Introduction

Since its enactment by the Supreme Court in in 1973, Roe v. Wade affirmed and protected the constitutional right to abortion in the United States [1]. However, just under fifty years later, the 2022 Dobbs v. Jackson Women’s Health Organization case led to the overturning of this decision, bringing an end to federal protection of abortion rights. With each state granted the power to enact individual abortion laws [1], there was a rapid and fragmented policy response across states. Several states enacted total or near-total abortion bans. Among these, some had “trigger bans” in place to immediately criminalize the actions of individuals either seeking or providing abortions once Roe v. Wade was overturned, while others continued to permit legal abortions with certain restrictions and eligibility requirements. Other states enacted legislation to preserve and protect abortion rights, with some creating additional policies to expand access to abortion [2]. This fractured legal landscape has renewed scholarly attention towards the intersection of reproductive autonomy with the broader issues of equity, accessibility, and educational opportunity.

Recent studies have demonstrated how abortion access continues to impact women’s socioeconomic outcomes. Denial of abortion care is associated with higher likelihood of poverty and lower likelihood of full-time employment amongst women, compared to those able to pursue and receive abortion care [3]. Conversely, regions with accessible, less restrictive abortion care correlate to a higher likelihood of graduating from college, a greater income, and economic stability [4].

Educational decisions—particularly among women—are deeply influenced by reproductive rights and autonomy, reproductive healthcare availability, and related state-level policies. Access to contraception – specifically, oral contraceptive pills (OCPs) – directly allowed for greater career investment among women since its availability to young, unmarried women in the 1960s [5]. Moreover, there is an association between improved reproductive health access for women and educational and economic empowerment [6,7], and prior research has linked abortion access to educational attainment and professional planning. Anticipatory abortion bans and inaccessibility in American states have been associated with a decline in female college applicants to colleges in these states [8].

Medical schools are critical gateways to the healthcare workforce, making the demographic makeup of applicants and matriculants incredibly important as it helps shape the future of care delivery and workforce diversity [9–11]. There is a strong connection between medical education and workforce contribution as physicians tend to practice in the state or region where they are trained [12]. Given the prolonged and intensive demands of medical training, concerns about reproductive autonomy and in-state policies may have particularly significant implications for women’s educational and career decisions. These shifts are particularly poignant in regions already experiencing provider shortages [13]. Therefore, trends in who applies to medical school – and where – are consequential for local healthcare landscapes.

However, while associations with access to reproductive care have been studied in undergraduate populations [8], little is known about how such policy shifts may affect female representation in graduate and professional education, including medical school. This study examines whether the reversal of Roe v. Wade was associated with differential trends in the proportion of female medical school applicants and matriculants in states with restrictive versus protective abortion policies.

Methods

Abortion policy classification

States and jurisdictions were categorized based on their abortion laws using policy classifications from the Center for Reproductive Rights (2). These categories were used to stratify states into two major groups for analysis:

• Expanded/Protected: States that either codified the right to abortion into law (Expanded) or maintained protective policies without further expansions (Protected). These jurisdictions demonstrated a consistent legal commitment to preserving reproductive autonomy.
• Hostile/Not Protected: States that implemented restrictive abortion laws following the Supreme Court’s overturning of Roe v. Wade, including trigger bans, gestational limits, or reason-based prohibitions (Hostile), and those that lacked formal legal protections (Not Protected).

The classification is summarized in Table 1 and geographically summarized in Table 2. State assignments remained fixed over the study period for consistency, reflecting their status at the time of Roe’s reversal.

Download:

• PNG
  larger image
• TIFF
  original image

Table 1. Definitions of State Category Based on Abortion Laws.

https://doi.org/10.1371/journal.pgph.0006436.t001

Download:

• PNG
  larger image
• TIFF
  original image

Table 2. States Categorized by Abortion Laws.

https://doi.org/10.1371/journal.pgph.0006436.t002

Results

Forty-five U.S. jurisdictions (44 states and Washington, D.C.), with 17 classified as Expanded/Protected and 28 as Hostile/Not Protected, were included. Six states (Alaska, Delaware, Idaho, Maine, Montana, Wyoming) were excluded due to missing data.

Parallel trends analysis

Pre-Roe (2018–2021), the trajectories of female applicants in both Expanded/Protected and Hostile/Not Protected jurisdictions were similar, with no statistically significant divergence, supporting the assumption that post-Roe, differences were due to policy shifts rather than pre-existing divergence. Fig 1 displays the parallel trend lines during the pre-Roe period, followed by a visible divergence in female applicant proportions in the post-Roe period.

Download:

• PNG
  larger image
• TIFF
  original image

Fig 1. Parallel Trends of Female Applicants in States with and without abortion protection.

https://doi.org/10.1371/journal.pgph.0006436.g001

Discussion

Our findings indicate the reversal of Roe v. Wade may have impacted the relative growth in female medical school applicants in states with abortion restrictions (Hostile/Not Protected). While the nation-wide trends demonstrate and overall increase in female applicants to medical school with each application year, states without reproductive health protections experienced a significantly slower rate of growth. This is an important observation and potential indicator of more significant future shifts in the physician workforce in these states.

Although the absolute difference between abortion protective and restrictive states is modest, seemingly small shifts in applicant pools can have outsized long-term effects – especially if trends continue. This is particularly important in fields like medicine, where entry is highly competitive and training is resource intensive. A slight dip in the number of female applicants could translate into a more substantial shortage of female physicians, and greater deficits in specialities like obstetrics and gynecology where there are higher proportions of female providers [15].

