Look through any medical dictionary, and before you get to appendectomy and anesthesia, you’ll find abortion.
The first two procedures are part of standard physician training. But for many American medical school students and residents who want to learn more about abortions, options are few.
And new restrictions are piling up: In the past year, bills or laws to limit abortion education have been proposed or signed into law in at least eight states. The changes come from abortion opponents emboldened by new limits on the procedure itself, as well as a pending Supreme Court ruling that could overturn the landmark Roe v. Wade legalizing abortion.
“It’s pretty terrifying what’s going on,” said Ian Peake, a third-year medical student in Oklahoma, where the governor signed a measure April 12 banning most abortions.
Abortion training is not offered at Oklahoma’s two medical schools, and education on the subject is limited. Aspiring doctors who want to learn more usually seek out doctors who perform abortions outside of the traditional medical training system.
Peake, 32, said if he wanted to learn how to do colonoscopies, for example, he could work with school staff to follow a doctor doing research or working in a clinic.
“It would be easy,” he said. “Doing the same for abortion is almost impossible.” He said it took him six months to find a supplier willing to teach him.
Nevada medical student Natasha McGlaun trained outside and created a workshop on how to perform a standard medical procedure used in abortions. She offers it at night, during her free time.
The 27-year-old is the daughter of “pro-feminist” parents and the mother of two young girls whose right to reproductive choice she wants to protect.
“It was kind of a joke in my family: if people tell me I can’t do something, I’ll do it twice as hard,” she said. “I kind of feel that moral and righteous will to go for it.”
‘GLARING ABSENT’ COURSES
Physician education in the United States typically includes four years of medical school, during which students learn the basics of general medicine and practical patient care. They get a medical degree which officially makes them doctors. Most then spend at least three years in residency programs where they receive intense on-the-job training and specialized skills.
US medical schools require students to complete an internship in obstetrics and gynecology, but there is no requirement to include abortion training. At the post-graduate level, OB-GYN residency programs are required by an accreditation group to provide access to abortion training, although residents who object may refuse to perform abortions.
OB-GYNs perform the most abortions in the United States, followed by family medicine specialists. But they are not always the first doctors women see when they learn of an unwanted pregnancy. Proponents of abortion rights argue that all physicians should know enough about the procedure to educate and counsel patients, and that this education should begin in medical school.
In 2020, researchers at Stanford University said they found that half of medical schools included no formal abortion training or only one lecture.
“Abortion is one of the most common medical procedures,” they wrote. “Yet abortion-related topics are conspicuously absent from medical school curricula.”
McGlaun helped sponsor a measure last year that called on the American Medical Association to support mandatory abortion education in medical schools, with an opt-out provision. The influential group has long opposed curriculum mandates and rejected the proposal, but said it supports giving medical students and residents the opportunity to learn about abortion and opposes efforts to interfere with such training.
Legislative efforts to curb abortion target all levels of medical education.
An Idaho law enacted last year illustrates this trend. It prohibits the use of tuition and fees for abortion and related activities at school clinics in institutions that receive state funds.
Other efforts include a Wisconsin bill that would ban employees of the University of Wisconsin and its hospitals from participating in abortions, including training. He did not move forward in March but his sponsor is considering reintroducing the measure. Similar proposals target public universities in Missouri and Ohio.
Divya Jain’s initiation into abortion didn’t happen at her medical school in Missouri — where she said the procedure is rarely discussed — but at a Planned Parenthood clinic in Kansas. She was a volunteer at the clinic and saw the barriers women from out of state faced in getting the procedure. Some ended up by mistake at a crisis pregnancy center across the street that tried to change their minds, Jain said.
Jain, 23, said her first experience of observing an abortion was “anti-climactic”, a far cry from the scary image she had heard described by naysayers.
“It’s just normal internal procedure,” she said. “These are just patients asking for medical treatment.”
At that moment, she knew she wanted an abortion. “It was like a snap of the finger. It was kind of a game-changer for me,” said Jain, who is studying public policy at Harvard while on leave from medical school at the University of Missouri-Kansas City.
The daughter of open-minded but traditional parents who immigrated to Kansas from India, Jain recalls growing up feeling trapped by her family’s traditional culture and a conservative white community where abortion was never discussed.
“I loved stirring the pot” and pushing the boundaries, she says.
Jain knows that the United States Supreme Court’s decision on whether to uphold Mississippi’s abortion ban after 15 weeks of pregnancy could dramatically change the abortion landscape in the United States. Regardless of the decision – expected by the summer – Jain said his goal is set: to perform abortions in “unfriendly” states where providers are scarce.
“It’s really hard for patients to get the care they deserve and need, and I just think that’s wrong,” Jain said.
EXPANSION OF TRAINING
Dr. Keith Reisinger-Kindle, 33, associate director of the OB-GYN residency program at Wright State University School of Medicine in Dayton, Ohio, said his goal of boosting abortion education “has been an uphill battle” due to legislative hurdles.
When he arrived at school nearly two years ago, he said “there was no formal abortion education”. He has created and implemented abortion courses for medical students and residents, with support from his university, and offers training at a nearby clinic where he also performs abortions.
The doctor said a state legislator pressured university administrators to fire him. And in December, the governor of Ohio signed into law a measure that prohibits doctors who work in state institutions from working as locum doctors in abortion clinics when rare complications arise. The clinic where Reisinger-Kindle works is suing to block the law.
“There are days that are definitely tough,” Reisinger-Kindle said. Young doctors eager to learn help him to continue. The program currently has 24 residents. They can opt out of abortion training, but he said nearly all have chosen to participate “at least to some degree.”
He fears more restrictions on abortion are coming, but adds: “In the long run, I believe we will succeed. I just hope my students won’t have to suffer.