How Roe v Wade reversal could affect training in abortion and reproductive health

The Supreme Court's reversal of Roe v Wade in June may have dramatic implications for OB/GYN residents and other medical trainees—potentially limiting access to required abortion training and related reproductive procedures in affected states, according to a new policy analysis published in Obstetrics and Gynecology.^[]

The court ruling dealt a decisive blow to women’s access to abortion care, with abortion bans likely to become law in 13 states by the end of August, thanks to “trigger laws” which automatically go into effect without needing further legislative action. Even more severe laws were expected to be enacted in Idaho, Tennessee, and Texas by month’s end.

Now, medical educators are concerned that OB-GYN residents in states than ban abortions may not have access to training in the necessary skills for pregnancy termination, thus affecting care for future patients.

Access to abortion training

All OB/GYN residents are required by the Accreditation Council for Graduate Medical Education to have access to abortion training. In 2020, 92% of OB/GYN residents reported that they had access to abortion training.

Of 286 OB/GYN residency programs nationwide, 44.8% are in states that are either certain or likely to ban abortion, according to the analysis in Obstetrics and Gynecology. Of these, 38.8% of these programs are in states certain to ban abortion and 5.9% are in states likely to ban abortion.

The Obstetrics and Gynecology article predicted that with the overturning of Roe v. Wade, the number of OB/GYN residents with access to abortion training would decrease to 56%.

However, the authors noted that this number is likely underestimating the potential implications of the Supreme Court’s ruling, as their research only included OB/GYN residencies. The implications on other residency programs (such as family medicine, which often includes abortion training, whether on-site or through travel programs) were not taken into consideration.

How will OB/GYN training change?

Many of them will be unable to learn how to perform abortions, which are often life-saving measures.

“Many people who generally oppose abortion still believe it should be available to save a mother’s life,” said Margaret Boozer, MD, a professor of obstetrics and gynecology at the University of Alabama at Birmingham Heersink School of Medicine, in an article published by the AAMC.^[]

OB/GYN training is also expected to change in other ways. For example, with the potential for many patients to be denied access to abortions, there is an increased likelihood that OB/GYNs will start seeing more patients who would have otherwise terminated their pregnancies, such as those with severe complications or high-risk pregnancies.

There is the potential for residents to be affected beyond abortion training, with some educators worrying that abortion bans will also limit access to related reproductive procedures such as management of miscarriages, excessive uterine bleeding, and endometrial biopsies.

In addition to OB/GYN residents, family medicine residents are also likely to be affected by the dismantling of Roe v. Wade. While many family medicine doctors learn abortion care during residency, now these residents may no longer be given this opportunity. With the potential increase in self-managed abortions, emergency medicine residents are also expected to be impacted.

Possible workarounds

While the Accreditation Council for Graduate Medical Education is actively looking into alternative mechanisms to enable OB/GYN residents to complete their abortion training, the council’s requirements currently are unchanged, according to a recent Time article.^[] Under these requirements, all accredited programs must have a family-planning curriculum in place, and residents must be given direct training on pregnancy termination.

One approach medical educators in affected states are considering is to make sure residents can fulfill their abortion training requirements by sending residents for training in states with broader abortion access.

This approach is not free of complications, however, as programs have to find institutions willing to take on additional residents, not to mention dealing with the related costs, travel, and scheduling. Programs also have to navigate complicated licensing and insurance requirements.

For example, Lauren Thaxton, MD, MBA, an assistant professor at Dell Medical School at The University of Texas at Austin, provided simulation training to teach residents dilation and evacuation that utilized a small watermelon to simulate a uterus.

And in the Time article, Kavita Vinekar, MD, an OB/GYN at UCLA Health, suggested that residency programs expand their miscarriage training, as it overlaps with abortion training.

Some institutions are planning to alte

r the scope of their current educational offerings. In the AAMC article, Dee Fenner, MD, chair of the Department of Obstetrics and Gynecology at Michigan Medicine in Ann Arbor, Michigan, spoke of beefing up training on self-managed medical abortion, in which patients would take two pills prescribed through telemedicine.