Opinion | Protected States Can Expand Access to Abortion Training

The fall of Roe v. Wade brought an unprecedented onslaught of abortion restrictions across the U.S. These restrictions — from total and partial bans to laws criminalizing abortion providers — are already dramatically reshaping undergraduate and graduate medical education.

As a result of the Dobbs decision, less than a third (29%) of U.S. medical students are training in abortion-protective states; the other 71% includes 51% of students in states with highly restrictive abortion bans and 20% in states with mixed restrictions and protections. These laws and policies make it difficult, and frequently impossible, for U.S. abortion providers to offer routine reproductive healthcare, which in turn prevents medical students from developing essential clinical knowledge. Hundreds of students each year are now being forced to accept inadequate abortion education, or have to travel domestically or internationally to complete family planning rotations. In the absence of national curricular standards for abortion education, such educational disparities between restrictive and protective states will worsen, to the detriment of future physicians and our patients.

Beyond disrupting our education, abortion bans are now reshaping career decisions for many medical students. Throughout medical school, students grapple with life-altering decisions about which specialty to pursue and which residency program to choose. Even pre-Dobbs, geographic location was the leading factor that influenced medical students’ application and ranking choices. Location is even more consequential now: it determines whether reproductive healthcare providers like ob-gyn and family medicine residents can develop foundational skills in abortion care, and whether applicants and their families across all specialties can access routine medical care.

Though these blows have been devastating for medical trainees, hope is not lost.

New York Gov. Kathy Hochul (D) will soon have the remarkable opportunity to give us a lifeline. This month, the New York General Assembly introduced new legislation, NY S03060, to create a reproductive healthcare training state fund for medical interns and residents. The proposed legislation, introduced by Democratic state senator Liz Krueger and assembly member Harvey Epstein, amends New York public health and finance laws to earmark funds for medical trainees to complete 2 to 6 weeks of abortion training here in our hospitals and clinics, as is mandated by current Accreditation Council for Graduate Medical Education standards. Grants could cover a range of costs for training programs and residents alike. It funds residency programs seeking to establish new abortion training programs or expand the capacity of existing ones, and covers trainee-related expenses like travel and housing that pose barriers for many.

Such funding cannot undo all the damage that abortion restrictions have wrought. It cannot make abortion legal in places where it is banned, nor prevent avoidable morbidity and mortality that results from abortion restrictions. However, it can substantially expand access to comprehensive reproductive healthcare training and do it equitably. It can equip future physicians with the knowledge and skills to perform abortions, regardless of where they trained. And someday, when universal abortion rights and access are again enshrined into U.S. law, it can ensure that physicians in every state are prepared to resume the provision of full-spectrum reproductive healthcare. This bill is a win for current and future medical trainees across the country — and indeed a win for the physician workforce, the healthcare system, and critically, for our patients.

Moreover, enacting this bill in New York would provide a valuable model for other city, state, and federal governments to replicate. The Guttmacher Institute has rated 15 U.S. states as “protective” of abortion rights and access, including six “very protective” states: California, New Jersey, New Mexico, New York, Oregon, and Vermont. Others like Connecticut and Hawaii have recently upgraded their ratings by passing protective reproductive health legislation. By signing this bill once it passes the state Congress, Hochul could not only continue reifying New York as a safe haven for abortion providers, but also inspire states like these to follow suit, in a powerful, collective move to reduce systemic barriers facing physicians and patients in abortion-restricted states.

As a medical student, I know that my generation of physicians is inheriting a policy landscape that is uniquely hostile to reproductive healthcare providers. That makes this bill personal for me and my peers. Hundreds of us agree: this bill is an essential next step in counteracting the virulent opposition we face. New York should take it, and inspire other states to follow.

Sarah McNeilly is an abortion advocate and medical student at the Albert Einstein College of Medicine in New York City. She is a leader within the Medical Students for Choice.