Dr. Damla Karsan, an OB-GYN in Houston, Texas, has considered leaving the state to practice medicine somewhere else.

Several years ago, when Texas was ramping up its abortion restrictions, she was being recruited to a hospital in North Carolina, where she did her residency training. The offer was tempting. Even without Texas’ conservative laws around reproductive health, Texas politics overall weren’t exactly in line with Karsan’s. She thought North Carolina might be a nice change of pace.

But Karsan, a born-and-raised Houstonian has cared for patients in the area for more than 20 years, including Kate Cox and Amanda Zurawski, who both sued the state of Texas in 2023 after they were denied abortion care. She said she couldn’t bring herself to leave her patients behind—not even as new laws have made it nearly impossible for pregnant people to get abortion care in Texas.

“At this point I’m staying put,” she said. “I’m a fighter. So, onward.”

But other OB-GYNs feel differently. According to the Texas Tribune, by 2030 Texas is expected to have 15 percent fewer OB-GYNs than needed. Many reported that they planned to leave the state or retire early.

The OB-GYNs who remain report feeling not only overworked—they’re seeing proportionally more patients than before—but also angry and afraid. Despite the barriers the state has imposed on their legal ability to care for pregnant, miscarrying, and birthing patients, many Texas OB-GYNs, including Karsan, say they’re not leaving.

Texas has a long history of legislating abortion. But the state’s current abortion laws—which outlaw all abortion care unless it is necessary to save the pregnant person’s life, and allow private citizens to sue doctors who provide or help patients obtain abortions outside of this exception—are the most severe in its history.

Abortion-limiting laws in Texas go back as far as 1854, when it was first made a criminal offense to “procure the miscarriage of any woman........

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