As I was walking between classes as a pre-medical undergraduate student in 2018, I saw that the Student Assembly for Gender Empowerment was distributing hats that read “PROTECT ROE v. WADE.” I picked one up and stepped into my classroom, only to be greeted by a classmate who said, “Protect Roe v. Wade? Why would it need protection?”
Fast-forward four years, I sat in my bedroom, selfishly thankful that I had been accepted into a medical school in Illinois, a state that serves as a reproductive rights haven for the Midwest. I knew that the SCOTUS ruling on Dobbs v. Jackson Women’s Health would have profound negative impacts on patients throughout the country; however, it was not until I began medical school that I started to understand its repercussions on current and future health care providers.
Following the SCOTUS decision, restrictions on abortion access were enacted immediately in many states through “trigger laws.” However, in the 2022 midterm elections, voters chose to protect access to abortion in California, Vermont, and Michigan, and voters in Kentucky and Montana rejected ballot measures that would have made protecting abortion much more difficult in the future. Despite this strong outward support for reproductive rights, even in historically swing and red states, abortion remains highly restricted in 14 states. Just as equal access to abortion hangs in the balance, so does access to training in abortion care for medical trainees.
This is not the first time medical trainees have had to advocate for preserving access to abortion education. In 1993, Medical Students for Choice (MSFC) was founded to address the “deficit of abortion education” in medical training. There are now more than 220 chapters at medical schools worldwide. These chapters work to improve family planning education for students at their schools and advocate for pro-choice policy changes. Through MSFC, medical students have the opportunity to travel, even internationally, for abortion training. Such opportunities are a vital lifeline after the SCOTUS decision but depend on a student’s significant investment in time and effort; this is even more the case for any opportunity outside MSFC. For residents who are already swamped, acquiring a thorough training in abortion care would introduce an additional burden. There may not be sufficient training alternatives for the many employed by programs where it is presently banned.
While students going into obstetrics and gynecology will most certainly attempt to seek this training, what may not be understood by all medical students is how profoundly abortion can affect every physician. Many specialties, especially in primary care, will have to deal with the complex reproductive and sexual challenges their patients face, and all physicians will treat patients who have had abortions. This means there is an ethical imperative to provide more robust abortion training at the medical school level to all trainees.
Considering the midterm election outcomes, it is not unrealistic to expect that abortion will regain legal status slowly throughout the United States. Providing abortion training to all trainees is even more important, given the nationwide shortage of OB/GYN physicians. In states where abortion is still legal, it is unlikely that there are enough providers to support the huge increases in demand. It would be irresponsible not to invest resources into bolstering family planning training in medical school and residency curricula to mitigate the exacerbation of a provider shortage. Many medical students and residents train out of state and can carry their skills wherever they establish their practices. Additionally, with a base level of training and exposure, medical students may feel more comfortable matching into a state where abortion access is restricted.
Moreover, the American College of Obstetricians and Gynecologists (ACOG) recommends that abortion training be continually integrated into medical school education as it is crucial to reproductive health care. However, only one-third of medical schools have at least one abortion-related lecture, and less than half provide clinical exposure to abortion. Half of the schools surveyed have a family planning elective, but 17% have no formal abortion education at all. Throughout the country, students are dissatisfied with the amount of training they receive. The Liaison Committee on Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA) do not require medical schools to provide abortion training to receive accreditation. While incorporating abortion training into accreditation standards is the larger goal, schools should irrespectively strive to offer this education. In states like Illinois, where abortion remains legal, and rates have recently risen, the need for increased training and providers is evident. All medical schools must teach their students about essential health care, and training in abortion, especially now, is certainly essential.
Shreya Sridhara is a medical student.