As medical students — the next generation of physicians — we believe that the Supreme Court’s Dobbs v. Jackson Women’s Health decision, which overturns Roe v. Wade and Planned Parenthood v. Casey, undermines the health of our future patients and our ability to become competent physicians.
As M.D. candidates in our second year of training, we are still learning the fundamental skills of being a physician while exploring the range of medical specialties. This period of medical school is focused on building a foundation of both knowledge and relationship-building skills that will be essential to the practice of medicine regardless of specialty. Students who do not participate in comprehensive sexual and reproductive education, including education about abortion, will be unable to navigate some of the complex medical and social challenges their patients will encounter.
Medical students who are trained in family planning counseling, including discussing abortion options, learn how to engage in difficult conversations with patients while providing support and communicating pertinent medical knowledge. Pregnant people seek abortion for many reasons, from life-threatening complications to socioeconomic barriers, providing for other children in an already struggling family, or a desire to remain in school as they build their own futures. Each patient’s life is unique, and the care provided to them must be adjusted to align with their needs, wants, and life circumstances. This is true not just for abortion care but for care in every clinical specialty.
By learning how to have these conversations through abortion training, medical students improve on metrics of respect for patient privacy and autonomy, professionalism, and humanism, which are core competencies of medical education established by the Association of American Medical Colleges (AAMC). Education about abortion challenges students’ existing perspectives and encourages them to question their biases about the reasons patients seek care and to respect their patients’ autonomy.
In a post-Roe era, medical students in states with highly restrictive abortion laws will not learn comprehensive reproductive health care. Conversations about sexual health are an important component of medical training in part because they are difficult. Abortion care necessitates confronting conflicting ideals and working with patients to provide treatment that is both grounded in evidence-based medicine and best meets their wants and needs. Sexual and reproductive health, including management of pregnancy complications and termination options, is universal, as well as deeply personal. Medical students who learn abortion care learn to build patient-physician trust and reinforce the shared humanity that is the cornerstone of medical care.
The existing physician shortage in the United States is getting worse, with estimates from the AAMC indicating a shortage of 37,800 to 124,000 physicians by 2034. In rural areas, where access to medical care, and particularly reproductive health care, is already limited, state policy changes in the wake of Dobbs may expand reproductive health care deserts as some students likely won’t pursue medical education and/or practice in states that outlaw or greatly limit abortions.
In states that ban abortion, pregnant medical students and physicians may have to take time off from school or work, be unable to meet the demands of rigorous and physically demanding medical school and residency programs, or may have to leave medicine altogether due to the demands of caring for a child. The proportion of women attending medical school has been steadily increasing over the past few decades. In 2020, 53.7% of medical school matriculants were women — our class at Emory University School of Medicine is 70% women.
We, along with many of our colleagues, do not want to train in states where abortion is illegal and where we cannot provide the best, evidence-based care. This means that reproductive health care in states like Georgia, which has the second-highest maternal mortality rate in the country, may be disproportionately affected by an uptick in the physician shortage.
As we grapple with the ramifications of Dobbs, both for our patients and for ourselves, we think of our own mothers. Kellen’s mother went into labor in the middle of an Oakland, Calif., movie theater. She says her water broke because she was laughing so hard watching “Analyze This.” After 36 hours of labor, her first baby was born. But something was wrong. She was lying in a pool of her own blood. She had a retained placenta, a complication of vaginal delivery that accounts for about 20% of severe cases of postpartum hemorrhage, a leading cause of maternal mortality. She was rushed to the operating room, where her life was saved by an OB-GYN who performed a dilation and curettage (D&C), a procedure for treating pregnancy complications that is also used for abortion. The physician who saved her life was able to do so because he was legally permitted to learn how to perform a D&C during his training.
On the other side of San Francisco Bay, Ariana’s mother, who learned those lifesaving skills during her OB-GYN residency, now practices reproductive endocrinology. She has the skills to save patients who would otherwise die from pregnancy complications so they can meet their daughters and sons. Her daughter may not be able to learn those skills during her medical training.
In Atlanta, the Dobbs decision will profoundly affect many of our patients, especially those who lack health insurance or who are from marginalized communities that face numerous barriers to care and bear a disproportionate negative impact of the social drivers of health. Many of these patients receive their care from free clinics in Clarkston, Ga., run by medical students with care provided by physicians who volunteer their time, because it is their only option. As medical students, it is our duty to offer them the highest quality of care possible. But we cannot do this unless our patients have access to abortion services.
We and many of our colleagues will lack the medical training and access to lifesaving treatment that our mothers were afforded, effectively setting us back more than 50 years in history. The Dobbs decision not only harms the health of women across the U.S. but also the future physicians of America and the integrity of U.S. health care.
Kellen Mermin-Bunnell and Ariana M. Traub are second-year medical students at Emory University School of Medicine in Atlanta. The views expressed here are theirs and do not necessarily reflect those of their school.
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