Sweeping restrictions and even outright abortion bans adopted by states in the year since the landmark Dobbs v. Jackson Women’s Health Organization ruling have had an overwhelmingly negative effect on maternal health care, according to a survey of OBGYNs released Wednesday that provides one of the clearest views yet of how the U.S. Supreme Court decision has affected women’s health care in the United States.

The poll by the health research nonprofit KFF reveals that the Dobbs ruling — which ended federal protection on the right to abortion — affected maternal mortality and how pregnancy-related medical emergencies are managed, precipitated a rise in requests for sterilization and has done much more than restrict abortion access. Many OBGYNs said it has also made their jobs more difficult and legally perilous than before, while leading to worse outcomes for patients.