Fewer and fewer OB-GYNs are learning to perform abortions. What happens when there is no one left?


This is one of the most ruthlessly effective weapons in human history: the destruction of knowledge. Opponents of reproductive rights in America understand this well. It is not enough to simply restrict or prohibit access to abortion. It is not enough to make access to safe and legal options prohibitive. You must erase his teaching, his training.

And that is exactly what happened in the United States.

The erosion of abortion education is not new. A press report from the National Academies, titled “The Safety and Quality of Abortion Care in the United States,” sounded the alarm about the problem in 2018. “While most women’s healthcare providers will interact with patients dealing with issues of unwanted pregnancy and abortion, abortion education is not not universally available for physicians or CPAs. [advanced practice clinicians] who intend to provide reproductive health services,” they noted at the time.

Limitations to training included “geography, institutional politics, and state law” as well as the rise of the “largest group of faith-owned, nonprofit hospitals” in the country—facilities owned by Catholics and Catholics, who must follow the strict ethical and religious guidelines of the United States Conference of Catholic Bishops. This means that for a growing number of aspiring reproductive health care providers, “medical students, residents and other health professional students are often responsible for seeking learning opportunities themselves.” And that was four years before the Dobbs decision.

“43.9% of residents currently train in states that are supposed to ban abortion.”

In May, research from the David Geffen School of Medicine at the University of California, Los Angeles reported in the journal Obstetrics & Gynecology that “43.9% of [OB/GYN] residents currently train in states that are supposed to ban abortion, a component of the obstetrics and gynecology residency required for certification. The disturbing possibilities are obvious. As the authors went on to note, “In 2020, 92% of obstetrics and gynecology residents reported having access to some level of abortion education. We anticipate that if Roe v. Wade was canceled, it would drop to 56% at most. And it gets worse, because “it probably understates the implications of overturning Roe v. Wade on training, as residencies outside of obstetrics and gynecology, such as family medicine, were not included in the study.”

Speaking to MedPage Today, the report’s lead author, Kavita Vinekar, MD, MPH, said, “I fear that a lack of residential abortion training will negatively impact residents’ skills in emergency uterine evacuation, office procedures, miscarriage management, patient-centered counseling and trauma-informed care. These are all skill sets that are central to abortion education.”

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“That’s almost half of all the inhabitants,” says Dr. Katharine White, associate professor of OB-GYN at Boston University School of Medicine and author of “Your Sexual Health: A Guide to Understanding, Loving and Caring for Your Body”, said of this systemic closure of abortion training. “It has big implications for all the people capable of pregnancy that they care for for the rest of their careers.”

As anyone with even the slightest understanding of the reproductive systems knows, creating a vacuum in any form of medical training has far-reaching consequences. “It impacts skills in abortion procedures and medication management with medical abortion,” White says, “whether it’s termination of pregnancy for abortion or miscarriage. That’s hundreds of thousands of people who experience pregnancy loss every year, who may not have a provider who feels comfortable treating them.” And if a dwindling number of suppliers know how to handle a D&C, how many more people will be required to do it. carry their dead fetuses in their bodies than those who are already enduring this nightmare now? How many more will see their own lives in danger because their pregnancies are not viable?

This almost inevitable shift in education will impact not only where students choose to go to school, but also where they settle and, by extension, the communities they choose. will serve. A 2021 AAMC Resident Retention Report found that “More than half (57.1%) of individuals who completed residency training from 2011 to 2020 are practicing in the state where they completed their residency training.” And if this prediction in Obstetrics and Gynecology is even close to accurate, that’s an astonishing number of our incoming OB-GYN providers trained and staying in states where they haven’t been taught abortion techniques.

“Next year’s residency match is going to be very, very interesting in OB-GYN.”

“Residents and vendors in these states have to decide, should I stay or should I go?” said Dr. White. “For residents, it’s, ‘Am I trying to get this training somewhere else? Do I accept that I won’t get it? For people applying for residency, am I even applying for programs that will limit my training? I think next year’s residency match is going to be very, very interesting in OB-GYN.

White is concerned about the long-term repercussions these choices will ultimately have.

“If you have providers and interns leaving those states,” she says, “it’s going to exacerbate the health disparities that already exist, because we have good data that states that restrict abortion have lower maternal mortality rates. There is a huge moral conflict between the providers and are we taking care of the people in this state who desperately need us, or are we going somewhere else where there is also need, and are we managing to provide all types of care? We’re not talking about small numbers. Half of our residents will get this training. Half of our residents stay where they practice or stay where they train. That’s a lot of exponential impact.

Even in states that provide more comprehensive abortion education, the effects are still unavoidable, subject to religious guidelines from specific institutions or a lack of facilities. “The numbers aren’t great and they’ve definitely gone down over time,” says Los Angeles OB-GYN and “Menopause Bootcamp” author Dr. Suzanne Gilberg-Lenz. “but that doesn’t mean there aren’t enough people to offer abortions. The problem is where they are. The problem is more like, ‘Look, there are providers in California, but there’s no one in Fresno.'”

And that, she explains, goes deep into some of the most troubling dynamics of reproductive care. “If you really look at global reproductive justice movements, there are a lot of issues with white supremacy,” Gilberg-Lenz says. “There are probably hundreds of doctors and abortion services in Los Angeles County, for example. When someone can afford to go to Fresno and do free clinics, yes, they are providing a service , but it’s also potentially very white supremacy, colonial, because now they’re making it much harder for a brown or black person to move into that community full-time and make a living doing it.”

“When we talk about medical racism,” she continues, “we have to understand that it affects not only patients, but also trainees, potential doctors, physicians. The way health care is delivered and administered is largely influenced by who provides that care. That’s a really important point, and it’s been discussed a lot in the abortion provider community.”

Even if a future provider ends up, for personal or professional reasons, never performing a single abortion on demand in their career, who in their right mind thinks that not equipping doctors with the most skills to handle the most of possible medical scenarios is anything but wildly irresponsible? Yet this is exactly the path the United States seems ready to send its suppliers. “I think, philosophically,” says Dr. Suzanne Gilberg-Lenz, “that not requiring every OB-GYN resident to learn how to perform an abortion is just morally and ethically wrong.”

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