Abortion medical education could be erased in red states


A key part of OB-GYN training — how to perform an abortion — could soon be dropped from medical school curricula in states that make the practice illegal.

Why is this important: A Supreme Court decision to overturn Roe v. Wade would not only affect patients, but would radically alter medical education and force young doctors to find workarounds to develop a skill considered essential by professional bodies.

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

  • “The politicization of our field has caused the public to see abortion as something very separate from reproductive care when in reality it’s very closely related to what we do,” Vinekar said.
  • “Abortion care is closely linked to miscarriage management, pregnancy care and reproductive care in general,” she said.

By the numbers: According to a study recently published in Obstetrics and Gynecology.

  • Of the approximately 6,000 residents in licensed OB-GYN programs, more than 2,600 (44%) are in states that may ban abortion.

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

  • According to the study, approximately 70% are able to perform first-trimester aspiration or induction of labor for second- and third-trimester pregnancy terminations.
  • A 2020 Stanford University Study found that half of medical schools in the United States include no formal training or offer only one lecture on abortion-related topics.

Enlarge: “I am one of the only doctors in the entire state of Indiana to practice [dilation and evacuation] procedures,” Caitlin Bernard, an obstetrician-gynecologist in Indiana and a member of Physicians for Reproductive Health, told Axios.

  • “I am currently training residents on how to perform [D&E] because I am able to perform abortions,” Bernard said. “When I am not able to perform abortions, I will not be able to train these residents.

Be smart: Abortion training isn’t just for OB-GYNs. This is part of training in family medicine, pediatrics and emergency medicine.

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

What they say : UCSF researchers suggest that clinical educators organize travel rotations to states where abortion is still legal, train patients to manage miscarriages, and have residents practice with anatomical models to prepare for the potential decline in access to abortion.

Yes, but: Travel rotations may not be feasible for nearly half of all US residents in OB-GYNs, so educators may need to explore more workarounds.

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