Pregnancy During Residency: Survey of 1,280 U.S. Trainees Reveals Persistent Barriers to Accommodations

For thousands of young physicians each year, the most demanding years of medical training coincide with the years when many hope to start a family. A new multi-institutional survey published in BMC Medical Education offers one of the most detailed portraits to date of how pregnancy and childbearing actually unfold inside U.S. residency programs, and the picture it paints is one of persistent structural friction. Drawing on responses from 1,280 residents across 165 institutions, the study, led by Lisa M. Bellini of the Perelman School of Medicine at the University of Pennsylvania and colleagues working with the Gender Equity in Academic Medicine and Science (GEMS) Alliance, documents how often trainees become pregnant during training, how frequently complications arise, and how often the systems meant to support them fall short.

The survey was conducted as a cross-sectional study between September and December 2024, targeting residents in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) across specialties. A total of 1,332 residents in postgraduate years one through four completed the survey; after excluding respondents who did not identify their gender or who completed less than half of the instrument, 1,280 responses representing 165 institutions remained for analysis. Because the survey was distributed through institutional networks rather than a single enumerable sampling frame, the authors note that a traditional response rate could not be calculated, a methodological caveat that shapes how the findings should be interpreted. Even so, the scale and geographic breadth of the sample make it one of the most comprehensive snapshots of reproductive experiences in graduate medical education assembled so far.

The demographic profile of the respondents reflects the changing face of the physician workforce. The overwhelming majority, 932 residents or 72.81 percent, identified as women, a proportion consistent with the fact that women now make up roughly half or more of entering medical school classes and are disproportionately the ones navigating pregnancy during training. Among the women respondents, about one quarter, 241 individuals or 25.86 percent, reported being pregnant at some point during residency. That figure underscores how routine pregnancy has become in the training pipeline, and yet, as the data show, the institutional machinery surrounding it remains uneven at best.

Perhaps the most clinically striking findings concern pregnancy-related health outcomes. Of the residents who were pregnant during training, 97, or 40.25 percent, reported experiencing pregnancy-related conditions, a burden of morbidity that raises questions about the physical demands of residency itself, including long call shifts, overnight duty, prolonged standing, and high-stress clinical environments. Pregnancy loss was reported by 39 residents, representing 16.18 percent of those who were pregnant during training. While the study was not designed to establish causal links between workload and adverse outcomes, the prevalence of complications and loss within this cohort provides a quantitative baseline that researchers and program directors have largely lacked, and it gives concrete weight to calls for evidence-based duty accommodations for pregnant trainees.

The survey also reached into the domain of fertility and family building more broadly. A small but notable fraction of respondents reported seeking reproductive specialist care: 87 women, or 9.33 percent of female respondents, and 23 men, or 6.61 percent of male respondents, consulted a reproductive specialist during training. These numbers touch on a growing conversation in medicine about assisted reproductive technologies (ART), delayed childbearing, and the financial and logistical barriers that residents face when pursuing fertility care on modest trainee salaries and rigid schedules. The inclusion of male residents in these figures is a reminder that family-building challenges during training are not exclusively a women’s issue, even though the burdens of pregnancy itself fall squarely on those who carry it.

When the researchers examined why pregnant residents struggled to obtain accommodations, a clear hierarchy of barriers emerged. The most frequently cited obstacle was staffing needs, reported by 137 residents, or 56.85 percent of those commenting on barriers. In other words, the most common reason pregnant trainees were denied or delayed in receiving modified duties was that their programs simply could not cover the clinical gaps their absence would create. This finding exposes a structural vulnerability in residency staffing models, which typically run with minimal slack and depend on every trainee filling a defined clinical role. When one resident needs reduced hours or lifted lifting restrictions, the burden ripples through the entire schedule.

Close behind staffing concerns were program-level and institutional-level requirements. Individual program requirements were cited by 116 residents, or 48.13 percent, while institutional requirements were cited by 108, or 44.81 percent. Taken together, these figures suggest that pregnant residents frequently encountered rules, whether written or informal, at multiple administrative levels that constrained what accommodations were available to them. The authors’ conclusion highlights three intertwined problems: unclear policies, inconsistent accommodations, and limited communication of available resources. A resident at one hospital might receive modified call schedules and ergonomic relief without difficulty, while a resident one mile away at a different institution might face opaque requirements and no clear point of contact, even when formal policies exist on paper.

The implications extend well beyond individual well-being, though that alone would justify attention. Residency is the crucible in which the physician workforce is formed, and the years of training overlap precisely with peak reproductive years. When trainees delay childbearing, experience pregnancy loss, or leave training dissatisfied because of unsupported pregnancies, the costs accumulate across the profession, contributing to burnout, attrition, and inequities that disproportionately affect women and, the authors suggest, intersect with broader concerns about underrepresented in medicine (UriM) trainees. The study was supported by the George B Quatman Foundation and The Research and Advocacy in Gender Equity Foundation, reflecting a growing philanthropic and professional investment in quantifying these workforce dynamics. The research protocol was reviewed and approved by the Advarra Institutional Review Board, participation was voluntary with informed consent obtained, and responses were anonymized to maintain confidentiality.

The authors’ recommendations center on structural fixes rather than individual resilience. Clearer policy frameworks, they argue, are needed at both the program and institutional levels, so that pregnant residents know in advance what accommodations they are entitled to and how to request them. Strengthened institutional communication, potentially through designated institutional officials (DIOs) and program directors, could ensure that existing resources actually reach the trainees who need them. The findings also implicitly support staffing innovations, such as float pools, cross-coverage systems, and flexible scheduling architectures, that would reduce the extent to which any single resident’s accommodation is treated as an unsolvable coverage crisis. Because the survey captured trainees across ACGME-accredited specialties and 165 institutions, the patterns it documents are unlikely to be idiosyncratic to a handful of programs; they point to systemic features of how graduate medical education is organized in the United States.

What makes this study resonate beyond academic medicine is the broader story it tells about institutions adapting, or failing to adapt, to a workforce that can no longer be assumed to be childless, male, or endlessly available. Nearly three-quarters of the respondents were women, a quarter of them were pregnant during training, and two in five of those pregnancies involved medical complications. Against that backdrop, barriers cited by roughly half of respondents, staffing, program rules, institutional requirements, read less like administrative details and more like a design flaw in the training system itself. The authors frame their conclusions cautiously, noting that clearer policies and better communication may improve trainee well-being and advance a more equitable and sustainable medical workforce. The data they have assembled give program directors, hospital administrators, and accreditation bodies a concrete evidence base for making those changes, and they give current and future residents something they have often lacked: confirmation that the difficulties they face during pregnancy in training are widespread, measurable, and, crucially, fixable.

Subject of Research: Pregnancy experiences and accommodation barriers among U.S. medical residents during graduate medical education

Article Title: Pregnancy and accommodations during residency training- insights from a multi-institutional survey of U.S. trainees

Article References: Bellini, L. M., Dine, C. J., Fisher, R. E., Wagner, C., Moyer, D., Weber, K., & Mladenovic, J. (2026). Pregnancy and accommodations during residency training- insights from a multi-institutional survey of U.S. trainees. BMC Medical Education. https://doi.org/10.1186/s12909-026-10211-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10211-z

Keywords: pregnancy, residency training, graduate medical education, ACGME, accommodations, resident well-being, gender equity, pregnancy loss, workforce policy, medical education, reproductive health, survey research