Medical Training Must Include Education in Abortion Care. Here’s Where to Start.

As Congress formulated an emergency bill to alleviate the effects of COVID-19 last week, abortion rights and access arose as an issue, delaying negotiations.

For me, the issue is personal: I am a medical student and future abortion provider. I am also the daughter of a former provider whose practice was threatened by protesters and life was changed by an abortion. My reproductive health training—however it is impacted by the national health crisis of COVID-19—will not be complete without this critical education in abortion care.

“This next year will be exhilarating and terrifying as I assume the role of a doctor amidst a national health crisis brought by COVID-19,” writes Trautner. “I hope to support my patients while synthesizing knowledge and staying well. Access to abortion training or care need not be among my considerations.” (Charles Edward Miller / Creative Commons)

While applying to Obstetrics and Gynecology (Ob-Gyn) residency this year, I learned that abortion care training varies widely across residencies.

A survey of Ob-Gyn applicants across the country found that 55 percent of medical students rated abortion training as an important factor. However, over a third of Ob-Gyn residency directors reported abortion training was not a routine part of their residency.

Furthermore, only 22 percent of residency directors reported Ob-Gyn residents had adequate surgical abortion training. This means nearly four in five Ob-Gyn programs provide inadequate abortion training—in spite of the American College of Obstetrics and Gynecology’s recommendation.

The process of applying to residency is a dizzying experience even without considering training in abortion care. We must determine which training environment, location and people to commit 80 hours per week for four years to while coordinating rotations, accommodations and interviews. Then, we rank our choices and an algorithm matches us with a residency.

Unfortunately, state-level abortion restrictions add an additional challenge for residency programs and applicants. Nine states passed legislation banning or restricting abortion earlier in pregnancy last year—before the fetus can survive independently—including Georgia. 

Although a federal judge blocked the ban on nearly all abortion care from going into effect, the legal battle continues. Restrictive abortion laws will further limit in-state abortion training opportunities.

Abortion restriction will widen health care disparities and may reduce provider access for pregnancy care. Since over half of physicians practice in the state they completed their residency, states with restrictive abortion laws will struggle to employ physicians who want to offer abortion in their practice.

On top of this, we’re in the midst of a national maternal mortality crisis, and Georgia reports some of the worst pregnancy outcomes of any state. Black women die of pregnancy related causes at a rate three times higher than white women and will be disproportionately affected by abortion restrictions

When thinking about abortion, I remember the difficult decisions my patients faced. While caring for these patients, I felt the heaviness of the choice in my chest. However, this is also a necessary choice. I fear that some day, I may not be able to offer this option to my patients.

I also wonder what I would do if I became unexpectedly pregnant during my medical training. If I desired an abortion, how far would I travel if my state restricted it? What if I had a serious medical condition, or was low-income or had lower access to care? The answers are unknowable. Since almost half of pregnancies in the U.S. are unplanned, these questions are painfully relevant to all of us.

I am unequivocally in support of the right to choose what care to access in pregnancy. If we care about the improvement and prolongation of life, then we must protect the life of every pregnant person by ensuring both abortion access and pregnancy care.

Anyone who becomes pregnant must have access to compassionate, timely, affordable abortion care—regardless of state of residence. A healthcare provider must also deliver patient-centered care without fearing for their life or liberty.

There are several avenues for increasing abortion training. First and foremost, abortion training should be routine for Ob-Gyn and Family Medicine residents—as is recommended by American College of Obstetrics and Gynecology. Since only 6 percent of abortions occur in academic centers, residencies could better incorporate community settings into training programs.

Residencies in states with restrictive laws should also partner with abortion-providing institutions across state lines. Additionally, we should train other health professionals to provide certain abortion services in order to further expand access.

This next year will be exhilarating and terrifying as I assume the role of a doctor amidst a national health crisis brought by COVID-19.  I hope to support my patients while synthesizing knowledge and staying well. Access to abortion training or care need not be among my considerations.

It is time once again to speak up and defend the basic liberty of control over our own bodies, and those of our loved ones and patients during this trying time.


Emily Trautner is a fourth-year medical student who will start her residency in Obstetrics and Gynecology in June 2020. She is passionate about improving health for underserved people and holds a Master’s degree in Health Policy.