September 13, 2013 — Antiabortion-rights legislation and the stigma surrounding abortion care are further eroding medical students' already limited opportunities to study abortion in medical school, the Thomson Reuters Foundation reports.
According to Medical Students for Choice -- an international group that supports abortion education for medical students and residents -- this lack of training opportunities threatens to exacerbate limited access to abortion care in the U.S. The group notes that 87% of all U.S. counties lack an abortion provider, 97% of family practice residents and 36% of ob-gyn residents have no experience with first-trimester abortion procedures, and 57% of current abortion providers are older than age 50.
According to the Thomson Reuters Foundation, some medical schools that depend on funding from antiabortion-rights state legislatures are terminating transfer agreements with abortion clinics. Those agreements allow clinics to train students and residents. Further, in the rare occasion of an emergency -- fewer than 1% of abortion cases -- the agreements allow clinics to transfer patients to university medical centers.
For example, Ohio requires abortion clinics to have the agreements, but abortion-rights opponents and some state legislators in April successfully pressured the University of Toledo Medical Center to decline agreements with two clinics. As a result, one clinic -- Center of Choice -- closed in June and the second -- Capital Care Network -- announced it is in danger of closing. Meanwhile, UTMC students have to travel an hour or more to train at a clinic in Ann Arbor, Mich.
Kentucky, Michigan, Nebraska, Pennsylvania, Tennessee, Virginia and Wisconsin also require transfer agreements, according to the Guttmacher Institute.
Training Opportunities Differ During Residency, Med School
Some private programs -- such as the Kenneth J. Ryan residency program and the post-residency Family Planning Fellowship -- are in place to support access to abortion training. In addition, the Accreditation Council for Graduate Medical Education requires obstetrics and gynecology residency programs to offer abortion training unless students object on moral or religious grounds.
However, abortion education during medical school is "still minimal and can be controversial," according to the Thomson Reuters Foundation. MSC Executive Director Lois Backus said medical school is "a rigidly hierarchical culture and it is, in most places, dramatically resistant to controversy," which means that students interested in providing abortion care "can be subtly, and not so subtly punished by the hierarchy."
Similarly, MSC Board President Sarp Aksel said students interested in abortion care are "shunned in their medical schools." He noted that if medical students are "not getting exposure [to abortion care] early in their medical training, it's unlikely they will be able to take advantage of the opportunities in their residency."
Those who do go on to provide abortion often face public stigma and the threat of physical harm, he added (Anderson, Thomson Reuters Foundation, 9/12).