See None, Do None, Teach None: How Dismantling Roe Impacts Medical Education and Physician Training.

Abstract

The impending U.S. Supreme Court decision in Dobbs vs. Jackson Women’s Health Organization has appropriately engendered critical thought and speculation as to what a post-Roe America would look like. Unfortunately, given the political and legislative hostility toward abortion since Roe was decided in 1973, this exercise does not require significant imagination. Many patients and providers already live in states where abortion services are extremely restricted with negative consequences on both maternal and neonatal health outcomes (Verma and Shainker 2020). As highlighted by Paltrow et al. (2022), even with Roe in place, the rights of pregnant people are constantly under attack. If Roe falls, the ramifications will be farreaching in scope with the potential to radically change not only prenatal care in this country but medical training and education as well. Around the time of Roe, only about 12% of obstetrics and gynecology (OB/GYN) residency programs required abortion training (Westhoff 1994). It was not until 1996 that the Accreditation Council for Graduate Medical Education (ACGME) mandated OB/GYN residency programs to provide experience with induced abortion. A few years later, the privately-funded Kenneth J. Ryan Residency Training Program in Abortion and Family Planning (Ryan Program) was implemented with the purpose of supporting formal integration of abortion training into OB/GYN residencies across the nation. In 2020, 92% of OB/GYN residents reported having access to some amount of abortion training (Horvath et al. 2021). Despite this increase in the number of physicians trained to provide abortions, millions of reproductiveaged people live in counties that do not have an abortion provider with some states such as Kentucky and Mississippi having only one abortion clinic (Jones, Witwer, and Jerman 2019). Clearly, a patient’s zip code, insurance status, financial resources, and distance from an abortion provider already influence their ability to receive care. As Watson (2022) discusses in her article, there are various structural, historical, and systemic barriers to accessing abortion that will only be exacerbated postRoe. The burden of these barriers will not fall equally on all communities. Poor people, particularly poor people of color who already suffer higher rates of maternal mortality, will be disproportionally impacted by anti-abortion legislation after Roe falls. Forced childbearing is already a reality for vulnerable patients through policies such as the Hyde amendment; however, with more extreme abortion restrictions anticipated in the wake of Roe’s reversal, an even greater number of patients will have their fundamental rights threatened. Paltrow et al. effectively outline the ways in which Roe protects the bodily autonomy and integrity of all pregnant people, regardless of their intentions to carry a pregnancy to term. Abortion bans and limits grounded in fetal “personhood” assert that the potential life of a pregnancy is more important than the life of the person carrying that pregnancy. While Paltrow et al. appropriately focus on the various ways in which this framework enables the prosecution of pregnant people for everything from miscarriage to refusal of cesarean section, we would like to call attention to the impact on medical trainees and, consequently, on the future of reproductive healthcare.