April 27, 2012 — Summary of "The New York City Mayoral Abortion Training Initiative at Public Hospitals," Guiahi et al., Contraception, March 2012.
The New York City mayoral abortion training initiative could serve as a model for policymakers looking to bolster abortion instruction in ob-gyn residency programs and expand the availability of abortion care, according to researchers led by Maryam Guiaha of the University of Colorado School of Medicine.
In 2002, New York became the first city to integrate abortion care as a standard part of training for ob-gyn residents at eight public hospitals. NARAL Pro-Choice New York pressed for the plan, which was endorsed by Mayor Michael Bloomberg. The participating hospitals are managed by the Health and Hospitals Corporation -- the largest public hospital system in the U.S. -- and are responsible for training more than 150 ob-gyn residents annually.
Because there is no public information on the progress of the training program, the researchers developed a study to evaluate the impact of the initiative.
The researchers conducted in-depth interviews with 22 participants who had knowledge of abortion training and services in the New York City public hospital system before and after the initiative was launched. For example, researchers met with a NARAL employee who was involved in the development of the initiative, various HHC ob-gyn program leaders, and current and former HHC abortion providers.
The researchers "combined case study and grounded theory approaches" in their analysis. They noted that case study research "involves the study of an issue explored through one or more cases within a bounded system," while grounded theory "is a qualitative approach in which a general explanation (theory) of a process is shaped by the views of participants, not generated by researchers."
Respondents in the study cited several positive changes that resulted from the initiative. For instance, while the initiative was being developed, it became clear that abortion services in HHC hospitals were provided in outdated facilities. NARAL and HHC officials were able to obtain funding from the city for renovations, resulting in state-of-the-art centers at five HHC hospitals. Respondents said the renovations allowed for centralized care, including counseling, ultrasound services, abortion and contraception. Before the initiative, patients had to visit multiple places to obtain the same level of care. The initiative also led to expanded outpatient services and updated practices, including new medication abortion protocols and modernized second-trimester abortion methods.
In addition to improved training for residents and attending physicians involved in abortion care, the project underscored the importance of abortion training for all hospital staff in the HHC system. Respondents reported that hospital staff who were not directly involved in abortion services participated in abortion-education sessions.
Respondents said the initiative led to more patient-centered abortion services, including safer care at earlier gestational ages, a wider variety of procedure options, shorter wait times, fewer in-patient hospitalizations and increased provision of postabortion contraception.