Safe abortions hinge on comprehensive education, which could go away if Roe v. Wade is overturned. Key TakeawaysIf the Supreme Court strikes down Roe v. Wade, some medical residents may not receive abortion trainings.Studies show that lack of abortion training is directly related to gaps patient access, so pro-choice advocates are looking for
The pending Supreme Court reversal of Roe v. Wade could jeopardize abortion access in multiple states, and force some people to turn toward dangerous alternatives to abortion care. As advocates prepare to bridge access gaps, they note that safe abortions hinge on comprehensive education–which may also be under threat.
“Many of the people who provide abortions also carry academic [positions] and provide significant amounts of education about contraception and abortion at their centers,” Brian Nguyen, MD, MSc, an assistant professor of obstetrics and gynecology at the Keck School of Medicine at the University of Southern California, told Verywell.
“If they are unable to continue with this work, or have their practice and their teaching curtailed, then we'll have a generation of OB-GYN providers who are unable to provide a very essential service,” he said.
A recent paper in the journal Obstetricians and Gynecologists suggests that if Roe v Wade is overturned, between 43.9% and 56% of obstetrics and gynecology (OB-GYN) residents will lack abortion training. Almost 45% of 286 accredited OB-GYN residency programs are located in states that are certain or likely to ban abortion care should Roe v. Wade be overturned, which could place restraints on training programs.
As such, researchers are encouraging providers to brace themselves for a double blow: less training for residents plus reduced abortion access for patients.
The anticipated hit targets an already weak area of study. Even with Roe in place, abortion education is incomplete.
In a 2018 survey of OB-GYN residency training programs in the U.S., 31% of respondents said abortion training was optional, and 5% said they offered no routine abortion training. While most program directors indicated graduates were "competent in first trimester aspiration," only 22% felt graduates were competent in dilation and evacuation (D&E) procedures, which are performed in the second trimester.
Results varied geographically, with respondents in the West more likely and in the South less likely to offer the training.
If certain states ban abortions, the few available programs in those states will no longer be allowed to operate. This will not only jeopardize individual institutions, but also the status and expectations for OB-GYN training curriculums in the U.S., Nguyen said.
The impact of training gaps is profound and directly related to provider shortages. A study from 2013 showed that providers who graduated from medical school in the 1990s and 2000s received low rates of abortion education, which corresponded with steep declines in patient access. Though pro choice organizations like Medical Students for Choice made efforts to increase numbers, even into the 2010s, 87% of U.S. counties had no abortion providers.
“If fewer and fewer of these sites are available across the nation, we're going to encounter a lot of women who are left without a provider,” Nguyen said.
If they are unable to continue with this work, or have their practice and their teaching curtailed, then we'll have a generation of OB-GYN providers who are unable to provide a very essential service.
Abortion training is the only training that medical residents can “opt out” of taking. According to requirements set by the Accreditation Council for Graduate Medical Education (ACGME), individual residents with moral or religious objections may elect not to participate in abortion trainings and are not required to participate in trainings for elective abortions.
Melissa Myo, MD, MS, a fellow in the Complex Family Planning program at the Keck School of Medicine at the University of Southern California, told Verywell that the opt-out structure speaks to the politicization of U.S. medicine.
"We have taken something that is a medical procedure and have turned it into something that someone could decline to learn about," Myo said. "That's not really something that exists for anything else in medical care."
ACGME does not require all hospitals to administer abortion trainings on site, as some hospitals that are connected to religious entities prohibit abortion care. However, ACGME does require hospitals without on-site trainings to give residents access to the skill elsewhere.
"In choosing OB-GYN [as a speciality], there's a certain 'opting in' for the type of care that we provide that is different from choosing a different specialty to go into," Myo said. "To be able to carve out a little part of our specialty that someone could say that they are not interested in participating in means that they're not learning the full spectrum of care. And I think that's a regrettable thing on a trainee's behalf to not learn everything possible."
Stigma and hostility toward abortion havers have also discouraged providers from seeking training or providing care, according to researchers.
ACGME is awaiting the Supreme Court decision before deciding if or how to alter their current requirements, but is advocating for continued abortion training where possible, an ACGME spokesperson wrote in an email to Verywell.
“Should it become illegal in some states to perform aspects of family planning, the ACGME is exploring alternative pathways for completing this training. At this time, the ACGME requirements remain the same,” the spokesperson wrote.
According to a 2020 study by researchers at Stanford University School of Medicine, half of U.S. medical schools offer no formal abortion trainings, or just one lecture on the topic. But ACGME requires OB-GYN residency programs to provide this training in order to maintain their accreditation.
Even with Roe v. Wade in place, some states already ban abortion treatment and training on a procedure-by-procedure basis, which may already impact providers' education levels and competency.
As of June 2022, three states—Alabama, Kentucky, and Texas—enforce bans on D&E procedures, with an exception for cases involving life threatening or severe health risks, according to the Guttmacher Institute.
D&E is an abortion procedure done in the second trimester of pregnancy. During a D&E, a provider dilates the pregnant person's cervix and then removes the fetus from the uterus.
In a 2018 survey in the American Journal of Obstetrics & Gynecology, 190 residency programs were asked to asses if they thought graduates were competent in D&E procedures. Of the 79% who responded, only 22% said yes.
To support trainees in states where abortion education may be stuck down, residency programs elsewhere will need to stand up, Nguyen said. California, where he is based, is in the process of becoming a sanctuary state for abortion care, and may be expanding its capacity to both treat patients and educate future OB-GYNs.
People who are not OB-GYNs may also find ways to support abortion care.
"A lot of us are asking the question: What can we do as individuals? Because how can we have an impact on a Supreme Court ruling when we're just regular everyday folks?" Myo said. "It is really important that people consider that this is not an isolated problem."
This decision means other individual and family protections may also be at stake, including privacy rights and gay rights legislation. Showing up to city council meetings and advocating for neighbors can be a way of providing support, even if indirectly, she said.
"It's very hard to be a provider of abortions to ponder the future, because this is my particular area," Myo said. "But I also don't want people to forget everything else that exists in that same spectrum that could be under threat if we don't really care about the other citizens who live around us."
If the Supreme Court strikes down Roe v. Wade, OB-GYN residency programs in some states may not be able to offer abortion training. And because safe abortion hinges on comprehensive education, pro-choice advocates are scrambling to locate alternate access to trainings.