Medical education of abortion could be erased in red states

ByGeraldine R. Pleasant

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A key piece of OB-GYN training — how to perform an abortion — could soon be stricken from medical schools’ curriculum in states that make the practice illegal.

Why it matters: A Supreme Court decision to overturn Roe v. Wade would not only affect patients but drastically alter medical education and force young doctors to find workarounds to develop a skill deemed essential by professional bodies.

What they’re saying: “The implications for our field are devastating,” Kavita Vinekar, assistant clinical professor at the David Geffen School of Medicine at UCLA, told Axios.

  • “The politicization of our field has made the public think of abortion as a very separate thing from reproductive care when really it’s very much intertwined in what we do,” Vinekar said.
  • “Abortion care is very much intertwined with miscarriage management, with pregnancy care, with overall reproductive care,” she said.

By the numbers: 128 of the roughly 300 U.S. OB-GYN residency programs in the U.S. are in states that are certain or likely to ban abortion if the Supreme Court strikes down Roe and eliminates a federal right to the procedure, according to a recently published study in Obstetrics and Gynecology.

  • Of the roughly 6,000 residents in accredited OB-GYN programs, more than 2,600 (44%) are in states that are likely to ban abortion.

Between the lines: Residency administrators already report stigma surrounding abortion has left only about 1 in 5 OB-GYN program graduates proficient in dilation and evacuation, a common second-trimester procedure, according to a 2018 study in the American Journal of Obstetrics & Gynecology.

  • Roughly 70% are adept performing first-trimester aspiration, or induction of labor for second- and third-trimester terminations, the study found.
  • A 2020 study from Stanford University found that half of medical schools in the U.S. include no formal training or offer a single lecture on abortion-related topics.

Zoom in: “I’m one of the only physicians in the entire state of Indiana who performs [dilation and evacuation] procedures,” Caitlin Bernard, an OB-GYN in Indiana and a fellow with Physicians for Reproductive Health, told Axios.

  • “I’m currently training residents on how to perform [D&E] because I’m able to perform abortions,” Bernard said. “When I’m not able to perform abortions, I’m not going to be able to train those residents.”

Be smart: Abortion training isn’t just for OB-GYN’s. It’s part of the training for family medicine, pediatrics and emergency medicine.

  • Further cutbacks in training could limit treatment for life-threatening conditions such as ectopic pregnancies, which comprise 1 to 2% of U.S. pregnancies, said Neel Shah, chief medical officer at Maven, a virtual women’s health clinic. He has worked in emergency rooms for the last 15 years.
  • These are not rare exceptions, Shah said. “If you live in a city and you’re covering emergency rooms, someone is going to come in with an ectopic pregnancy almost every night. It is extremely common.”

What they’re saying: Researchers from UCSF suggest that clinical educators arrange travel rotations to states where abortion still is legal, train patients to manage miscarriages and have residents practice with anatomic models to prepare for the prospective decline in access to abortion.

Yes, but: Travel rotations may not be feasible for the nearly half of all U.S. OB-GYN residents, so educators might need to explore more workarounds.