(Illustration by Tuesday Hadden)

Caroline Cary, a first-year at Washington University in St. Louis’ School of Medicine, decided to go to medical school because of her passion for obstetrics and gynecology. She was especially interested in the social justice and advocacy facet of reproductive healthcare. Yet four days after she committed to the medical school, Cary caught wind of a new decision coming from Washington, D.C.

That day, May 2, 2022, the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization was leaked which, once official, effectively overturned the 1973 decision in Roe v. Wade, which recognized the constitutional right to abortion. The decision also allowed individual states to regulate or outlaw abortions, and shortly after the decision was released, Missouri’s trigger ban went into place, prohibiting all abortions with no exceptions for rape or incest.

The decision impacted Cary before she even entered the School of Medicine.

“I was devastated,” she said. “Some of the medical schools I was considering are in states where abortion is still legal.” When considering her choice of medical school, Cary claimed that the Dobbs decision may have had an influence. Had she known she would be “attending medical school in a state that would strip away its citizens’ reproductive rights,” Cary explained, “my decision to come to WashU would have been much more difficult.”

Cary certainly isn’t the only one the Dobbs decision impacted. It has left people with significant barriers to reproductive healthcare and has increased maternal and infant mortality and morbidity in states with abortion bans. As a university located in Missouri, WashU students also face these barriers. Students can access abortions at one of the clinics across the river in Illinois, but this transportation costs money and time.

Missouri’s healthcare restrictions have not stopped at an abortion ban. A bill in the Missouri Legislature (SB 160) is trying to defund Planned Parenthood and further restrict access to reproductive healthcare for people on Medicaid, including STD testing and contraception. Recently, the Attorney General approved a bill that significantly restricts gender-affirming care. The sexual and reproductive healthcare impacts in a post-Dobbs world are quickly expanding.

One of the impacts that hasn’t necessarily been making headlines in the same way as the total abortion bans is the way this shift in legislation will affect medical school students. When Cary found out that her medical school was in a state without abortion access, she had to both consider her own access to reproductive care and how these healthcare restrictions may affect her education. Thus, her experience raises the question: are medical students in Missouri and other states with similar bans facing a hindrance in their education and futures as physicians?

Both Cary and medical student Paula Valiño are interested in becoming OB/GYN (Obstetrics & Gynecology) residents. They are also co-leaders of the Washington University in St. Louis chapter of Medical Students for Choice (MSFC), an international nonprofit organization which works to ensure that all medical students receive comprehensive reproductive medical care education, including information on abortion. Its 220 chapters around the world organize to ensure their schools are providing reproductive healthcare education.

As part of her pursuit to become an OB/GYN, Cary had planned on shadowing in an abortion clinic during medical school, an opportunity she explained as “highly limited” after the Supreme Court decision.

Nine states in the South have implemented full abortion bans and Georgia has a six-week ban, leaving thousands flooding to Illinois for abortions. 

“From my understanding,” Cary said, “the clinics nearby in Illinois are now very overwhelmed and have lower capacity to host medical students.” 

Medical students studying in states with reproductive care restrictions are facing similar barriers to their healthcare education. Past their pre-clinical education, medical students now have to consider what will happen as they move on to the graduate phase of medical school where they work as certified physicians as OB/GYN residents. For example, a study published this week by the Association of American Medical Colleges found that post-Dobbs decision, there was a 10.5% decrease in U.S. medical student senior applicants to OB/GYN residency in states with full abortion bans.

These difficult decisions aren’t limited to students studying reproductive health care. 

“We not only have to consider whether we’ll be able to provide the full spectrum of reproductive healthcare to patients, but students applying to residency in all specialties will also have to weigh whether they – and their partners – will be able to access comprehensive family planning services during the three to seven years of residency,” she said.

Sitting idly is not an option. Valiño emphasized a focus on reproductive justice as a whole, which fights for the ability to control all aspects of one’s reproductive health. It is about the right to have a child, not to have a child, and to raise a child “in a safe and healthy environment.”

Valiño emphasized how one of the central tenets of WashU’s Medical Students for Choice is spreading and ensuring that all people have access to comprehensive reproductive health education. As part of this effort, the group leads family planning procedure workshops and training.

“We take what we are learning in school and see where we can add to it through our events,” Valiño said. For example, Valiño explained the events they are planning now include “IUD insertion and no-scalpel vasectomy, as well as talks about culturally-informed care in the context of STIs and sexual violence.” Cary also shared that the chapter is collaborating with medical school faculty to support a comprehensive family planning education curriculum.

WashU’s MSFC chapter is also working in collaboration with other community and non-medical groups, hosting events that are co-sponsored by partner organizations, such as WashU’s LGBTQmed and the American Medical Women’s Association. Valiño emphasized how these partnerships display how reproductive justice issues go “beyond abortion,” creating opportunities so “many of us can agree to work together.”

Post-Dobbs decision, WashU Medical Students for Choice’s work has grown more focused on advocacy. 

“There is a greater community focus on lobbying and canvassing, which MSFC hopes to stay involved with,” Valiño said. “I feel like MSFC’s advocacy has greatly expanded in my few months with the group, and I am excited to see where it goes.” 

Cary further described this work, discussing how they, alongside campus groups and reproductive justice organizations, have held events such as “a panel discussion on how to advocate for reproductive justice in post-Roe Missouri.”

Cary and Valiño are not alone in their commitment to ensuring there is comprehensive family planning education for all medical students and in fighting for reproductive justice. 

“I know I am not the only WashU medical student who is frustrated and angry about the abysmal state of reproductive rights in Missouri,” Cary said. Valiño added, “We have had a great turnout at our info sessions and great responsiveness from our members to our advocacy efforts.”

Many students likely did not expect to go to medical school in a state where abortion is illegal. As a result of the significant barriers to abortion for these students along with their future patients, they have been profoundly impacted by Missouri’s and many of the surrounding states’ abortion bans. Still, Valiño stated, “We are excited to keep engaging with the community to advance reproductive rights in St Louis and Missouri.”