Abortion is not only common but an essential component of comprehensive care, with one in four pregnant people accessing abortion care in the United States. During my annual physical this summer, I reflected on what challenges people seeking abortion care in my home state of Georgia – and across the Southeast – now face. As the conversation drifted from lab results to my research in reproductive rights law, my doctor posed a question I hadn’t considered: What happens if the next generation of physicians is denied the right to train in abortion care?
On June 24, 2022, the Supreme Court’s decision in Dobbs v. Jackson Women’s Health signaled a seismic shift in reproductive care, affecting not only patients, but physicians in training. The fight to preserve abortion care has moved far beyond the operating room, and now extends to fellowship and residency programs, where trainees do not know if they will ever receive abortion care experience. In a nation where abortion is no longer a constitutional right, medical students, residents, and fellows in states with restrictive abortion laws are being forced to seek training across state lines, and even abroad. One fourth-year medical student planning to pursue a specialty involving family planning, was forced to independently find a rotation that would provide abortion care training, and had to travel as far as London after her school’s reproductive health clinic shut down.
Training in abortion care for medical students and resident physicians already had significant limitations pre-Dobbs in states with restrictive abortion laws. Along with barriers associated with geographic location or having the resources to travel, patients must now face the additional challenge of finding a physician with enough training to provide an abortion.
Critics of widespread access to abortion care often argue that medical exception laws are enough to prevent maternal mortality or morbidity. However, these “exceptions,” often written into law by people without medical training, using nonmedical language, have resulted in mass confusion for clinicians who, when faced with split-second decisions, are forced to deny or delay care for their patients. Post-Dobbs, there is scant opportunity for doctors in training to have hands-on abortion care experience in states that operate on medical exception laws.
Within Family Medicine and Obstetrics and Gynecology, some family planning program directors have already expressed concerns about the ability to attract residents and fellows to programs in states with abortion bans. These concerns are not without basis, with a cross-sectional study of 2,436 OB-GYN residency programs revealing a small but significant decrease in the number of applicants to residency programs in states with strict abortion laws. According to the study, state-specific abortion restrictions are impacting the training of around 44% of OB-Gyn residents in the U.S. Even though OB-GYN residency programs were also completely full in 2023, there was a statistically significant decrease in applications compared to 2022, and years pre-Dobbs.
While the long-term on the OB-GYN workforce may not be visible just yet three years out from the Dobbs decision, should the trend continue, maternal mortality and morbidity may rise, especially in maternal care deserts. Maternal care deserts are defined as counties where hospitals lack obstetric services, birth centers, obstetricians, gynecologists, or certified nurse-midwives. Maternal care deserts are often found in rural areas, with most rural countries having maternal mortality rates close to two times higher than rates in urban counties.
The future of abortion care training in OB-Gyn and Family Medicine residency programs in states with restrictions is uncertain, with no clear path forward. While some states with restrictive laws may offer medical exceptions, these may not provide enough opportunities for medical students and residents to gain enough training to confidently perform these procedures, impacting the standard of care nationwide.