MEDICAL TRAINING GAP
Abortion bans could leave close to half of U.S. obstetrics residents with inadequate preparation for career
Among the ripple effects of the Supreme Court’s overturning of Roe v. Wade, nearly half of the nation’s medical residents in obstetrics and gynecology are certain or likely to lack access to in-state abortion training.
That raises questions about how those programs can be accredited when a procedure required to be taught is illegal where they are based.
“Part of being an OB-GYN is being able to safely remove a pregnancy to save someone’s life,” said Dr. Jody Steinauer, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. “It’s our job as educators to ensure that everybody has those skills. What’s going to happen when we have 44% of medical residents in states where it’s illegal?”
Accreditation rules require obstetrics-gynecology medical residencies to provide training or access to training on the provision of abortions, according to Dr. Janis Orlowski, chief health officer for the Association of American Medical Colleges.
The Accreditation Council for Graduate Medical Education is exploring alternatives for completing training. It requires programs to have a curriculum for family planning that includes training on how to handle complications of abortions and the opportunity for direct procedural training in terminations of pregnancy.
The Guttmacher Institute, which works to advance sexual and reproductive health and rights worldwide, says 26 states are certain or likely to ban abortions now that the Supreme Court has struck down federally protected abortion rights. And 13 states have “trigger laws” that took effect automatically or will be quickly acted upon as soon as Roe no longer applies: Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah and Wyoming.
Losing access to such training is dangerous because it’s not just used for abortions, according to Susan White of the Accreditation Council for Graduate Medical Education.
“The technical procedure for providing an abortion — dilation and curettage — is the same procedure that is performed after a miscarriage or, in some cases, to treat excessive bleeding or take a biopsy from the uterus,” White said.
Medical residents who have religious or moral objections can opt out and must not be required to participate in the training or perform elective abortions, she said.
Workaround programs already exist but will need to be ramped up to deal with demand, said Steinauer, who leads the Bixby Center for Global Reproductive Health at UCSF. The Ryan Residency Training Program based at the center provides obstetrics and gynecology residents opportunities to travel to programs in states where they can get training and education in abortion and contraception care.
When Texas passed one of the most restrictive abortion laws in the country last year, OB-GYN residents there began looking elsewhere for the training they needed.
“We’ve supported 50 Texas residents to travel to other states,” Steinauer said. “Before, only about 20 residents a year reached out to us because they weren’t in a program that offered the training. It was a real challenge to add 50 students all at once.”
A study published in April found that, in 2020, 92% of obstetrics and gynecology residents reported having access to some level of abortion training and predicted the number would fall to at most 56% were Roe v. Wade overturned.
Not being able to get trained in such techniques will harm patient care, said co-author Dr. Kavita Vinekar of the University of California, Los Angeles.
“The public separates abortion from the rest of OB-GYN care, which it’s not at all,” Vinekar said. “Those skills are translatable to other parts of OB-GYN work. And, if you don’t master them, then you probably won’t be as competent in miscarriage management.”
Though doctors are most often cited when restrictions on abortion are discussed, nurses oversee many medication abortions. In 12 states —California, Colorado, Maine, Massachusetts, Montana, New Hampshire, New York, Oregon, Vermont, Virginia, Washington and West Virginia — and Washington, D.C., those health care providers are able to provide medicinal and in some cases aspiration abortions.
Training already is difficult to come by, said Amy Levi, a certified nurse-midwife and nurse practitioner. So training conferences have begun to include demonstrations of the procedure using papayas or dragon fruit to give students a sense of how the procedure is done, said Levi, a professor of midwifery at the University of New Mexico.
The training is important because nurse practitioners and nurse-midwives can provide miscarriage support. In states where licensing allows it as part of their practice, some provide abortion services.
“In Planned Parenthood, almost all medication abortions, over 95%, are done by advanced practice clinicians in states where it’s legal,” said Debbie Bamberger, a nurse practitioner with Planned Parenthood Mar Monte, which operates in California and Nevada.