This June the Supreme Court will release its decision in Whole Woman’s Health v. Hellerstedt -- a landmark abortion rights case challenging the constitutionality of Texas’ extreme anti-choice law HB 2.

HB 2 requires that abortion providers have admitting privileges to a hospital within 30 miles of their clinic and that clinics meet the standards of ambulatory surgical centers (ASCs). Although supporters claim that these restrictions are medically necessary and that they protect patient’s health, the vast majority of experts agree that HB 2’s mandates are based on medically inaccurate information. The Supreme Court's decision in Whole Woman’s Health v. Hellerstedt could set the precedent for all future abortion restrictions.

Even if the court rejects HB 2, Texas clinics still face an uncertain future. As Molly Hennessy-Fiske wrote for the Los Angeles Times, the process of reopening or reauthorizing clinics that closed when the law was implemented to perform abortions would be arduous. The piece quoted Whole Woman’s Health president Amy Hagstrom Miller, who said, “We can’t reopen clinics overnight.” Hennessy-Fiske explained that the process of reopening clinics is difficult because, as Miller noted, “providers have had to sell buildings, give up leases, lay off staff and allow doctors to take other jobs.”

A two-part report from Houston Public Media confirmed these warnings: Thanks to political attacks on abortion access, Texas may be facing a shortage of medical professionals capable of performing abortions. In the piece, Carrie Feibel reported that “the battle over reproductive rights has penetrated academic medicine in Texas” and deterred medical programs from providing abortion education and training. Feibel explained that this “abortion training taboo” in Texas was a result of the logistical challenges of and stigma surrounding abortion care after HB 2.

In part one, Feibel detailed the logistical hurdles created by HB 2 that have made providing abortion training “increasingly difficult,” if not impossible, for many medical programs. According to Feibel, only “three out of the 18 programs in Texas have made arrangements for residents to spend time learning at an outpatient family-planning clinic” -- the type of facility “where most abortions in Texas take place.” In many cases, program directors argue that providing such training is difficult when “the nearest abortion clinic is now closed.”

Dr. Robert Casanova, a recent residency director at Texas Tech University, told Feibel, “The limited choices for our patients pretty much parallels the limited choices for our residents to get training, to where they feel comfortable doing something along those lines.” Texas Tech is located in Lubbock, TX, where the last abortion clinic in the area closed after HB 2 went into effect. As Manny Fernandez reported for The New York Times, because there are no remaining clinics in or near Lubbock, many patients now must make “a five-hour trip to Dallas or to Albuquerque, some 320 miles away” in order to receive abortion care.

Lubbock is not unique in this sense. According to research from the Texas Policy Evaluation Project (TxPEP), since HB 2 went into effect nearly half of Texas’ abortion clinics have closed. In an article about the study, Rewire’s Andrea Grimes described the results in terms of their political ramifications. Grimes wrote that since May 2013 -- shortly before Texas lawmakers passed HB 2 -- “Forty-six percent of Texas’ legal abortion providers have closed.” In addition to the loss of clinics, the overall number of physicians who perform abortions in Texas has also decreased since HB 2 went into effect. In a February 2016 research brief, TxPEP researchers also reported that HB 2 had decreased the number of “physicians providing services in the state” drastically:

In the fall of 2013, before HB2 went into effect, there were 48 physicians providing abortion across the state. Currently there are 28 physicians with admitting privileges providing abortions in Texas. This represents a decline of 42% in the number of physicians providing abortion in Texas since HB2 went into effect. An additional three physicians are currently providing services in El Paso and McAllen due to a partial stay of the Fifth Circuit Court of Appeals’ ruling issued by the US Supreme Court. These physicians would not be allowed to continue to provide abortion services if the Supreme Court ruled to allow the Fifth Circuit decision to go into effect.

Of the 28 physicians with admitting privileges currently providing abortion services in Texas:

• 15 (54%) were providing in Texas prior to HB2 and had admitting privileges prior to October 2013.

