The vulnerability of abortion access and training

The COVID-19 pandemic has exposed how vulnerable access to abortion care is in the U.S. health care system. Abortion is one of the most time-sensitive, potentially life-altering procedures an individual can undergo, however, lawmakers since March have explained it away as an elective and non-essential procedure. Bans and restrictions were instituted in 12 states in March and April, with most overturned thereafter or removed once elective procedures were allowed to resume. Arkansas still requires women to have a negative COVID-19 test within 72 hours of their abortion—a requirement that was extremely difficult to follow with the scarcity of tests in April and May.

The most common reasons that women have abortions are clearly exacerbated during a pandemic, highlighting the procedure’s necessity. 40% of women who had an abortion in the U.S. between 2008 and 2010 cited “not financially prepared” as their main reason; 36% chose “not the right time for a baby.” A global pandemic, with record-high unemployment rates (an all-time high of 14.7% in April 2020), only validates their reasons and designates abortion as an essential health service that cannot be restricted.

Many medical institutions quickly spoke out regarding the harmful nature of the bans instituted. The American College of Obstetrics and Gynecology (ACOG), in conjunction with other reproductive health organizations, issued a statement on March 18th, 2020 that they “do not support COVID-19 responses that cancel or delay abortion procedures.” The American Medical Association similarly responded on March 30th, stating that “it is unfortunate that elected officials in some states are exploiting this moment to ban or dramatically limit women’s reproductive health care.”

While this is reassuring, the stigma of abortion in the U.S. health care system is real and warrants concern. While almost one in four women (24%) will have an elective abortion by age 45, only 23.8% of obstetrician-gynecologists (OB/GYNs) stated that they provided any form of induced abortion between 2016 and 2017. Abortion has been relegated to a cornered subset of our health care system, mostly offered at independent clinics when it could be safely provided at private OB/GYN practices. Women must often venture beyond their usual health care provider to access an abortion, stripping away familiarity and further stigmatizing an already difficult process.

The reason for the lack of abortion care in private OB/GYN practices begins at the source: the similar lack of abortion training in medical school and even OB/GYN residency programs. Only 32% of medical schools surveyed in one study offered at least one abortion-focused lecture during the clinical years. 17% of clerkship directors stated that their program offered no formal abortion education in preclinical or clinical years, whereas 45% noted some clinical exposure to abortion. Even at schools that offered clinical abortion exposure, 45% of third-year students surveyed expressed dissatisfaction with the clinical opportunities given.

Even further in medical education, OB/GYN residency programs report a concerning lack of abortion training. 54% reported routine opt-out abortion training, 30% reported opt-in abortion training, and 16% reported that abortion training was simply not offered. With abortion’s unique significance as a life-altering procedure, its relative scarcity in all levels of medical education is unacceptable.

As a third-year medical student myself, and as a woman of color training to be in the physician workforce with a great interest in OB/GYN, these numbers were deeply disappointing. All physicians require the skills to provide equitable health care, whether that aligns with their personal beliefs or otherwise. We are health care providers, not politicians. As physicians, we are trained to leave our bias at the door of a patient’s room. And yet, to even access abortion training, many other future physicians and I may have to search outside our traditional medical curriculum.

With the current trend of increasing legislation against abortion in the last ten years, it worries me what the climate and access to reproductive health care could look like over the course of my potential career as an OB/GYN. If the COVID-19 pandemic could relegate abortion to a non-essential, unavailable procedure, even briefly, then access is clearly in jeopardy. When is the next future public health concern, whether great or small, that could render abortion inaccessible? That concern is why I feel determined to advocate for reproductive rights both as a woman and as a medical student, so I can do everything in my power to ensure access to essential services for my future patients and even myself.

Shereen Jeyakumar is a medical student.

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