Abortion care is one of the most common medical procedures in the U.S., yet even before the fall of Roe v. Wade, doctors and students had to navigate tricky legal and educational hurdles to train as abortion providers. With last month’s Supreme Court decision freeing states to ban abortions, those barriers are growing.
Some abortion advocates are warning that recent moves could aggravate the nationwide shortage of trained abortion providers, making the procedure scarcer — even in blue states that are acting to guarantee access — than first thought.
“At the end of the day, we can't train people to provide abortion care if we can't provide abortion care,” said DeShawn Taylor, an obstetrician-gynecologist who is the owner and primary provider at Desert Star Family Planning in Phoenix.
In the past year, lawmakers in at least eight states have introduced or passed legislation to block or limit abortion education, including by doctors who are employed at public universities and are therefore state employees.
Medical schools aren’t required to teach the procedure. Two years before Roe’s demise, Stanford University researchers already had determined that half of medical schools offered no formal abortion training or only a single lecture. This can harm a doctor’s holistic understanding of how pregnancy can affect a patient, said Pamela Merritt, executive director of the abortion-rights group Medical Students for Choice.
The nonprofit group that represents medical schools, the Association of American Medical Colleges, said it doesn’t have a firm fix on which ones offer abortion training. Alison J. Whelan, the group’s chief academic officer, said the organization’s curriculum-reporting program is voluntary. “A school may choose not to report coverage of a particular topic/issue, in which case the AAMC is unable to verify if it is taught at that institution,” Whelan said in an email.
Residency programs, where doctors learn specialties, have separate requirements. The Accreditation Council for Graduate Medical Education mandates that obstetrics and gynecology residencies offer abortion training or access to such training to doctors on an opt-out basis. About 45% of OB-GYN residency programs are located in the 26 states that have sharply curtailed abortion or are likely to do so.
Programs in states that block abortion training — and those with a religious objection — still must help residents get outside training, such as by traveling to other states to learn the procedure.
Even then, the ability to get proper training depends on another provider’s time and whether slots are available. More than a quarter of the 790 abortion clinics in the country are under threat of closure. These clinics often serve as the only places to obtain hands-on experience.
Taylor of Desert Star said she has taught trainees from as far away as New Jersey at her Arizona clinic.
Researchers at the University of California, San Francisco and the University of California, Los Angeles in April estimated that at most 56% of OB-GYN residents in the U.S. would have access to abortion training post-Roe, down from 92% in 2020.
State bans could exacerbate the shortage of providers. In the latest available study, published in 2019 but conducted in 2016 and 2017, only 24% of OB-GYNs who saw patients of reproductive age said they had performed an abortion in the prior year. Meanwhile, 72% said they had a patient ask them for such care in the same period.
Some states are coping with the shortage by expanding the types of authorized abortion care providers to include registered nurses, physicians’ assistants and nurse practitioners. And Physicians for Reproductive Health, a pro-abortion rights advocacy group, said doctors in other specialties, including internal medicine, sometimes are willing to perform the procedure.
Limiting abortions can also affect the treatment of miscarriages, which largely rely on the same medications and procedures as abortions. “My worry,” said Jody Steinauer, the director of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning, is that people who were trained in restrictive states won’t be able “to provide patient-centered high-quality care.”
The San Francisco-based Ryan program provides guidance to more than 100 hospitals and universities that conduct abortion training for medical residents. It helps them navigate the myriad ways in which targeted regulations on abortion providers — known as TRAP laws — create burdens for those who provide abortion care. “There's a lot more than just the state law,” Steinauer noted. “There's stigma, there's politics, and there’s dynamics within a hospital or university setting, too.”
Restricting the teaching of abortion care could be fatal for patients. A Duke University study published in December estimated that a total abortion ban would result in a 21% increase in pregnancy-related deaths, and a 33% increase for Black people. Taylor, the OB-GYN in Arizona, said it’s not uncommon for her to diagnose patients with health complications such as ectopic pregnancies, which occur when a fertilized egg grows outside the uterus, because such care was beyond the scope of prior doctors they’d seen.
“It really is something that anyone who's taking care of people who can become pregnant should be aware of, and should know how to talk to patients about the options that they have for pregnancy,” said Quinn Jackson, a family physician who practices in Kansas City, Kansas, and is an advocate with Physicians for Reproductive Health.
