Abortion Education in U.S. Medical Schools: Curricular Variability by State Law

Reproductive health, including abortion care, is a critical component of undergraduate medical education (UME) that is inconsistently included in UME.

The objective of this study is to investigate the association between the inclusion of abortion and contraception topics in UME curricula overall and state-level abortion restrictions.

A national cross-sectional survey of medical students was conducted from August 2022 to June 2023 using the American Medical Student Association Reproductive Medical Education Survey. Students reported whether abortion, contraception, options counseling, and values clarification were included in their schools' preclinical and clinical curricula. State-level abortion laws as of July 2024 were categorized as banned, banned before 12 weeks, banned after 12 weeks, or unrestricted. Logistic regression was used to evaluate the association between state law and inclusion of each curricular topic.

Responses were received from 101 of 190 U.S. medical schools (53%) in 41 states. Preclinical coverage was 63.4% for abortion, 82.2% for contraception, 52.5% for options counseling, and 47.5% for values clarification. Clinical coverage was 53.5% for abortion, 61.4% for contraception, 56.4% for options counseling, and 44.6% for values clarification. While there was no association between state-level abortion restrictions and inclusion of abortion in preclinical curricula, schools in unrestricted states were more likely than those in banned states to include clinical education on abortion (OR: 2.83; 95% CI: 1.04-8.20) and values clarification (OR: 2.98; 95% CI: 1.08-8.91).

Inclusion of reproductive health topics in UME remains limited, and our findings are the first to indicate that a decrease in clinical abortion education is seen in states with state-level abortion bans. All medical schools must strive to include contraception and abortion education to ensure a workforce trained to meet the community's health needs.