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The fall of Roe v. Wade turned Dr. Jasmine Chan’s career around.
As a medical student originally from Texas wanted to provide abortions as an obstetrician-gynecologist. But in 2022, as Chan prepared to apply for residency—a sort of long apprenticeship after medical school—she worried that the quirks of the residency process would hold her back in Texas, which banned abortion after the US Supreme Court overturned Roe.
“I met with my advisors and had very strong heart-to-heart conversations about how I couldn’t imagine practicing medicine if it didn’t involve doing abortions,” Chan said. Instead of becoming an OB/GYN, she decided to become a family medicine doctor – a less competitive major that increases her chances of finding residency in a given state which protects access to abortion.
Now, two years into his residency program in New Jersey, Chan is preparing to finally receive the training he’s longed for his entire career. But like many other doctors seeking abortion training after Roe’s death, she will still have to overcome hurdles that didn’t exist just two years ago.
For the next few months, Chan will pursue abortion training at two different clinics, the closest of which is three hours away, in addition to her day job. In the fall, she will have to move entirely to study at a third clinic.
She will have to jump through all these hoops because there simply aren’t enough clinics left to train future doctors in the US in a relatively quick and straightforward procedure which one in four women will undergo at some point in their lives.
When the US Supreme Court overturned Roe exactly two years ago, it paved the way for more than a dozen states to ban nearly all abortions. It also plunged the American medical training system into chaos. Because a lot hospitals have long refused performed most abortions, residents who wanted to learn the procedure often received their training in abortion clinics. But now the bans have fallen so many clinics, just not enough facilities for training all residents.
“Clinical training sites are overwhelmed, just trying to meet the needs of patients, making it much less likely that they will admit as many trainees or for as many days as they used to,” said Latona Giwa, executive director of the Midwest Access Project. a non-profit organization that helps a range of health care professionals receive training in reproductive health, including abortion instruction.
But if they don’t, she said, “we will not have a next generation of abortion providers.”
Doctors across the country already say abortion bans have forced them to delay caring for pregnant women in medical emergencies. But as abortion training becomes scarcer or available only to doctors like Chan who have the time and money to navigate a logistical obstacle course, fewer doctors will have the skills to deal with dangerous pregnancy complications, including miscarriages. abortions, which are often treated with the same procedures used for abortions.
Abortion education may soon become even harder to come by. Project 2025, a playbook written by the influential Heritage Foundation think tank in anticipation of Donald Trump’s second administration, recommends that the Department of Health and Human Services “ensure that training for healthcare professionals (doctors, nurses, etc.) ) and is not used for abortion training’.
Project 2025 too recommends penalizing institutions that fail easier for medical professionals to opt out of abortion education on grounds of conscience.
Although the language is ambiguous, its enforcement could ultimately lead to bans or even criminalization of abortion education, said Mary Ziegler, a professor at UC Davis who studies the legal history of reproduction.
“It sounds like ideally they want to defund or essentially have as a Hyde Amendment any kind of federal support, direct or indirect, for education,” said Ziegler, citing a nationwide rule that prohibits the use of federal dollars for abortions. Residency programs and medical schools, like almost all educational institutions in the US, take money from the federal government.
“It’s just so closed”
It has never been easy for American doctors to learn how to perform abortions. Hospital systems that run medical schools and residency programs are deeply hierarchical institutions that rely on public funds — and so they tend to avoid such controversial issues as abortion. In 1992, two decades after the US Supreme Court first decided Roe, only 12% of obstetrics and gynecology residency programs routinely offered training in abortion. Three years later, the Accreditation Council for Graduate Medical Education decided for the first time to require obstetrics and gynecology residency programs to teach doctors how to perform abortions.
Since 2018 though. only 64% offered obstetrics and gynecology residencies routine, specific abortion training. Meanwhile, hospitals perform only 3% of all abortions – and usually only in high-risk pregnancies or cases of fetal abnormalities. This left the burden of training to abortion clinics.
To help close the gap, a national initiative called the Ryan Residency Training Program (RRTP) assists in the placement of OB/GYN in training clinics.
In 2021, when Texas enacted a six-week abortion ban, RRTP stepped up to help residents travel out of state for abortion training. But the process turned out to be a bureaucratic nightmare, as programs and clinics struggle to secure the proper documentation and legal clearances.
“Oh my God, it took six months before even the first resident could travel,” said Dr. Jody Steinauer, who directs the RRTP. “That’s how hard it is to set them up.”
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After Roe fell, the Accreditation Council for Graduate Medical Education announced it would require obstetrics and gynecology programs to either offer residents abortion training or send them to states where they can get it. However, a council spokesman declined to say how many obstetrics and gynecology programs currently meet this requirement. There are now nearly 1,300 obstetricians living and working in states with near-total abortion bans—all of whom must travel out of state for hands-on abortion training.
RRTP helped 16 programs in abortion-ban states create partnerships to help residents travel out of state for training.
States with abortion bans, which typically have among the highest rates of maternal mortality and morbidity in the nation, now face a worsening shortage of obstetricians and gynecologists. Fewer obstetricians even apply to residency programs in these countries. Louisiana, for example, saw a 17% drop; Alabama saw a 21% drop; Missouri, 25%.
Along with obstetricians and gynecologists, family medicine physicians are the specialists most likely to learn how to perform abortions. But they aren’t required to complete that training—and those who want it, even in blue states, can’t necessarily get it.
“There’s just a lot more competition for training spots,” said Erica Chong, executive director of Family Reproductive Health Education Medicine (Rhedi), the family medicine version of the RRTP.
Dr. Amy Hoffman is a family medicine specialist in Pennsylvania, a state that allows abortion. But even though her institution supports her desire to learn to perform abortions, she doesn’t have faculty with the skills to teach her. At this point in her residency, she doubts she will receive the tuition.
“I have to find a month where I can leave my residency and give myself months and months before scheduling to get the medical arrangements in place,” Hoffman said.
Her daily work is hard enough already. Residency programs are permitted to require residents to work up to 80 hours per week; they can also make them work 28-hour shifts.
“Every doctor in every specialty has seen a C-section or seen an appendectomy or taken care of diabetes, but the majority of doctors have never seen abortion care and never seen the procedure performed,” Hoffman said. “It’s so isolated and inaccessible to both patients and learners.”
A spike in interest
Medical education advocates are thrilled that since Roe came down, so many new providers want to be trained in abortion. Several new residency programs have already joined the Rhedi program. Steinauer said there is now “much more collaboration within states, within regions, at the national level” between institutions that want to increase their abortion training.
The Midwest Access Project received nearly 50 applications in its first application cycle since Roe fell. At the time, it was the most it had ever received.
Now, the nonprofit receives somewhere between 100 and 200 applications each cycle. It can still only accommodate about 50 people each cycle, but it gives hope to Giwa.
“It’s a huge number of big impact because every time one abortion-trained provider is added to a community or a region, a state, they can train tenfold more providers, and they can do it in a primary care setting, ideally,” Giwa said. She imagines a future in which “You can just go get your allergy medicine and your abortion pills from the same person and it’s not a huge extra ordeal.”
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