Without adequate training, U.S. doctors are woefully unprepared to have nuanced discussions on the ethics of abortion on a national stage, and lack the knowledge required to objectively discuss abortion care with patients.
Abortion has been a key political and often partisan issue for the last 50 years. Laws that seek to restrict access to abortion often include misinformation that can discourage patients from seeking care. Educating health professionals on abortion care is a powerful method of preventing the politicization of medical care such as abortion access, but abortion education is severely under-emphasized in medical curricula. By failing to educate medical students on abortion, the medical institution effectively contributes to the continued politicization, restriction and stigmatization of abortion care in the U.S.
As second-year medical students, we have advocated for the inclusion of basic contraceptive and abortion care in our curriculum. Abortion care encompasses a spectrum of different types of medical care, from patient counseling, to medication options and surgical abortion procedures. Of 118 first- and second-year medical students at our institution surveyed, 38 percent report they had received no sex education or abstinence-only sex education before medical school. On top of the sparseness of medical training on reproductive care, over a third of these future physicians have little to no foundation of knowledge on safe sex practices and contraception—let alone abortion care or pregnancy options and counseling.
Despite the American College of Obstetricians and Gynecologists (ACOG) recommending the inclusion of abortion education in medical school, a national survey of medical school programs in 2005 revealed that 23 percent offered no formal education on abortion. Of those that did offer education, 32 percent only had one abortion-related lecture during the clinical years.
Abortion education is often optional due to immense legislative and institutional barriers—meaning many schools are training physicians to practice medicine without the scientific background to deliver evidence-based care. We would never allow an internist to treat a patient’s diabetes without understanding the physiology; sexual health should not be any different. Without adequate education and training, our nation’s doctors are woefully unprepared to have nuanced discussions on the ethics of abortion on a national stage, and lack the knowledge required to objectively care for patients desiring to discuss abortion as an option.
To be sure, it is unreasonable to expect all medical students to be future abortion providers, or to personally agree with the procedure. However, a core teaching of evidence-based medicine is that we should fully know the risks and benefits of any medical procedure and discuss those options with all our patients. For example, medical students are expected to learn about challenging issues such as opioid prescription. Although opioid dependency is a huge problem in the U.S, there are also instances when responsible opioid prescription is appropriate. This is not to say that all physicians must prescribe opioids, but rather that we understand that it is a medication that our patients may need, and therefore, a medication we must fully be educated on. By discussing opioids objectively instead of morally, we replace fear of potential controversy with a sense of duty to our patients. Similarly, ignoring the reality that we will have patients who seek abortion care contributes to its controversiality.
Despite its controversy, abortion is a common medical procedure: One in four women in the U.S. receive an abortion at some point in their life and six in 10 (63 percent) Americans personally know someone who has received an abortion (including themselves). Unfortunately, there is a pervasive lack of knowledge around the topic, and 70 percent of Americans surveyed incorrectly think most abortions occur eight weeks or later into pregnancy. The survey of our peers showed that these misconceptions extend to medical students. Medical schools have an obligation to give students the information necessary to provide care for their patients. In the case of abortion, politics have restricted the ability of medical schools to do so, and have therefore placed the onus of learning these skills on the learners who are interested in doing so.
This educational failure is also reflected within the field that cares for these patients the most, obstetrics and gynecology (ObGyn). In a 2008 survey of ObGyns, nearly three out of four had a patient who wanted to end a pregnancy in the past year, yet fewer than one in four were willing and/or able to perform an abortion themselves. Even more shockingly, those who weren’t able to perform ones may not refer patients to a provider who can: 13 percent neither provide nor refer for abortions. Regardless of personal beliefs, not having the knowledge to refer or perform abortion contributes to restricting access. By providing insufficient material to students on these topics, not only are these incomplete curricula impairing learning, but schools are graduating students inadequately prepared to work with this population of patients.
As abortion law changes and the likelihood of a post-Roe v. Wade landscape grows, the responsibility of protecting the right to abortion may shift to individual states. States such as Illinois, the only midwestern state with no legal limits on abortion until fetal viability, will be tasked with serving people seeking abortions for a huge geographical area. This inevitability further motivates us to ensure future generations of physicians will have the medical knowledge and patient-centered framework to support the rising need for abortion care.
In light of the December 1 Supreme Court hearing on Dobbs v. Jackson Women’s Health Organization and the recent extreme political attacks on abortion (SB.8), we must reinvigorate our efforts to educate future physicians on the importance of evidence-based abortion care.
Abortion is a healthcare issue. Regardless of our choice to perform abortions in the future, it is our ethical obligation to have a fundamental understanding of abortion care in order to care for and counsel our patients. A failure to educate on abortion care represents a failure in medical education at large and contributes to the continued stigmatization of abortion in our medical institutions, healthcare, and the U.S. This stigma is undeniably dangerous to our future patients, and we refuse to be complicit in its perpetuation.
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