Although access to training in medical and surgical abortion has improved over the decades, barriers still prevent some new physicians from obtaining the training, according to the authors of a recent study.1

“The reason we looked into this topic was because of the recent increase in the barriers women faced when trying to access reproductive services,” says Aleksandra Polic, MD, resident in the department of obstetrics and gynecology at the University of South Florida Morsani College of Medicine. Polic notes that her views on abortion training are her own and are not the views of her institution.

“We found that residents (mostly in OB/GYN and family medicine) who completed their training after 1998 were more likely to perform pregnancy terminations than residents graduating prior to that,” Polic noted.

In 1998, the Accreditation Council for Graduate Medical Education enacted a requirement stating that abortion is an important part of OB/GYN training.

“We found, over time, more and more residencies are reporting training for their residents, but only 64% of graduating residents in 2019 reported routine abortion training,” Polic explains. “We were shocked to find it’s not a large majority reporting the accessibility of this training.”

Polic and colleagues collected data from surveys of doctors. “One of the numbers we tracked is making sure we understand how to perform surgical procedures related to abortion, whether performing elective or medically necessary terminations,” she says. “There is a lot of variability and opportunities for us to be involved in learning the procedural aspect of things, but the article is more focused on how adequately residents are exposed to all aspects of family planning in residency.”

Opt-Out Training Preferred

Many residency programs provide opt-out training. “The idea — and this is regarded as one of the better ways to train residents and fellows — is that abortion is built into the curriculum, and residents who have moral or religious objections are allowed to remove themselves from that situation,” Polic explains. “Opt-in training does not require a formalized curriculum, and it requires residents to speak out.”

Opt-out is preferable because abortion training is part of the curriculum, but residents do not have to participate, she adds.

In a 2014 survey, 54% of residents reported availability of opt-out training, 30% were offered opt-in training, and 16% reported no available abortion training.1

Available research shows that although abortion training access has improved over the years, there still is room for improvement to standardize the curriculum, Polic says. “We need to make sure all graduating residents have an opportunity to participate in a full range of family planning services offered to women,” she adds.

Abortion training can take place in a hospital or freestanding community clinic, depending on local and state laws, Polic says.

Patient experience is the focus. Physicians are trained to counsel patients on the full range of services offered, including pregnancy continuation and termination. “Programs make sure they’re prepared to appropriately counsel the patient and provide training in medication abortions, understanding the pharmacology and doses required, and also training for surgical abortion and knowing how to perform those,” Polic says. “Personally, I’ve had some amazing mentors who shared their experiences, and they are abortion providers. My opinion is that doctors who are taking care of women should be appropriately trained in all aspects of family planning to whatever degree they feel comfortable. For people taking care of women, contraception and family planning are very important parts of women’s health. To neglect that training does a huge disservice to women.”

Few Data on Training Available

Polic and colleagues found data on abortion training are limited, and the information that is available mostly comes from surveys. “It’s difficult to extract the specifics,” she says. “What we do know is we’ve seen a gradual increase in the percentage of graduating residents who are reporting availability of training.”

Further research could examine how the recent age of increasingly restrictive abortion legislation affects both women’s access to care and providers’ access to abortion training. “We looked at the available surveys, and the only part about attitudes is there are a lot of residents who opt for partial participation in abortion training,” Polic says. “They’re not comfortable doing all aspects of it, and a majority of them say they benefit from participating in family planning — ultrasounds, procedures, other aspects — even if they choose not to perform elective abortions.”

The data show that even residents who do not hold favorable attitudes toward elective termination still benefit from training and experience involving partial participation in these trainings, she adds.

“Even if a provider does not themselves perform a termination, knowing how to counsel the patient and what to expect if she does proceed is a very important and valuable skill,” Polic says. “We get exposure to contraceptive counseling throughout most of our rotation, but often in family planning rotations, it can include termination training,” she adds. “There’s definitely a focus on contraception, knowing all the methods, and how to counsel patients. We help them pick the right one for them.”

Current residents have not necessarily seen women die from do-it-yourself abortions, as have past generations, but they have witnessed the ways states are limiting women’s access to abortion care.

“Women’s access to care is impacted through financial, travel, and other barriers,” Polic says. “The difficulties in accessing family planning services are changing and evolving. As providers, we have to evolve with those barriers and help our patients overcome them.”

REFERENCE

  1. Polic A, Rapkin RB. Access to abortion training. Semin Perinatol 2020;44:151-271.