• 6 (21%) were providing in Texas prior to HB2 and were able to get admitting privileges after the law went into effect.

• 7 (25%) are new abortion providers with admitting privileges.

The lack of available resources for training medical students in abortion care is not entirely a product of accessibility challenges. As Feibel explained, for many programs, HB 2 has had a chilling effect on institutional willingness to support abortion training. “Academic medical centers in Texas receive tens of millions of dollars a year in state funding,” reported Feibel. Because of this funding relationship, “Doctors working in these institutions are walking a very delicate line,” Carol Joffe, a medical sociologist who studies abortion providers, told Houston Public Media. Joffe explained that even when doctors want to provide abortion training, “they are fearful of the other sectors of the university coming down on them and saying ‘You’re threatening our funding.’”

Although abortion is both common and overwhelmingly safe, Feibel explained that institutional concerns coupled with a fear of “backlash from anti-abortion groups and politicians” means that when medical students receive abortion training, it “happens quietly, almost in secret.”

Abortion stigma is defined as the “shared understanding that abortion is morally wrong and/or socially unacceptable." This belief is reinforced through media coverage, popular culture, and by a lack of accurate information in the general public about the procedure itself. Right-wing media and anti-choice groups have worked relentlessly to “exploit the stigma of abortion” -- describing the procedure as sickening, “grisly,” and “selfish” while calling abortion providers “villains” and comparing them to Nazis.

According to Feibel, one of the best ways to combat stigma is for residents to work with patients and understand their motivations for seeking an abortion. She wrote:

There’s another intangible, but critical, experience residents get from abortion training, though it has nothing to do with technique. Jane, the resident, summed it up this way: “Every woman has a different story and a different reason why she chooses to end her pregnancy.”

Hearing those stories from patients is crucial to an ob-gyn’s professional development, said Dr. Jody Steinauer, an ob-gyn professor and researcher at the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

Counseling patients teaches doctors valuable bedside skills like compassion, empathy, and political awareness.

“When they spend time in a setting that provides abortion care, they have real epiphanies,” Steinauer said. “They become more aware of their biases. They’re surprised that more than half of women having abortion are already mothers, for example.”

Challenging abortion stigma by encouraging greater dialogue is a familiar strategy for many reproductive health advocates. Organizations including Sea Change, #ShoutYourAbortion, and the 1 in 3 Campaign all encourage people to speak out about their abortion experiences through a variety of media.

Aside from the social benefits of addressing abortion stigma, exposing medical residents to abortion procedures is beneficial for their development overall. As one doctor told Feibel, “The technical procedure is the same, whether you are doing it for a miscarriage, or whether you’re doing it to terminate an ongoing pregnancy.” Another resident explained that a number of the skills practiced during her time at an outpatient abortion clinic would improve her proficiency in other aspects of the field:

Jane spent about a month at this family planning clinic during the third year of her residency. Abortion is just one of the skills she learned. She counseled patients about abortion, contraception and sexually-transmitted diseases. She also learned techniques for pain management and dilation of the cervix.

Many of those skills will be useful in other practice areas, Jane said. For instance, ob-gyns use ultrasounds for many different reasons.

“Before in residency, we were doing ultrasounds maybe once during a clinic afternoon, or a few ultrasounds in the o-b triage area,” Jane said. “But here we do 30 ultrasounds in a morning, so it’s a lot of good learning about how to do ultrasounds.”

Despite these tangible benefits from providing abortion training to medical students, many training programs won’t embrace the practice; contacted by Feibel, program representatives refused to answer questions about whether they train students to perform abortions. One hung up on her, another cancelled the interview, and six more “simply refused to answer the questions about how the training takes place.”

If the Supreme Court upholds HB 2, the need to “train the next generation” of abortion providers will only grow. To underscore this point, Feibel included comments from Dr. Bernard Rosenfeld, a 74-year-old abortion provider who “hasn’t been able to line up a successor” to lead his medical practice. According to Rosenfeld, although he’s reached out to other doctors, “none of them are interested in the political consequences of providing abortions.”