Impact of Abortion Bans on Medical Education
Nearly 40% of OBGYN residents, family medicine residents, and medical school students are located in states where they will not be able to receive comprehensive abortion training.
Since Roe v. Wade was overturned by the U.S. Supreme Court in June 2022, 14 states have enacted complete abortion bans, 2 states have 6-week bans, and 5 states have bans in the late first-/early second-trimester of pregnancy (Guttmacher Institute, 2023). These restrictions prevent providers from practicing evidence-based medicine through abortion provision.
By extension, students who are on the pathway to becoming physicians will not be able to perform or observe abortions in states with abortion bans. These students will need to travel out-of-state to receive abortion training, or they may not receive comprehensive training at all (Murphy, 2023). This is even more alarming when we consider the existing deficits in abortion training. For example, a nationwide study conducted in 2018– prior to the Dobbs v. Jackson decision– revealed that nearly 3 in 10 OBGYN program directors did not consider their residents to be fully competent at performing first-trimester aspiration abortions (Steinauer et al., 2018).
It is still unclear how the Dobbs decision will impact abortion training for people who are on the pathway to becoming providers, but we are beginning to see some preliminary patterns. For instance, in 2023, there was a decline in U.S. MD applicants and OBGYN residency applicants across the country, with the steepest drops in applicants occurring in states with abortion bans (Orgera et al., 2023).
But what about the cohort of students currently receiving their medical education?
This chart visualizes where providers-in-training are receiving their medical education according to four different levels of abortion restrictions. Abortion-performing residents include OBGYN and family medicine residents. Additionally, the chart includes medical students in MD and DO programs, who also may receive abortion education and training. The data covers all 50 states and Washington, D.C., and only widely accredited, public sources were used to obtain the number of residents and medical students in programs (see drop-down below for more information on data sources).
An estimated 34% of OBGYN residents, 38% of family medicine residents, and 39% of medical students in MD or DO programs are located in states that have restrictions on abortion provision. As a result, these students will either have to take additional steps to receive comprehensive abortion training, perhaps at another institution, or will fail to experience this type of education entirely. The implications for future U.S. abortion providers are bleak; as current programs fail to integrate extensive abortion education into their curricula, their students will be unequipped to employ the skill set necessary to provide the necessary medical care in the future. This threatens to further exemplify the growing nationwide abortion “desert” as abortion care becomes increasingly inaccessible.
The National Resident Matching Program (NRMP) facilitates the resident matching program every year. The NRMP’s 2023 “Results and Data: Main Residency Match” report contained the name of every program to which OBGYN residents matched in 2023 (NRMP, 2023). We extracted the number of residents matched to each program in 2023 and the state in which each program operates. The number of residents matched was multiplied by 4 to estimate the total number of residents in the program in 2023, since OBGYN residencies are typically 4 years long. The same source and procedure was used for family medicine residents, but the number of residents was multiplied by 3 because family medicine residencies are typically 3 years long.
For medical students, two sets of data were used: the number of MD students in each state, published by the Association of American Medical Colleges, and the number of DO students in each state, published by the American Association of Colleges of Osteopathic Medicine.
- Ali A. Osteopathic Medical College Total Enrollment By Race/Ethnicity 2000-2023. American Association of Colleges of Osteopathic Medicine; 2023 Sept 13 [cited 2024 Feb 11]. Available from: https://www.aacom.org/searches/reports/report/2000-23-TEbyCOM-RE
- Interactive map: US abortion policies and access after Roe [Internet]. Guttmacher Institute; 2024 Jan 24 [cited 2024 Feb 10]. Available from: https://states.guttmacher.org/policies/
- Murphy B. After Dobbs, M4s face stark reality when applying for residency [Internet]. American Medical Association; 2023 Jul 31 [cited 2024 Feb 10]. Available from: https://www.ama-assn.org/medical-students/preparing-residency/after-dobbs-m4s-face-stark-reality-when-applying-residency
- Steinauer J, Turk J, Pomerantz T, Simonson K, Learman L, Landy U. Abortion training in US obstetrics and gynecology residency programs. AJOG. 2018;219(1):86.
- Vinekar K, Karlapudi A, Bauer CC, Steinauer J, Rible R, Brown K, Turk JK. Abortion training in U.S. obstetrics and gynecology residency programs in a post-Dobbs era. Contraception. 2024;130.
- Orgera K, Mahmood H, Grover A. Training location preferences of U.S. medical school graduates post Dobbs v. Jackson Women’s Health [Internet]. AAMC Research and Action Institute; 2023 Apr 13 [cited 2024 Feb 10]. Available from: https://www.aamcresearchinstitute.org/our-work/data-snapshot/training-location-preferences-us-medical-school-graduates-post-dobbs-v-jackson-women-s-health
- Mengesha B. Implications of the Dobbs decision for me dical education. JAMA. 2022;328(17):1697-1698.
- Results and data: 2023 main residency match [Internet]. NRMP; [cited 2024 Feb 10]. Available from: https://www.nrmp.org/wp-content/uploads/2023/05/2023-Main-Match-Results-and-Data-Book-FINAL.pdf
- Total enrollment by U.S. MD-granting medical school and gender, 2019-2020 through 2023-2024 [Internet]. AAMC; [cited 2024 Feb 10]. Available from: https://www.aamc.org/media/6101/download
