Abortion restrictions are sweeping the country, from Florida to Texas to Idaho, limiting the already limited training options for medical students and residents in the United States who want to learn how to perform abortion procedures.

The American College of Obstetricians and Gynecologists recommends that future physicians receive standardized abortion care training during their medical residency, which is a period of training following medical school that gives them on-the-job experience in a specific specialty. However, the number of residency programs in states where hospital employees are prohibited from performing or teaching about abortion — or at Catholic-owned hospitals with similar prohibitions — has increased dramatically in recent years, an unnoticed byproduct of anti-abortion legislation gaining traction in the American South, Midwest, and Mountain states.

Danna Ghafir, a native Texan and third-year medical student in her home state, will leave for residency training when the time comes.

Some students and teachers at Ghafir’s school have become more vocal about advocating for abortion education since Texas passed a six-week abortion ban, she said. However, she has seen students who want to practice complex obstetrics struggle to find mentors.

According to medical residency directors and students, aspiring obstetricians and gynecologists who want training in abortion procedures are increasingly seeking out teaching hospitals and universities that promote that training as a critical skill in women’s health care, resulting in a rush of qualified applicants for prized spots in Seattle, San Francisco, and New York. Residents who did not want to learn abortion care used to be able to reserve a few spots in the Department of Obstetrics and Gynecology at the University of Washington in Seattle. However, as access to teaching hospitals that offered abortion training became more limited two years ago, UW decided to admit only residents who were committed to providing abortion care.

Medical students in St. Louis, Missouri, usually travel to Illinois, which has fewer restrictions. However, a Republican amendment to a Missouri state health bill introduced by Rep. Mary Elizabeth Coleman would make it illegal to perform an abortion on a Missouri resident anywhere in the country, and administrators fear that medical students traveling across state lines would be prosecuted. Another Missouri bill, sponsored by Republican Sen. Mike Moon, would tax universities with medical faculty who perform abortions or facilitate abortion training for medical students’ endowments. Moon has stated that the bill, which was first introduced in 2021 and is being reintroduced this year, is aimed at Washington University in St. Louis.

A proposed bill in Idaho would prohibit state employees from teaching about abortion, including University of Idaho physicians. Last fall, University of Washington professors based in Seattle used Zoom to teach a class about contraception and abortion to students in Idaho.

“They’re focused on travel bans because they know it’s important to abortion rights advocates to maintain the pipeline of providers,” said Pamela Merritt, executive director of Medical Students for Choice, which works with student volunteers across the country to advocate for abortion training. Merritt advises medical students to train in “abortion refugee states” while people try to undo the impending “catastrophic, slow-moving car crash.”

The clinical skills required for abortion procedures are often the same as those required to clear the uterine lining after a miscarriage or to terminate a pregnancy that is causing hemorrhaging and other complications that can lead to maternal death. Experts say that doctors who are unfamiliar with abortion procedures are often less skilled at performing these life-saving procedures.

Espey has seen an increase in patients arriving from Texas seeking to terminate pregnancies, some with serious pregnancy complications, in the nearly seven months since Texas’ ban on abortions after embryonic cardiac activity is detected (at about six weeks of gestation) went into effect.

The United States Supreme Court will decide later this spring whether to uphold a Mississippi law prohibiting most abortions after 15 weeks of pregnancy, a decision that could overturn or weaken federal abortion protections. If Roe v. Wade is overturned, 26 states are likely to prohibit abortion, and doctors say clinics in states that support abortion rights, such as California, Oregon, New York, and New Mexico, will be overwhelmed with patients, leaving little time for residents to be trained.