Many OB-GYNs aren’t getting abortion training, government report finds

Obstetrician-gynecologists are seeing more pregnant patients with dangerous medical complications two-plus years after the Supreme Court’s Dobbs decision, while at the same time receiving less training as residents about how to perform abortions, according to a new report.

The findings, shared exclusively with NBC News, are the result of a monthslong investigation by Democrats on the House Committee on Energy and Commerce. They’re based on conversations with leaders and educators from 20 OB-GYN residency programs conducted from February to June. Half of those programs are in states that restrict abortion access.

The report highlights several worrisome effects of abortion restrictions instituted after Roe v. Wade was overturned, including fewer applicants to OB-GYN residency programs in states that restrict abortion, practicing OB-GYNs moving out of these states and new doctors being left unprepared to treat pregnant patients in life-threatening scenarios.

“I don’t think people realize how dire the situation has become so quickly,” said Rep. Frank Pallone Jr., of New Jersey, the committee’s ranking Democrat.

Several residency program directors interviewed for the report recalled dangerous, sometimes tragic, situations in states with abortion bans.

One director described a patient who died from sepsis after she wasn’t able to get an abortion. Another said their hospital had to hold off on providing an abortion for a patient whose amniotic sac had ruptured at 20 weeks, which creates a risk of infection.

The report also reinforces the conclusions of other prior research: that pregnant patients have to travel longer distances to obtain abortions or wind up visiting multiple hospitals before they can find one that will treat them for complex medical issues. The share of patients traveling to other states for abortions doubled from 2020 to 2023, according to the Guttmacher Institute, a research organization that supports abortion access.

“Those delays in care really can lead to downstream complications and preventable morbidity,” said Dr. Justin Lappen, chair of the Society for Maternal-Fetal Medicine’s Reproductive Health Committee, who wasn’t involved in the new report. 

The report also highlights how little education some OB-GYN residents are receiving in how to provide an abortion. 

“It’s already happened in the restricted states that women who needed an emergency abortion were not able to get it because [doctors] were afraid to perform it. Now, on top of that, you layer the fact that even if the doctors wanted to do it, they don’t have the knowledge to do it,” Pallone said.

In the past, residency programs often partnered with abortion clinics to provide that training, but in states with abortion bans, those clinics have shut down. Some programs pay for residents to get such training out-of-state, but that often requires additional medical licenses and liability insurance and means residents must spend multiple weeks away from home. 

In states that restrict abortion, some OB-GYN residents have to rely on textbooks in lieu of observing an abortion firsthand or simulate the procedure using a piece of fruit. 

“You can tell who has done it and who has learned it from a book,” one residency director said in the report. “There is a gap in how they’d manage patients.”

Lappen said residents who don’t receive sufficient training might not develop expertise about how to manage situations like miscarriages or ectopic pregnancies or may lack the skills to quickly intervene in life-threatening emergencies when an abortion is medically necessary. 

“Abortion care can be the fastest way to save someone’s life, and the easiest way to save someone’s life” in certain cases, he said. “That skill set is really, incredibly important and there are parts of the country where it currently is in significant shortage or may not exist.”

Applications to OB-GYN residency programs in states with abortion restrictions have declined since Dobbs, according to the report. Other research has found the same trend: The number of medical school graduates who applied to residencies in states with abortion bans fell 3% in the 2022-2023 application cycle compared to the previous year, then another 4% in the 2023-2024 cycle. 

Some states with strict abortion laws have also seen OB-GYNs move away, making it harder for residents to access reproductive care. Idaho, for instance, lost 22% of its practicing obstetricians from August 2022 to November 2023, according to one report.

Like many doctors and nurses in states that restrict abortion, OB-GYN residents fear being fined or held criminally liable for providing an abortion in an emergency, the new report says. They also lack clarity as to when the procedure is legally allowed to save a patient’s life. 

Some patients, doctors and advocates have begun to seek that clarity in court. In May, the Texas Supreme Court rejected a challenge to the state’s abortion ban from 20 women and two doctors who sought more information about what’s considered a “medical emergency” under state law. In June, the U.S. Supreme Court dismissed an appeal in a case about whether doctors in Idaho can perform abortions in emergencies. The decision allowed emergency abortions to continue in the state.

The problems outlined in the new report existed before Dobbs, several OB-GYNs said, since some states already had restrictions that made abortions difficult to obtain — but they said the issues have gotten worse in the last two years. 

The report suggests that reinstating a federal right to abortion is the way to keep these problems from escalating, and it calls on Congress to pass the Women’s Health Protection Act, a bill that would safeguard abortion access nationwide.