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The likely end of federal abortion rights won鈥檛 just make it more difficult for women to get an abortion. It鈥檚 also almost certain to make it more difficult to train medical professionals on abortion procedures 鈥� a skill that doctors and others who take care of women鈥檚 health consider essential.

The prospect raises 鈥渁 huge public health issue鈥� in the words of one doctor 鈥� and one that can affect not just patients seeking an abortion, but those who experience miscarriage or stillbirth.

Any day now, the U.S. Supreme Court will hand down its decision over a Mississippi law that bans abortion after 15 weeks. In a draft of the pending opinion that was , Justice Samuel Alito calls for overturning the 1973 opinion in Roe v. Wade that legalized abortion nationwide. 

If the final opinion reflects that conclusion, in Wisconsin it would bring back an 1849 state law that . While that is expected to face a legal challenge, if the 173-year-old law takes effect, it would become a crime to terminate a pregnancy, regardless of the reason.

Overturning Roe would at least endanger, and could very likely end, training in abortion procedures for medical residents learning to practice obstetrics and gynecology in Wisconsin and other states with abortion bans on the books. OB/GYN residency programs are required to offer that training; in the worst-case scenario, Wisconsin OB/GYN residency programs might lose national accreditation.

National standards

The Accreditation Council for Graduate Medical Education () sets requirements for medical residency programs in every specialty, including obstetrics and gynecology. OB/GYN programs must include a family planning curriculum, which the  must include 鈥渢raining or access to training in the provision of abortions.鈥� OB/GYN residents 鈥渕ust have experience in managing complications of abortions and training in all forms of contraception, including reversible methods and sterilization.鈥�

The requirements allow residents with a religious or moral objections to opt out and state that they cannot be required to take part in abortion training or performing abortions. 

Accreditation 鈥渆nforces a uniform set of specialty peer developed standards across all residency programs within each specialty so that patients have access to the highest quality care across the United States,鈥� the council鈥檚 spokeswoman, Susan White, said in an email message.

The council鈥檚 priority in its requirements for abortion training 鈥渋s safeguarding women鈥檚 health,鈥� White said. 鈥淪hould it become illegal in some states to perform aspects of family planning, the ACGME is exploring alternative pathways for completing this training.鈥�

The UW Hospital and Clinics Authority 鈥� UW Health 鈥� sponsors an OB/GYN residency program in Madison, with faculty from the University of Wisconsin School of Medicine and Public Health鈥檚 OB/GYN department serving as educators.

 鈥淲e expect the impact of a final decision by the Supreme Court on the future of Roe v. Wade could have broad implications for institutions such as ours,鈥� said Emily Kumlien, UW Health press secretary, in an email statement. 鈥淗owever, until that decision is reached, we are unable to speculate on outcomes.鈥�

The residency programs are accredited by ACGME, Kumlien stated. 鈥淲e expect to closely monitor for any changes to requirements and work to ensure continuity of the robust training opportunities we provide.鈥�

Broader applications 

Dr. Abigail Cutler, a Madison OB/GYN, says medical students and medical residents far beyond just the OB/GYN field need to learn how to counsel patients in a wide range of situations where pregnancy is involved. Those include  unintended pregnancies, pregnancy complications including fetal anomalies and other complications that affect the health of the fetus or the health of the mother. They also include patients who have a miscarriage.

(Cutler is a member of the UW medical school faculty, but she adds she is speaking as a private citizen and medical professional, not as a representative of the medical school.)

鈥淢ost physicians in general who are taking care of patients in the office setting will be seeing some patients who are capable of becoming pregnant,鈥� says Cutler. 鈥淭his comes up not just for OB/GYNs but for all physicians.鈥�

And for doctors who will enter the OB/GYN field, knowing abortion procedures, including the use of medication as well as surgical options, equips them to take better care of their patients, she says, whether or not a patient wants to terminate a pregnancy. Surgical abortion procedures 鈥渁re also procedures used to manage miscarriage, or in the second trimester or later, fetal demise鈥� 鈥� stillbirth.

In surveys of OB/GYN doctors, those who have had less training in abortion care or none at all have reported that they 鈥渇elt less prepared to offer comprehensive care to people who are experiencing a miscarriage,鈥� Cutler says. For doctors with more exposure to and practice in abortion care, 鈥渢here was a correlation between that and their comfort level with surgically managing miscarriage later on.鈥�

If a state鈥檚 laws severely restrict or ban abortion, that will limit access to that training, Cutler says, which causes her concern. 

鈥淥ne in five pregnancies end in abortion,鈥� Cutler says. Restricting access 鈥渞esults in preventable morbidity and death. This is a huge public health issue.鈥� 

Support for abortion access

In May the American College of Obstetricians and Gynecologists (ACOG), the specialty鈥檚 primary professional association, updated its longstanding policy that . 鈥淎ll people should have access to the full spectrum of comprehensive, evidence-based health care. Abortion is an essential component of comprehensive, evidence-based health care,鈥� the policy states.  

鈥淎bortion is a critical medical intervention,鈥� said Dr. Iffath Abbasi Hoskins, ACOG鈥檚 president and board chair, in a statement that accompanied the policy revision. The policy was revised, she said, to 鈥渕ake it unmistakably clear that ACOG trusts doctors and patients 鈥� and not lawmakers 鈥� to make decisions about what is best for patients鈥� health and well-being.鈥�

Surveys have found broad support for abortion rights and abortion care among doctors. In 2019, the Collaborative for Reproductive Equity (CORE) at the UW medical school polled the school鈥檚 doctors on the impact of restrictions on abortion that had been enacted since 2011. More than 900 doctors responded to the survey, and more than 90% said overturning Roe v Wade 鈥渨ould worsen Wisconsin women鈥檚 health,鈥� says Jenny Higgins, CORE鈥檚 director. 

鈥淲e surveyed people across all medical specialties, and we found overwhelming support for abortion services as well as abortion providers,鈥� Higgins says. In addition to the concerns for women鈥檚 health, a majority said that more restrictions on abortion 鈥渕ake it more difficult to recruit faculty and trainees.鈥�

Cutler says among the residents and medical students she has encountered, 鈥渢here鈥檚 a high desire for this training and education.鈥� She expects that to persist even if Roe is overturned, 鈥渁nd maybe an increased demand for that training,鈥� she adds. 鈥淏ut that will leave only so many states where that training will be available.鈥�

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