Where resources are inadequate for giving birth, infant mortality tends to be high. Among the Dobbs Fourteen, all but Idaho, North Dakota, and Texas have infant-mortality rates higher than the (shockingly high) national average of 5.42 deaths per 1,000 births. In some of these states, infant mortality is substantially higher. In Mississippi, it’s 9.39 deaths per 1,000 births. In Oklahoma, it’s 7.13 deaths per 1,000 births.

It hardly surprised me when Kate, comparing their houses in Oklahoma City and Washington, said their Washington bungalow was “half the size for double the cost.” But the two physicians also took substantial cuts in pay—not quite 50 percent for Caroline, and about 25 percent for Kate. How could that be? If Washington’s cost of living is higher, shouldn’t salaries be higher, too? For most occupations, yes. But OB-GYN salaries, Kate and Caroline explained to me, vary dramatically according to local demand. Washington has plenty of OB-GYNs; the nation’s capital is too urban and too geographically small to be a maternity care desert. Oklahoma, on the other hand, suffers a desperate shortage of OB-GYNs, and therefore must pay top dollar.

Mississippi is the poorest state in the country. But the average base salary for an ob-gyn at Wayne General Hospital in Waynesboro, Mississippi, is $350,000. (I take this and the salary figures that follow from the workforce data company Glassdoor, because the Bureau of Labor Statistics’ information is one year out of date.) Compare Waynesboro’s largesse to the average base salary for an OB-GYN at ClearMD Health Center in Manhattan: $275,000, or 21 percent less. (Even that’s a little high for New York City, where, according to Glassdoor, average ob-gyn pay is $243,000.) In Oklahoma City, average base salary for an OB-GYN at CompHealth Physician Obstetrics and Gynecology is $325,000. In Fort Smith, Arkansas, average base salary for an OB-GYN at CompHealth Physician Obstetrics and Gynecology is $312,500. Meanwhile, average base pay for an OB-GYN in Los Angeles is $235,000.