We must acknowledge that our findings on female applicant trends were not accompanied by a corresponding shift in female matriculants to medical school. This may suggest that female applicants are not opting out of medicine altogether but instead are adjusting their strategies for pursuing medical education. For example, female applicants choosing to avoid states with restrictive policies, may be both applying to and matriculating in more states with protective reproductive legislation.

A growing body of literature is highlighting how political climates influence behavior, and shape access to education. Our results align with broader literature showing that young women consider reproductive policies and autonomy when making decisions about pursuing college undergraduate programs [16]. This notion extends to professional schools, which demand long-term planning and personal sacrifice. For these students, the perceived stability of reproductive rights may influence application decisions in subtle but measurable ways.

This trend is not limited to medical school applications. Emerging survey data is starting to identify that many students do not want to train in abortion-ban or abortion-restrictive states. For example, in recent survey by Mermin-Bunnell et al. [16], a majority of medical students reported they were unlikely to pursue residency training programs in a state with abortion restrictions, and female respondents were more driven in this regard than male respondents. As physicians tend to practice in the state or region where they complete their medical school and residency [12], this suggests the impact of state policies will continue to be felt as students transition into the physician workforce. Additional links between state political climates and career decision-making have also been shown through practice location preferences amongst physicians [17].

In the context of gender equity in the physician workforce, a longstanding disparity between male and female physicians in the United States exists [18]. While the proportion of female matriculants to medical school has grown in recent years, there continues to be a gap in leadership, administrative, and academic roles. Importantly, states with abortion restrictions are often the same jurisdictions already facing critical workforce shortages. Recent studies show the distribution of training and specialty decisions are changing, with a notable decline in interest and pursuit of obstetrics and gynecology, a female-dominated specialty, in states with stricter abortion policies [13,15,19]. If such trends in barriers to medical education for women persist, and fewer women apply to medical school in these states or choose to practice there afterwards, the downstream impacts could cause further perpetuation of gender inequities in the physician workforce, medical leadership and legislation, augmenting regional disparities.

Combined, the literature informs of impending geographic and gender maldistributions in healthcare access. Further, policy shifts that dissuade female applicants today may also impact future generations, which will intensify disparities over time. Beyond workforce composition, these trends carry important implications for population health [20]. Regions experiencing attenuated growth in female medical school applicants may face compounded challenges in access to care, particularly for reproductive, maternal, and preventive health services. Female physicians are more likely to practice in primary care and to care for underserved populations, and greater gender concordance between patients and physicians has been associated with improved communication, trust, and certain health outcomes [12,13,20]. Consequently, policies that indirectly deter women from entering local training pipelines may exacerbate existing inequities in healthcare availability and quality, particularly in states already facing physician shortages.

Gender-based differences in application behavior should also be understood within broader structural contexts. Political climate, socioeconomic background, and race/ethnicity shape educational opportunity and perceptions of safety, belonging, and long-term viability within a state. Restrictive reproductive policies may therefore function as a visible signal of broader sociopolitical environments that differentially affect marginalized groups. Although our analysis focuses on gender, these intersecting dimensions likely compound one another, and future work should examine how abortion policy interacts with race, class, and geography to influence medical career trajectories. Conceptually situating reproductive policy within a wider framework of structural determinants of educational access may help clarify how state-level legislation contributes to stratification within the physician pipeline.

Our results, while preliminary, suggest the unfolding political climate surrounding reproductive health post-reversal of Roe v. Wade is impacting the career decision-making of future physicians in the United States, with potential consequences over the long-term on its healthcare system. From a higher education perspective, this study highlights the need to understand how policy environments shape who feels able or willing to pursue professional degrees. Admissions offices and policymakers alike should be attentive to these dynamics, as they influence both access and diversity in education and in the workforce.

There are many limitations to this study. While the current analysis shows a correlation between declining growth in female medical school applicants in abortion-restrictive states post-Roe v. Wade’s reversal, we cannot be certain of causal or long-term effects. Moreover, this study is restricted to medical school applicants and does not explore further milestones in the medical career pathway. Finally, educational and career decisions are influenced by an individual’s intersectionality and lived experiences, which the objective data in this study cannot capture.

Future research should examine whether these trends persist over time as political climates continue to develop and change, and explore additional factors, such as specialty selection, residency applications, and retention of female physicians in states with restrictive reproductive policies. There is also a need for qualitative exploration of female applicants’ perspectives that shape their motivations, concerns and decisions on where and why they apply and matriculate to medical school.

Conclusion

Reproductive policy shifts may be subtly but meaningfully influencing women’s pursuit of medical education. The attenuated growth in female applicants in states with abortion restrictions suggests that reproductive autonomy is not only a health issue, but also a factor shaping participation in highly skilled professional training pathways. While the absolute differences observed are modest, sustained divergence in applicant growth has the potential to compound over time, contributing to gendered and geographic maldistributions within the physician workforce.

These findings matter beyond medical school admissions and may ultimately influence local access to care, availability of reproductive and primary care services, and broader health equity. Our results underscore how legislative decisions outside the education sector can reverberate through workforce pipelines in ways that are difficult to reverse.

From a higher education and policy perspective, this study highlights the importance of considering reproductive autonomy as a structural determinant of educational access. Ongoing monitoring of application, training, and practice patterns, alongside qualitative work exploring applicants’ lived experiences and decision-making, will be essential to understanding the long-term consequences of the post-Roe policy landscape. Ensuring a resilient, equitable healthcare system requires attention not only to who enters medicine, but also to the social and political conditions that shape who feels able to pursue it..

Supporting information