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The likely end of federal abortion rights won’t just make it more difficult for women to get an abortion. It’s also almost certain to make it more difficult to train medical professionals on abortion procedures — a skill that doctors and others who take care of women’s health consider essential.
The prospect raises “a huge public health issue” in the words of one doctor — and one that can affect not just patients seeking an abortion, but those who experience miscarriage or stillbirth.
Any day now, the U.S. Supreme Court will hand down its decision over a Mississippi law that bans abortion after 15 weeks. In a draft of the pending opinion that was leaked May 2, Justice Samuel Alito calls for overturning the 1973 opinion in Roe v. Wade that legalized abortion nationwide.
If the final opinion reflects that conclusion, in Wisconsin it would bring back an 1849 state law that outlaws most abortions. While that is expected to face a legal challenge, if the 173-year-old law takes effect, it would become a crime to terminate a pregnancy, regardless of the reason.
Overturning Roe would at least endanger, and could very likely end, training in abortion procedures for medical residents learning to practice obstetrics and gynecology in Wisconsin and other states with abortion bans on the books. OB/GYN residency programs are required to offer that training; in the worst-case scenario, Wisconsin OB/GYN residency programs might lose national accreditation.
The Accreditation Council for Graduate Medical Education (ACGME) sets requirements for medical residency programs in every specialty, including obstetrics and gynecology. OB/GYN programs must include a family planning curriculum, which the requirements state must include “training or access to training in the provision of abortions.” OB/GYN residents “must have experience in managing complications of abortions and training in all forms of contraception, including reversible methods and sterilization.”
The requirements allow residents with a religious or moral objections to opt out and state that they cannot be required to take part in abortion training or performing abortions.
Accreditation “enforces a uniform set of specialty peer developed standards across all residency programs within each specialty so that patients have access to the highest quality care across the United States,” the council’s spokeswoman, Susan White, said in an email message.
The council’s priority in its requirements for abortion training “is safeguarding women’s health,” White said. “Should it become illegal in some states to perform aspects of family planning, the ACGME is exploring alternative pathways for completing this training.”
The UW Hospital and Clinics Authority — UW Health — sponsors an OB/GYN residency program in Madison, with faculty from the University of Wisconsin School of Medicine and Public Health’s OB/GYN department serving as educators.
“We expect the impact of a final decision by the Supreme Court on the future of Roe v. Wade could have broad implications for institutions such as ours,” said Emily Kumlien, UW Health press secretary, in an email statement. “However, until that decision is reached, we are unable to speculate on outcomes.”
The residency programs are accredited by ACGME, Kumlien stated. “We expect to closely monitor for any changes to requirements and work to ensure continuity of the robust training opportunities we provide.”
Dr. Abigail Cutler, a Madison OB/GYN, says medical students and medical residents far beyond just the OB/GYN field need to learn how to counsel patients in a wide range of situations where pregnancy is involved. Those include unintended pregnancies, pregnancy complications including fetal anomalies and other complications that affect the health of the fetus or the health of the mother. They also include patients who have a miscarriage.
(Cutler is a member of the UW medical school faculty, but she adds she is speaking as a private citizen and medical professional, not as a representative of the medical school.)
“Most physicians in general who are taking care of patients in the office setting will be seeing some patients who are capable of becoming pregnant,” says Cutler. “This comes up not just for OB/GYNs but for all physicians.”
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And for doctors who will enter the OB/GYN field, knowing abortion procedures, including the use of medication as well as surgical options, equips them to take better care of their patients, she says, whether or not a patient wants to terminate a pregnancy. Surgical abortion procedures “are also procedures used to manage miscarriage, or in the second trimester or later, fetal demise” — stillbirth.
In surveys of OB/GYN doctors, those who have had less training in abortion care or none at all have reported that they “felt less prepared to offer comprehensive care to people who are experiencing a miscarriage,” Cutler says. For doctors with more exposure to and practice in abortion care, “there was a correlation between that and their comfort level with surgically managing miscarriage later on.”
If a state’s laws severely restrict or ban abortion, that will limit access to that training, Cutler says, which causes her concern.
“One in five pregnancies end in abortion,” Cutler says. Restricting access “results in preventable morbidity and death. This is a huge public health issue.”
Support for abortion access
In May the American College of Obstetricians and Gynecologists (ACOG), the specialty’s primary professional association, updated its longstanding policy that favors abortion rights. “All people should have access to the full spectrum of comprehensive, evidence-based health care. Abortion is an essential component of comprehensive, evidence-based health care,” the policy states.
“Abortion is a critical medical intervention,” said Dr. Iffath Abbasi Hoskins, ACOG’s president and board chair, in a statement that accompanied the policy revision. The policy was revised, she said, to “make it unmistakably clear that ACOG trusts doctors and patients — and not lawmakers — to make decisions about what is best for patients’ health and well-being.”
Surveys have found broad support for abortion rights and abortion care among doctors. In 2019, the Collaborative for Reproductive Equity (CORE) at the UW medical school polled the school’s doctors on the impact of restrictions on abortion that had been enacted since 2011. More than 900 doctors responded to the survey, and more than 90% said overturning Roe v Wade “would worsen Wisconsin women’s health,” says Jenny Higgins, CORE’s director.
“We surveyed people across all medical specialties, and we found overwhelming support for abortion services as well as abortion providers,” Higgins says. In addition to the concerns for women’s health, a majority said that more restrictions on abortion “make it more difficult to recruit faculty and trainees.”
Cutler says among the residents and medical students she has encountered, “there’s a high desire for this training and education.” She expects that to persist even if Roe is overturned, “and maybe an increased demand for that training,” she adds. “But that will leave only so many states where that training will be available.”
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