Browse any medical dictionary and you’ll find miscarriage before appendectomy and anesthesia.

The first two programs are part of standard physician education. But for many U.S. medical students and residents who want to learn about abortion, options are few.

New restrictions are piling up: At least eight states have proposed or enacted bills or laws aimed at limiting abortion education in the past year. The changes come from abortion opponents buoyed by new restrictions on the procedure itself, as well as a potential Supreme Court ruling that could overturn the landmark Roe v. Wade decision legalizing abortion.

“What’s going on is horrific,” said Ian Peake, a third-year medical student in Oklahoma, where the governor signed a measure April 12 that would ban most abortions.

Two Oklahoma medical schools offer no abortion training and education on the subject is limited. Aspiring doctors who want to learn about it often look outside the traditional medical education system for doctors who offer abortions.

Pique, 32, said that if he wanted to learn to do colonoscopies, for example, he could follow a doctor who does research or works in a clinic with school staff.

“That’s easy,” he said. “It’s almost impossible to do the same thing with abortion.” He said it took him six months to find a provider willing to teach him.

Nevada medical student Natasha McGlaun received outside training and created a workshop on how to perform standard medical procedures for abortion. She offers in the evenings, in her own free time.

The 27-year-old is the daughter of “pro-feminist” parents and the mother of two young girls who want to protect their reproductive choices.

“It’s a joke in my family: If people tell me I can’t do something, I go the extra mile,” she said. “I have a moral, just drive to pursue it.”

“Notably absent” courses

American physician education typically includes four years of medical school, where students learn the fundamentals of general medicine and practical patient care. They graduate with a medical degree that officially makes them doctors. Most of them then spend at least three years in a residency program, where they receive intensive on-the-job training and specialized skills.

U.S. medical schools require students to complete a traineeship in obstetrics and gynecology, but there is no mandate that it includes abortion education. At the graduate level, the accreditation panel requires OB-GYN residency programs to provide abortion training, but residents who object can choose not to have an abortion.

OB-GYN performs most abortions in the United States, followed by family medicine specialists. But these aren’t always the first doctors women encounter when they learn of an unplanned pregnancy. Proponents of abortion rights argue that all physicians should have sufficient knowledge of the process of informing and counseling patients, and that this education should begin with medical school.

In 2020, Stanford University researchers said they found that half of medical schools had no formal abortion training or only one lecture.

“Abortion is one of the most common medical procedures,” they wrote. “However, abortion-related topics are conspicuously absent from medical school curricula.”

McGlaun helped launch a measure last year that would require the American Medical Association to support mandatory abortion education in medical schools, with an opt-out provision. The influential group has long opposed course requirements and rejected the proposal, but it has expressed support for giving medical students and residents a chance to learn about abortion and opposing efforts to interfere with such training.

further restrictions

Legislative efforts to curb abortion target all levels of medical education.

The Idaho law enacted last year exemplifies this trend. It prohibits the use of tuition and fees for abortion and related activities in school-based clinics at state-funded institutions.

Other efforts include a bill in Wisconsin that would bar employees at the University of Wisconsin and its hospitals from participating in abortions, including training. It failed to make progress in March, but its sponsors plan to reintroduce the measure. Similar proposals target public universities in Missouri and Ohio.

Divya Jain’s presentation on abortion wasn’t at her Missouri medical school — she said the procedure was rarely discussed — but at a Planned Parenthood clinic in Kansas. She is a clinic volunteer who has seen the barriers that out-of-state women face in getting surgery. Jain said some people strayed into the crisis pregnancy center across the street and tried to change their minds.

Jain, 23, said her first experience watching abortion was an “anti-climax”, a far cry from the horrific images she heard opponents describe.

“It’s just a normal internal procedure,” she said. “It’s just patients seeking medical care.”

At that moment, she knew she wanted to provide abortion services. “It was like a snap of fingers. That changed it for me,” said Jain, who was studying public policy at Harvard during a sabbatical at the University of Missouri-Kansas City School of Medicine.

The daughter of open-minded but traditional parents who immigrated to Kansas from India, Jain recalls growing up feeling trapped by her family’s traditional culture and a conservative white community that never discussed abortion.

“I love stirring the pot” and pushing boundaries, she says.

Jain knew that the U.S. Supreme Court’s decision on whether to uphold Mississippi’s ban on abortion after 15 weeks of pregnancy could revolutionize the abortion landscape in the United States. Regardless of the decision — expected by summer — Jain said her goal is certain: to have abortions in “hostile” states where providers are scarce.

“It’s hard for patients to get the care that patients deserve and need, and I just think that’s wrong,” Jain said.

Expand training

Dr. Keith Reisinger-Kindle, 33, associate director of the OB-GYN residency program at Wright State University School of Medicine in Dayton, Ohio, said his goal of promoting abortion training “has been an uphill battle” because of legislative obstacles. .

When he came to the school about two years ago, he said, “formal abortion education is zero.” With the support of his university, he created and implemented an abortion curriculum for medical students and residents, and Training is provided at a nearby clinic, where he also performs abortions.

A state lawmaker has lobbied university administrators to fire him, the doctor said. In December, Ohio’s governor signed a law restricting doctors working at state agencies from serving as backup doctors at abortion clinics in the event of rare complications. The clinic where Reisinger-Kindle works is suing to block the law.

“Some days are definitely challenging,” Reisinger-Kindle said. A young doctor eager to learn helps him keep going. The program currently has 24 residents. They can choose not to attend abortion training, but he said almost all opted to attend “at least in some capacity.”

He worries about more abortion restrictions, but added: “In the long run, I’m sure we’ll get there. I just hope my students don’t have to suffer.”