Imagine you are an eager, new medical student in Idaho about to begin your first year courses. You dive into the complex pathology of kidney disease, pulmonary physiology, and rare neurological disorders. However, one key lesson is glaringly absent from your reproductive health curriculum: education in abortion and miscarriages. You assure yourself that your mentoring physicians will better explain this during your clinical rotations, where you have proper exposure to patients. Nonetheless, you go your entire Obstetrics and Gynecology rotation without any mention of or training in abortion or miscarriage management, despite the high volume of patients who seek clinical counseling. A couple years later, you and your classmates finally earn the ‘M.D.’ behind your last name and embark on a new journey as a resident physician, without ever learning that one in four reproductive-age patients will have an abortion by age 45, or how to treat 10 to 20 percent of pregnancies that end in miscarriage.
This exact scenario is reality for many medical students across the country. According to a study by Stanford University, researchers found that half of medical schools included no formal abortion training–not even a single lecture. In fact, a law in Idaho barred using tuition and fees for abortion-related activities at institutions that receive state funds, despite abortion procedures being three times more common than appendectomies. Similarly, public universities in Wisconsin, Missouri and Ohio, have current and upcoming proposals that ban hospital employees from participating in and training students on abortion.
However, medical students in both abortion-hostile and abortion-friendly public universities are willing and eager to participate in training for abortion and miscarriage management. Students who have exposure to abortion curricula not only find it valuable, but 70% of students from religiously affiliated institutions report dissatisfaction with their lack of clinical exposure to abortion training. Abortion and miscarriage curriculum, whether through lecture-based or clinical training, isn’t only vital for future OB-GYN physicians. Physicians in other specialties may encounter patients with a past surgical history of abortions, or emergency department physicians may see patients with procedural complications.
However, omitting medical education in abortion and miscarriage management can have consequential impacts outside of just satisfaction. Experts, including the American College of Obstetricians and Gynecologists (ACOG), agree. In fact, ACOG recommends that all medical schools teach abortions without requiring an in-person component. Dr. Alison Whelan, the chief academic officer at the Association of American Medical Colleges (AAMC) is especially supportive of training medical students in abortion because, ‘the technical procedure for providing an abortion — dilation and curettage — is the same procedure that is performed after a miscarriage, or in some cases, to treat excessive bleeding or take a biopsy from the uterus.’
Thus, it is imperative that comprehensive reproductive health curriculums are standardized and required among medical schools. Trainees must have some type of exposure to abortions, whether in didactic or lecture series, hands-on virtual training simulations, or observation/participation in clinics. Medical students are taught to treat patients with respect, empathy and nonjudgement; this same virtue should be extended to patients who are seeking abortion. Normalizing abortion and miscarriage management as healthcare is especially imperative to students residing in abortion-hostilestates, where the already higher rates of maternal mortality would continue to rise with more under-trained physicians.
This change may come in the form of enacting policies that require medical schools to have exposure to abortion/miscarriage training in order to receive accreditation from the Liaison Committee on Medical Education (LCME). Similar to ACOG’s guidance, abortion curriculum should be an ‘opt-out’ versus an ‘opt-in’ program where training is normalized and integrated in students’ coursework rather than serving as an additional burden on students to plan.
Alternatively, policies may focus on offering certain levels of achievement or recognition for medical schools that offer abortion/miscarriage training. This reward system may be used to incentivize institutions to adopt comprehensive reproductive health care in their medical curriculum and attract a higher number of applicants.
The future of reproductive health care, for all patients and their families, rests in the hands of our future providers. Without well-trained medical students who recognize abortion and miscarriage management as healthcare, patients will continue to be denied essential treatment, perhaps leading to even higher rates of maternal mortality. As a whole, both providers and policymakers should work towards these goals to increase our standards of medical care.