As states impose abortion bans, young doctors travel far to learn the procedure

A deluge of abortion restrictions spreading across the country, from Florida to Texas to Idaho, is shrinking already limited training options for medical students and U.S. residents who want to learn to practice abortion procedures.

The American College of Obstetricians and Gynecologists recommends standardized training in abortion care during medical residency, the training period after medical school that provides future doctors with work experience in a particular specialty. But the number of residency programs located in states where hospital workers are prohibited from practicing or teaching about abortion — or in Catholic-owned hospitals with similar bans — has skyrocketed in recent years. years, a neglected byproduct of anti-abortion legislation taking root in the United States. Southern, Midwestern and Mountain states.

Danna Ghafir, a born-and-raised Texan and third-year medical student in her home state, will leave Texas when the time comes for residency training.

“How does the law influence my approach to preparing residency applications? It informs all the decisions I made in the last year,” said Ghafir, who asked that his school not be identified. “What if I fit a program in a state hostile to abortion that has a trigger law that would automatically ban abortion?”

Since Texas passed a six-week abortion ban, Ghafir said, some students and teachers at his school have become more vocal in advocating for abortion education. But she has also witnessed students who want to practice complex midwifery having difficulty finding mentors.

“I will go where I can get the training I need,” Ghafir said. “But I will go back to Texas.”

Increasingly, aspiring obstetrician-gynecologists seeking training in abortion procedures are seeking teaching hospitals and universities that champion this training as an essential skill in women’s health care, creating a crush of qualified candidates for popular locations in Seattle, San Francisco and New York, according to medical residency directors and students.

The Department of Obstetrics and Gynecology at the University of Washington in Seattle used to reserve a handful of spots for residents who wanted to opt out of learning abortion care. But two years ago, as access to teaching hospitals offering abortion training narrowed, UW decided to admit only residents committed to providing abortion care.

“If we live in a state where abortion care is legal, we need to recruit medical students into our program who want to provide abortion care,” said Dr. Alyssa Stephenson-Famy, associate professor of maternal medicine. -fetal to the department. “We shouldn’t waste our place on people who don’t want an abortion.”

Teaching hospitals and universities that train future obstetricians and gynecologists are required, as part of the accreditation process, to provide abortion training or allow medical residents out of state for undergo clinical training.

In Missouri, medical students from St. Louis typically travel to neighboring Illinois, where there are fewer restrictions. But an amendment to a Missouri state health bill introduced by Republican Rep. Mary Elizabeth Coleman would make it illegal to perform an abortion on a Missouri resident, even in another state, and administrators believe students in medicine traveling across state lines would risk being prosecuted. .

Another Missouri bill, sponsored by Sen. Mike Moon, a Republican, would mandate endowment of medical school-affiliated universities that perform abortions or facilitate abortion education for medical students. Moon said the bill, introduced in 2021 and again this year, targets Washington University in St. Louis.

“The University of Washington is a leading institution that trains students to perform abortions,” Moon told Christian publication The Pathway. “These students are then hired to murder developing human babies across our country. They won’t stop on their own. This will put financial hardship on their ability to train these students.

In Idaho, a bill would ban state employees, including University of Idaho doctors, from teaching about abortion. In anticipation, Seattle-based University of Washington professors taught a course on contraception and abortion to Idaho college students via Zoom last fall.

The anti-abortion movement knows it’s important for abortion rights advocates to maintain the pipeline of providers, “and that’s why they’re focused on travel bans,” said Pamela Merritt, executive director. of Medical Students for Choice, which works with student volunteers across the country to advocate for abortion education. Merritt advises medical students to train in “aborted refugee states while people try to fix the catastrophic, slow-moving car crash that’s about to happen.”

“The accrediting agencies aren’t going to change the standard of care just because the Supreme Court strikes down the constitutional right to abortion,” Merritt said. “We need to have doctors who know what they are doing.

The clinical skills used in abortion procedures are often the same as those used to clean the uterine lining after a miscarriage or terminate a pregnancy in the event of a death that causes hemorrhage and other complications that can lead to death. the mother. Clinicians unfamiliar with abortion procedures are often less qualified to perform these lifesaving procedures, experts said.

“Any obstetrician who says there is never a need for abortion care is not telling the truth about obstetrics,” said Dr. Eve Espey, a professor in the university’s department of obstetrics and gynecology. from New Mexico to Albuquerque.

In the nearly seven months since a ban on abortions in Texas after embryonic heart activity was detected (at about six weeks gestation) went into effect, Espey said, she has seen a increase in the number of patients arriving from Texas seeking termination of pregnancy, in some cases with serious pregnancy complications.

“We have patients getting on planes with ruptured membranes,” she said. Since doctors in Texas can still detect heart activity using an ultrasound, some fear lawsuits for terminating vanishing pregnancies.

“Providers in Texas are afraid to take care of them,” she said. “It directly endangers a woman’s life.”

The U.S. Supreme Court is expected to rule later this spring on whether to uphold a Mississippi law that bans most abortions after 15 weeks of pregnancy, a decision that could nullify or weaken federal protections for pregnancy. abortion. If Roe v. Wade is overturned, 26 states are likely to ban abortion, and doctors say clinics in states that endorse abortion rights — including California, Oregon, New York and New York — Mexico – will be overrun with patients, leaving them little time to train doctors. residents.

“We’re all really worried about the future of safe abortion care because of the impact on training,” Espey said.

Medical students caught up in the changing legal landscape must consider whether they should alter methodically mapped career paths.

Already, half of medical schools in the United States include no formal training or offer only one lecture on abortion-related topics, according to a 2020 study by researchers at the University of Stanford, leaving medical residents who may want to incorporate the procedure into their future practice. from square one, or almost.

“I don’t want to spend another four years not having abortion training if I haven’t already had it in the last four years,” said Jasmine Chan, 26, a fourth-year medical student. at Texas Tech University in Lubbock.

Chan co-founded the Medical Students for Choice chapter on her campus, but said she was often reluctant to discuss her practice goals with classmates, many of whom oppose abortion.

Given his Texas roots, Chan wanted to stay in the state for his residency. But her academic advisors warned her against certain programs because her resume included abortion advocacy and education, which she sought out of state.

Late last month, just days before the deadline to submit her list of top residency picks, she made a sober assessment of the political momentum in Texas and abruptly upended her plans. “I was starting to spiral,” she said. “I realized that I would end up in a state with no abortion training.”

She changed her specialty from OB-GYN to family medicine to expand her training site options. And last Friday — the famous “Match Day” for medical residencies — she learned she had been matched with Cooper University Health Care based in Camden, New Jersey, a state that has enshrined abortion rights into law. state in January.

Sarah Varney, Kaiser Health News. (KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of KFF’s three main operating programs ( Kaiser Family Foundation). KFF is a non-profit endowed organization providing information on health issues to the nation.)

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