Dobbs ruling will deprive many medical students of abortion care training
As medical students – the next generation of physicians – we believe that Dobbs v. Supreme Court’s Jackson Women’s Health, which overturned Roe v. Wade and Planned Parenthood v. Casey, jeopardizes the health of our future patients and our ability to become competent doctors.
As medical candidates in our second year of training, we are still learning the fundamental skills of a physician while exploring the range of medical specialties. This period of medical study is focused on building a foundation of knowledge and relational 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 abortion education, will be unable to overcome some of the complex medical and social challenges that their patients will face.
Medical students who are trained in family planning counseling, including discussing abortion options, learn to engage in difficult conversations with patients while providing support and communicating relevant medical knowledge. Pregnant women seek abortions for many reasons, from life-threatening complications to socio-economic barriers, to other children in an already struggling family, or the desire to stay in school while they build their lives. own future. Each patient’s life is unique and the care provided to them should be tailored to their needs, desires and life situation. This is true not only for abortion care, but for care in all clinical specialties.
By learning to have these conversations through abortion education, medical students improve the parameters of respect for patient privacy and autonomy, professionalism, and humanism, which are essential skills in the profession. education established by the Association of American Medical Colleges (AAMC). Abortion education challenges students’ existing perspectives and encourages them to challenge their assumptions about why 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 education, in part because they are difficult. Abortion care requires confronting conflicting ideals and working with patients to provide treatment that is both evidence-based and best meets their wants and needs. Sexual and reproductive health, including the management of pregnancy complications and pregnancy termination options, is universal and deeply personal. Medical students learning about abortion care learn to build patient-doctor trust and reinforce the shared humanity that is the cornerstone of medical care.
The current shortage of doctors in the United States is worsening, with AAMC estimates indicating a shortage of 37,800 to 124,000 doctors by 2034. In rural areas, where access to medical care, and especially to reproductive health care, is already limited, state policy changes in the wake of Dobbs may extend reproductive health care deserts, as some students are unlikely to continue their studies and/or practice medicine in States that prohibit or severely limit abortions.
In states that ban abortion, pregnant medical students and physicians may have to miss school or work, be unable to meet rigorous and physically demanding medical school and residency program requirements , or may have to give up medicine altogether due to the demands. to take care of a child. The proportion of women attending medical school has steadily increased over the past few decades. In 2020, 53.7% of medical students were female – our class at Emory University Medical School is 70% female.
We, and 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. That means reproductive health care in states like Georgia, which has the nation’s second-highest maternal mortality rate, could be disproportionately affected by an increased doctor shortage.
As we wrestle with the ramifications of Dobbs, both for our patients and for ourselves, we think of our own mothers. Kellen’s mother gave birth in the middle of an Oakland, California movie theater. She says her water broke because she was laughing so hard while watching “Analyze This.” After 36 hours of labour, 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 birth that accounts for about 20% of severe cases of postpartum hemorrhage, a leading cause of maternal death. She was rushed to the operating room, where her life was saved by an OB-GYN who performed dilation and curettage (D&C), a procedure for treating pregnancy complications that is also used for the abortion. The doctor who saved his life was able to do so because he was legally allowed to learn how to perform a D&C during his training.
Across the San Francisco Bay, Ariana’s mother, who learned these vital techniques 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 these skills during her medical training.
In Atlanta, the Dobbs decision will profoundly affect many of our patients, especially those without health insurance or from marginalized communities who face many barriers to care and experience a disproportionate negative impact from social drivers. of health. Many of these patients receive their care at free clinics in Clarkston, Georgia, 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 provide them with the highest quality of care possible. But we can only do this if our patients have access to abortion services.
We and many of our colleagues will not have the medical training and access to life-saving treatments that our mothers enjoyed, setting us back more than 50 years in history. The Dobbs decision harms not only the health of women across the United States, but also future American doctors and the integrity of American health care.
Kellen Mermin-Bunnell and Ariana M. Traub are second-year medical students at Emory University School of Medicine in Atlanta. The opinions expressed here are their own and do not necessarily reflect those of their school.