Potentially Wide-Ranging Effects of Abortion Bans on Women’s Health and Safety
More than six months after the overturn of Roe v. Wade, questions about potential repercussions remain.
In June 2022, the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to abortion care. Data are not yet available on whether medical schools and residency programs in abortion-ban states will teach students about abortion or provide any opportunities for hands-on experience with abortion care.
Or they could be taught abortion procedures without actual human patients. Media reports indicate that medical students are using papayas in place of a cervix to learn the procedure in some cities.1
“Our main concern is not people who decide to go into obstetrics and gynecology because residents can get training through visitor residency programs where residents move around to different states to get clinical experience,” says Alyssa B. Stephenson-Famy, MD, an associate professor in the department of obstetrics and gynecology at the University of Washington. “Our concern is about undifferentiated medical students and medical students going into other fields, like maternal medicine, pediatrics, family medicine, internal medicine, and emergency medicine.”
All these future doctors will need to know about how to handle contraceptive and abortion care for the safety of their patients, but they may not receive that education. “It could have a tremendous and long-term impact on students in a variety of other fields,” Stephenson-Famy says.
Most pregnant patients are unprepared for bad news. They might assume their doctors will provide the safest and most effective medical care if something goes wrong, says Kari White, PhD, MPH, lead investigator of the Texas Policy Evaluation Project and an associate professor at the University of Texas at Austin Steve Hicks School of Social Work.
White has heard stories of people who were experiencing major complications in their pregnancies and were shocked to learn their state’s abortion ban prevented them from receiving care.
“They thought for sure their case was one of the ones that would be allowed,” White explains. “They come to find out it doesn’t meet their clinician’s or institution’s interpretation of an abortion that is permitted, and they feel very abandoned in the care they need very quickly.” Everyone should be concerned when clinicians are prohibited from providing standard care to any person who needs it, she adds.
Despite frustration and moral distress over the abortion bans affecting patients’ reproductive health, some clinicians in Texas feel they cannot abandon the people in their state and will remain there as advocates.
“Other folks we have talked to as part of our research say they do feel this is not a setting where they feel like they can provide the best care for their patients,” White says. “It’s challenging for them, and they have complicated feelings about it.”
Medical students and residents have already decided their future practices based on abortion laws, says Hillary J. Gyuras, MA, a research associate in public health at The Ohio State University. Gyuras’ study is part of the Ohio Policy Evaluation Network, which received a grant to conduct research as part of an effort to expand reproductive health services in Ohio and neighboring states.
“We conducted focus groups and interviews with OB/GYNs in Ohio in 2022, prior to Dobbs. We saw the abortion restrictions in Ohio were already creating training limitations to physicians,” Gyuras explains. “We found in the wake of Dobbs that it would lead them to leaving the state and choosing never to come here to practice.”2
Pre-Dobbs, medical schools and residency programs would send their medical students and residents to local abortion clinics to train in abortion care provision. “The people who participated in our focus groups and interviews felt those were great, but still didn’t provide them with enough training in abortion care,” Gyuras says.
One participant said she had only been trained to provide a medication abortion and could not train for a procedural abortion, which left her completely unprepared. “That was pre-Dobbs. In the post-Dobbs environment, we expect those issues will be exacerbated, and there will be fewer training opportunities for medical students and residents,” Gyuras says. “Our participants expressed a lot of frustration with the laws. They wanted to provide good care to their patients, and they were unable to. They felt the laws prevented them from exercising their clinical judgment and practicing in the way they felt was best.”
It is important for medical students to experience a wide swath of care given to patients, says Rachel S. Casas, MD, EdM, an associate professor of medicine in the division of general internal medicine at Penn State Milton S. Hershey Medical Center.
Because of abortion bans and restrictions, there will be fewer educational opportunities to learn abortion care. That means OB/GYN students and residents will have first chance at these clinical experiences, Casas says. This is a missed opportunity because all physicians could benefit from knowing about abortion care and knowing more about the beliefs and concerns of patients in need of this care.
“I think an important part of what we learn in medical school and residency is that sometimes our personal beliefs may not align with those of our patients,” Casas says. “While we’re never forced to do anything, it’s still part of our job to get patients the care they need, as long as it’s legal and available.”
To understand patients’ perspectives, providers should talk with patients who find themselves in various situations — including needing an abortion.
“We also need to hear from colleagues who provide this care and those who don’t provide this care — and, in that way, we learn from each other,” Casas explains. “It’s the most powerful way to understand each other’s perspectives.”
- Sharma S. Texas doctor tells Biden students being forced to practice abortions on papayas after Roe v Wade ban. Independent. Oct. 26, 2022.
- Field MP, Gyuras H, Bessett D, et al. Ohio abortion regulations and ethical dilemmas for obstetricians-gynecologists. Obstet Gynecol 2022;140:253-261.
In June 2022, the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to abortion care. Data are not yet available on whether medical schools and residency programs in abortion-ban states will teach students about abortion or provide any opportunities for hands-on experience with abortion care. Or they could be taught abortion procedures without actual human patients. Media reports indicate that medical students are using papayas in place of a cervix to learn the procedure in some cities.
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