The ongoing shortage of abortion providers is blamed on many culprits: the stigma attached to abortion provision, the hostile and sometimes dangerous practice environment, and even a perceived lack of interest in abortion provision. One of the less known problems, however, is the lack of training opportunities. If medical students and residents don’t have the chance to learn how to provide abortions, they simply aren’t going to be providing them when they’ve finished their training.
Prior studies have shown that an increased amount of abortion training in residency is associated with an increased likelihood of abortion provision in the future. A recent study showed that, in addition to having training available, integrating abortion training into residency training for obstetrician-gynecologists may be key to reducing the abortion provider shortage.
The study followed residents at two different programs. At one of the programs, OB/gyn residents had the normal exposure to family planning (contraception and abortion). In the other program, a structured specialty family planning rotation was instated. Those who participated in the structured program were much more likely to report planning to perform abortions after graduating from residency than the other group. In addition, at the beginning of the rotation only 1/3 of residents planned to perform abortion after residency, while after the rotation all of them stated they would perform abortions.
Results like these show us that although many in the abortion community attribute the decreasing numbers of abortion providers to lack of interest on the part of younger doctors, the situation is much more complicated than that. There aren’t enough training opportunities for those who seek them out, but clearly even those who don’t seek out training find they are interested in providing abortions when they have a high-quality experience with family planning. Abortion training needs to be a regular, structured part of all OB/gyn and family medicine residency programs.
Unfortunately, political resistance to abortion education is only growing. In May, the House approved the Foxx Amendment, which would have prevented residencies receiving federal funds from providing abortion training. Since all residency programs are almost entirely funded by money from Medicare, such a restriction could essentially end all abortion training in residency programs, shutting down the pipeline of new abortion providers. (The Foxx Amendment was not approved by the Senate, granting programs a temporary reprieve).
Several programs are working assiduously to improve training opportunities. If you are a medical student interested in training, Medical Students for Choice has resources to help you increase training at your school, externships you can apply to (some with funding), and guides to help you pick the right residency. Residents can contact the National Abortion Federation for help finding training opportunities if such opportunities are unavailable at their residency. Such initiatives are, however, a drop in the bucket. As the studies above show, leaving residents on their own to pursue abortion training leads to few if any choosing to be abortion providers. Routine training leads to doctors who want to perform abortions after graduating residency. If we want to fix the abortion provider shortage, we have to focus more closely on training opportunities.