has been overextended to near-breakage like a brittle rubber band. But the looming OB-GYN shortage isn’t a fundraising effort or a bloodless voter targeting apparatus. What could soon happen to women across the country, from Buffalo to Los Angeles, is something that affects individual women, sure, but also their families, their futures. It’s bigger than a bill. It’s more than a fight.

Via The Daily Beast