Predictors of Abortion Attitudes in Medical Students After the Reversal of Roe v. Wade

Background On June 24, 2022, the United States (U.S.) Supreme Court ruled in Dobbs v. Jackson Women's Health that the Constitution does not grant women the right to abortion. This new ruling may have a profound impact on not only the attitudes of medical trainees but the nature in which they are trained when it comes to abortion practices, indications, or procedures. Some clinics where medical schools provide first-hand abortion experience have closed. As a surge of extreme restrictions on abortion has been seen in certain states in the U.S., medical schools and residency programs need to address these issues to ensure future physicians are adequately prepared. The purpose of this study was to assess factors that influence medical students' attitudes toward abortion, specifically knowledge about abortion, religiosity, and philosophical group affiliation regarding abortion (i.e., "pro-choice vs. "pro-life"). Methodology This cross-sectional study collected data from a convenience sample of 413 medical students between October and December 2022 via an online, anonymous questionnaire. Major study variables as depicted in the published literature led to the development of the Abortion Attitudes Questionnaire (AAQ) for medical students. The AAQ contained validated scales to assess the contribution of levels of abortion knowledge and religiosity as well as sample characteristics on attitudes about abortion in medical students. Speakman rank correlation and linear multivariate regression were used for hypothesis testing to explore the contributions of the dependent variables to attitudes about abortion in medical students. Results The mean age of the participants was 25.8 years (SD = 2.96; range = 21-45 years). Linear regression modeling indicated that religiosity, abortion knowledge, being a woman, and group affiliation regarding abortion ("pro-choice" or "pro-life") explained a significant amount of the variance (60%) in abortion attitudes scores in medical students. A significant regression equation was found, F(6,373) = 83.570, p < 0.0001, R² = 0.603, R² adjusted = 0.611). Less religiosity, greater abortion knowledge, being a woman, and identifying as "pro-choice" significantly contributed to more positive attitudes toward abortion in this sample of medical students. Interestingly, while moderately correlated with abortion attitudes (r = 0.436,p < 0.01), the single item regarding the importance of religion in one's life did not contribute to the model. Conclusions The present study is the first, to our knowledge, to identify medical student characteristics (i.e., sex, "pro-choice" vs. "pro-life" group affiliation, level of knowledge about abortion, and religiosity) as indicators of abortion attitudes. With the reversal of Roe v. Wade, attention must be given to the possible change in medical students' attitudes toward abortion (as well as any newly developed constraints on clinical training) and to ensure the provision of comprehensive education as U.S. states will determine the limits of these practices and procedures. While further research in this area is needed, findings from this study can help assess students' attitudes about abortion and guide medical education efforts to better prepare tomorrow's obstetrics and gynecology physicians.

Abortion Stigma: Imagined Consequences for People Seeking Abortion Care in the United States

Prior to and since the 2022 Dobbs decision, U.S. state laws have endorsed individuals surveilling and punishing those associated with abortion care. This practice presents an urgent need to understand the characteristics of abortion stigma, particularly the perspectives of individuals with stigmatizing beliefs. To examine the concept and characteristics of abortion stigma, we interviewed 55 individuals about whether they thought there should be consequences for getting an abortion and, if so, what the consequences should be. Adults from three states (Michigan, Kansas, and Arizona) were purposively sampled to include a range of abortion identities and levels of religious engagement. We used reflexive thematic analysis to code and interpret the data. Participants imagined consequences including financial penalties, incarceration, and forced sterilization. Three themes highlighted how abortion was described as violating the law, women's gender roles, and religious doctrine; accordingly, abortion was imagined as deserving of negative consequences, although abortion was legal in all states during data collection. We argue that these imagined consequences relied on carceral logics and interconnected sexist, racist, and classist stereotypes that reflect and reproduce abortion stigma. This study deepens the understanding of abortion stigma from the perspective of the stigmatizer, underscoring the danger of legislation grounded in stigmatizing beliefs.