Abortion restrictions and female medical school applicants: A retrospective study

Following the reversal of Roe v. Wade in 2022, U.S. states enacted divergent abortion policies that may influence women's educational and career decisions. This study examined whether these policy shifts were associated with changes in female representation among medical school applicants and matriculants across the United States. Using publicly available state-level data from the Association of American Medical Colleges (2018-2025), we conducted a fixed-effects regression analysis comparing trends in states with abortion protections (Expanded/Protected) versus those with restrictive or absent protections (Hostile/Not Protected). Forty-five jurisdictions were included after excluding six with incomplete data. Across the study period, the proportion of female applicants to medical school increased nationally by 5.3 percentage points. However, after reversal of Roe v. Wade, this growth was significantly slower in Hostile/Not Protected states than in Expanded/Protected states (β = -0.58 percentage points per year; 95% CI -1.14 to -0.025; p = 0.041). No statistically significant difference was observed in female matriculants between policy groups (β = 0.68; 95% CI -0.70 to 2.06; p = 0.332). Parallel-trend testing confirmed similar trajectories across groups before the reversal of Roe v. Wade, supporting that divergence emerged after policy change. Subgroup analyses within restrictive states revealed no differential effects by type of abortion ban (trigger, pre-viability, or reason-based). These findings suggest that restrictive reproductive policies may be subtly reshaping women's professional pathways even at the earliest stages of the physician workforce pipeline. Although absolute differences remain modest, sustained disparities in application growth could have long-term implications for gender equity and healthcare access, particularly in states already facing physician shortages. Understanding how reproductive autonomy intersects with higher education and workforce planning is essential to ensuring equitable representation in medicine and maintaining a resilient healthcare system.