- In states with strict abortion laws, many medical residents are unable to receive abortion training.
- Some medical students have left states such as these to obtain full-scope OB-GYN training, which includes abortion care and counseling.
- One healthcare professional in Louisiana faced this dilemma midway through her medical residency.
- After completing her residency, she left the state to pursue an OB-GYN practice in the Northeast, where abortions are permitted.
As states pass sweeping restrictions against abortion, it’s become increasingly clear these bans have far-reaching consequences.
Evidence has shown, for example, that abortion restrictions can push families into poverty, worsen pregnant people’s long-term physical and mental health, and cause increases in both maternal and infant deaths.
Less known, however, is the impact abortion bans have on the healthcare professionals who care for pregnant individuals.
A new report from the University of California San Francisco revealed that the fall of Roe v. Wade, which led to an influx of abortion restrictions in multiple states, has been particularly distressing for obstetrics and gynecology (OB-GYN) residents.
Healthline spoke with one healthcare professional who can attest to this. Due to privacy concerns, this source’s name has been changed to Emily Green for the purpose of reporting and protecting her identity.
Green moved to Louisiana in 2020 for her OB-GYN residency at an academic hospital.
When considering hospitals to apply to, reproductive justice was at the forefront of her decision — she chose a program that would provide her with the training to be a full-scope OB-GYN.
“To me, that includes good training and solid foundation in contraception counseling, in abortion counseling, and in abortion training,” Green told Healthline.
But in June 2022, Roe v. Wade was overturned, and Green, who was halfway through her residency, suddenly found herself smack in the middle of the country’s anti-abortion movement.
Green’s experiences, as detailed below, are her own opinions and not those of the larger institutions she’s been a part of.
How abortion bans changed medical residency programs
Even with Roe v. Wade in place, abortion was hard to come by in Louisiana — there were only three clinics in the state that offered elective abortion and strict laws in place that completely banned the procedure with few exceptions.
When the June 2022 Dobbs v. Jackson Women’s Health Organization decision revoked the constitutional right to abortion, Louisiana banned most types of abortion.
“I remember exactly where I was because I was scheduled to go on this rotation [for abortion training] in September of 2022,” Green said.
That summer, multiple short-lived protections went into place to keep those three clinics running, causing a lot of back-and-forth about if and when Green would be able to do her training and whether or not her patients could access abortion services.
“You’d tell patients, ‘You have these three options within the state, but tomorrow, I don’t know if they’re accepting new patients,’” Green, who worked with a primarily Medicaid and uninsured population, shared.
There was the added concern of whether she was legally protected as a physician.
There was a lot of ambiguity regarding the new bans — of what was or was not permitted — and how well a hospital’s legal counsel could protect physicians.
She hustled to stay current with the rapidly changing legislation to ensure that her patients were getting the most accurate information.
Watching this play out was heartbreaking for her.
“You come into this profession wanting to help people make decisions about their body and their life that feel safe and healthy for them, and then the ability to do so becomes really challenging,” Green said.
Green added that many of her patients already had a lot stacked against them, and seeing them further lose control of their bodies and decisions was very difficult. She said she felt helpless knowing she could not offer patients full-scope care.
Many people found scheduling an appointment, which may or may not happen due to changing laws and lengthy wait times, arranging child care, securing transportation, and managing finances overwhelming.
The new restrictions disproportionally affected birthing people of color and socially disadvantaged communities, Green said.
In medical school, Green read a lot of books about remote places in the United States where abortion was inaccessible.
“All of a sudden, it became very real. These stories were no longer just something you were reading about far away. This is what I was working with on a day-to-day basis,” she said.
Residents scrambled to get abortion training
Meanwhile, the clinic Green was slated to do her abortion training was shut down due to the state’s abortion ban.
Green specifically chose her program for the abortion training it offered — now, it was unclear if Green would get trained.
She struggled with the implications of being in a place where healthcare providers aren’t properly trained to offer abortion care.
“Not only are you affecting women’s ability to access abortion now but it’s really affecting their ability to make their own reproductive decisions down the line,” Green said.
Without proper training, future physicians might not understand how the procedure works and won’t be able to counsel women about evidence-based abortion care.
“You start to lose generations of of people that have that skillset,” Green said.
This could create a situation where pregnant people resort to alternatives that aren’t as safe, she said.
Fortunately, Green’s program was affiliated with the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning (Ryan Program), which ensures OB-GYN residents get comprehensive contraception and abortion training regardless of where they live, which secured out-of-state abortion training for interested residents.
In 2023, Green traveled to Massachusetts to complete abortion training.
Residents grapple with the decision to stay or leave
Green, who recently wrapped up her residency, made the difficult decision to move to a state in the Northeast that has many abortion protections in place.
Although she is looking forward to providing evidence-based reproductive healthcare to her patients, she said this decision has brought on a significant amount of moral distress.
If proponents of abortion care leave states like Louisiana, there might be more geographic areas where physicians lack the skillset to perform abortions or the interest and ability to support women through these challenging situations.
Green said it’s hard to move away when you know you could offer a perspective or advice that could be comforting and life changing for females looking to terminate pregnancy.
“The decision to leave in some ways feels like you’re abandoning a patient population you care a lot about and deserves access to this information,” Green said.
“I am so grateful and have so much respect for the people in my program who will stay and continue to make sure we can train in the way we need to and provide care in a safe way, especially in states like Louisiana where things are just so restricted,” she shared.
Takeaway
In states with strict abortion laws, many medical residents are unable to receive full-scope reproductive training, which includes abortion care and counseling.
One healthcare professional in Louisiana faced this dilemma midway through her medical residency and ultimately left the state to pursue an OB-GYN practice where abortions are permitted.
The future of medical residency programs for aspiring OB-GYNs in states where abortions are banned or restricted remains uncertain.
