Deep within President Donald Trump’s 2026 budget proposal is a provision on training for obstetricians that could become a pivotal issue in the debates over abortion over the next few years. 

A small section in the president’s fiscal blueprint would ban teaching hospitals that receive federal funding from making abortion training the default.

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The rule would make abortion training an opt-in program. That would be a reversal from the current system, which requires students with conscience objections to opt out of abortion training programs.

The provision would affect obstetrics residency programs or post-medical school training in which new doctors hone specific skills in obstetrics. The rule would make federal funding contingent upon obstetric residency programs designing their training to allow residents to choose actively to participate in abortions instead of automatically being included in their portfolio.

Trump’s proposed budget is merely a suggestion for Congress to consider legislation, but it sets the tone for the policies that the administration would like the GOP to pursue in the coming years.

Rebecca Weaver, director of advocacy and policy for the American Association of Pro-Life Obstetricians and Gynecologists, told the Washington Examiner that her organization has been at the forefront of codifying an opt-in policy as a conscience protection mechanism for young doctors in the field of obstetrics. 

“All of us as patients want quality medical professionals who are conscience-based, who are going to act in a way that they view as the best ethical way for us and our loved ones, and that aligns with their sincerely held beliefs,” Weaver said. 

Many obstetrics residency programs used to design their abortion education using an opt-in model.

But in 2017, the American Council for Graduate Medical Education, the nonprofit body that establishes the accreditation criteria for medical residency programs in the U.S., required obstetrics residencies to make induced abortion education part of their programs and only allow residents to opt out, rather than opt in. 

Weaver says that, since then, training doctors in obstetrics who are opposed to induced abortion have faced subtle pressure from their hospitals and medical schools to participate in abortion training despite their consciences. 

“Even though there is this ability for a student to opt out and not have to participate in abortion training, we’ve seen this pressure on students to conform,” said Weaver. “We’ve seen fear of students pursuing obstetrics because they’re afraid of a conscience violation and how that process is going to work. So they just choose to self-select out of pursuing obstetrical care.”

The issue of obstetrics medical training has become a more critical facet of abortion politics since 2022, with the overturning of federal abortion protections under Roe v. Wade. 

Abortion advocates have feared that state laws banning or severely restricting elective abortions would contribute to a mass exodus and shortage of OB-GYN physicians. But the data haven’t borne that out. 

A 2025 study found that the number of OB-GYNs has decreased across the country in recent years, but they haven’t moved out of states with prohibitions on abortion early in pregnancy. 

Similarly, a 2024 study found that the shortage of OB-GYN residencies compared to medical school enrollment rates and the falling birth rate in the U.S. are more likely causes of the decline in the overall number of OB-GYNs across the country. 

Abortion-rights medical organizations are likely to push back against the opt-in provision for abortion education should it make its way into legislation in the next few years. 

The American College of Obstetricians and Gynecologists, which supports abortion at any stage of pregnancy, has historically been against opt-in training programs on abortion care, saying that doctors trained in opt-out-only programs are more well-rounded in their practice. 

ACOG says that doctors who train in providing elective abortions include transferable skills that are necessary in other areas of practice, such as miscarriage care and counseling on pregnancy options.  

“The nature of opt-in training places the burden to create a clinical experience on the residents and establishes a culture of marginalization for abortion provision and those who wish to obtain training,” reads the ACOG website on abortion training for obstetrics residents. 

Weaver clarified that training on how to provide an abortion “would still certainly be available for individuals who wanted to pursue it.” Still, it would no longer be the standard of training should such a rule pass.

ACOG did not respond to the Washington Examiner’s request for comment regarding the specific provision in Trump’s budget proposal. 

AAPLOG, which formed as a splinter group from ACOG in the 2000s over abortion policy, has been the primary legislative advocate on requiring an opt-in style training program for abortion. 

Weaver said her organization has been working closely with the labor section of the House Appropriations Committee to codify the rule. The same language in Trump’s 2026 budget proposal was included in the House’s Labor-HHS fiscal 2025 bill, but was ultimately cut. 

“When we saw that provision in the president’s proposed budget, we were very appreciative and excited,” said Weaver. “It’s just such an important policy that we are continuing to prioritize.”