Looming Roe Decision Increases Urgency for Scaling Up Abortion Training

— Medical training programs can help prevent further limits to essential care

MedpageToday
A photo of a female professor guiding a female medical student through a pelvic exam on a practice dummy.

According to data we recently published in Obstetrics & Gynecology, almost 1 in 6 medical students have had an abortion. Yet, most will never learn how to perform this procedure during their training. Only 32% of medical schools provide a lecture on abortion during clinical rotations and less than half of medical students have clinical exposure to abortion care. In many cases, students' only exposure to abortion in medical school comes in the form of ethics lectures debating the legitimacy of this procedure. As physicians and medical students, this is highly concerning not only from the perspective of comprehensive medical education, but also because physicians too are patients who receive abortion care. In omitting abortion from our training or only teaching it in the context of ethical debate, we further stigmatize this necessary healthcare to future healthcare workers.

With news of the likely overturning of Roe v. Wade, the situation is even more dire for residency training. Nearly half of our 286 obstetrics and gynecology residency programs are in the 26 states certain or likely to ban abortion if the Supreme Court overturns Roe v. Wade. In the face of an existing shortage of clinicians providing abortion care, the end of Roe v. Wade makes it even more important that training programs step up and teach trainees how to provide compassionate abortion care.

The Shortage of Clinicians Providing Abortion Care

With Roe v. Wade almost certain to be overturned, the right to abortion will soon no longer be legal in many states. But even in the present moment, the shortage of clinicians providing abortion care already limits access to abortion. In 2017, 89% of U.S. counties did not have a single clinic that provided abortion care. Medical schools and residency programs need to proactively invest in abortion training to meet the demand and to ensure the health and safety of our patients who will be most affected by abortion bans.

Limited Abortion Care Training Opportunities

The opportunities to learn about abortion in medical school are limited. Even at institutions that provide some abortion education, students are oftentimes responsible for seeking out opportunities for exposure and training. This is unheard of for many other commonplace procedures.

Opportunities for additional training outside of medical curricula exist. In 1993, Medical Students For Choice was founded to create "tomorrow's abortion providers and pro-choice physicians." The organization provides opportunities for students to attend trainings on abortion care, and students can apply to get clinical experience working with clinicians who provide this care. Even so, the program only provides training for a small number of students: In 2021, 41 medical students and 13 residents were able to participate in these clinical electives (in part because of some limitations due to COVID-19). This program was a success in that participants stated they were more likely to practice abortion care after their participation. But with such small numbers of participants, programs like these are no substitute for systemic change.

A slew of statewide abortion restrictions and the impending overturning of Roe v. Wade also mean that fewer programs than before can legally train medical students and residents to provide abortion care. While residency programs in obstetrics and gynecology are required to provide abortion training, the number of residency programs located in states where hospital employees are prohibited from performing or teaching about abortion or at Catholic-owned hospitals with similar bans continues to rise. One bill in Missouri would even penalize the universities affiliated with physicians who perform abortions or train medical students on abortion.

Physicians Need Abortion Care Too

Abortion care is critical not only for the health and wellbeing of the general public, but for physicians and trainees too. In our study, we asked physicians and physicians-in-training who wanted to have biological children to share with us how they built their families. We found that over 11% of participants had gotten abortions. For those who cannot imagine raising a child during their grueling medical training, cannot afford to raise a child in the face of $200,000 of debt, or are simply not ready to parent, having access to abortion care is critical to their health and careers. For patients who can become pregnant, reproductive freedoms are intimately related to educational pursuits and economic freedoms. For physicians-in-training, abortion affords us the privilege to serve our patients.

Expanding Abortion Care Training

In addition to those trained in obstetrics and gynecology, physicians in other specialties should be trained to practice abortion care, particularly in the form of medically managed abortion. Leveraging the physician workforce in specialties such as family medicine, internal medicine, and emergency medicine alongside advanced practice clinicians including nurses, nurse midwives, and physician assistants/associates may help fill the gap in abortion care supply and demand. This would require, however, that their respective training programs teach abortion care.

To prevent further exacerbation of current shortages related to abortion care, we offer three primary recommendations. First, everyone involved in medical education must be vocally supportive of abortion as fundamental healthcare. We cannot stand by idly while human rights are under attack. Second, abortion care should be integrated into medical student education, not as an elective or learning opportunity that students must specifically seek out. We must also train physicians and advanced practice clinicians who are not specialized in obstetrics and gynecology to provide abortion care and encourage them to offer this procedure. Finally, insurance companies must provide coverage for abortion care to both support those who perform abortions and for patients who need affordable care.

Abortion care is not a rare medical procedure. As medical students and physicians, we all know people who have had one, and many of those people are our colleagues. It is our duty, as healthcare workers, to stand up now and affirm the importance of maintaining the right to abortion and the need to train the next generation of abortion clinicians.

Morgan S. Levy is a medical student in the MD and Master's in Public Health program at the University of Miami Miller School of Medicine. Shira Fishbach is a medical student at the Pritzker School of Medicine at the University of Chicago, and an incoming resident in Obstetrics and Gynecology at the University of Michigan. Vineet Arora, MD, MAPP, is the Herbert T. Abelson Professor of Medicine and Dean of Medical Education at the Pritzker School of Medicine at the University of Chicago. Arghavan Salles, MD, PhD, is a Senior Research Scholar at the Clayman Institute for Gender Research and the Special Advisor for Diversity, Equity, and Inclusion Programs at Stanford University Department of Medicine.