How The Stigma Of Abortion Affects Family Planning Education In Medical Schools

With Poland’s legislature’s recently proposed, near-total ban on abortion, along with the September 24 pro-choice marches decrying Ireland’s strict abortion laws that took place in a number of cities worldwide, reproductive rights and access to abortion are currently stirring immense debate and rightfully earning recognition on a mass global scale.

The United States is no stranger to the complexities and controversies associated with the issue of abortion. Most recently, with the Supreme Court’s ruling this past June that struck down one of Texas’ many restrictions on abortion clinics, one would assume that the country is slowly on its way to improving the reproductive rights of women. However, individual women’s access to abortion is only part of this complex healthcare issue.

“We always say, without providers, there is no choice when it comes to pregnancy counseling,” says Sarp Aksel, president of the board of Medical Students For Choice (MSFC), in reference to the troubling decline in abortion training and reproductive education in medical schools across the United States.

The American College of Obstetricians and Gynecologists (ACOG) recommends that all medical schools offer opt-out abortion training. Yet, according to a 2005 American Journal of Obstetrics and Gynecology study, 23 percent of medical schools offer “no formal education” about abortion during OB-GYN rotations, and 55 percent of medical schools offered no clinical exposure to abortion.

“The training situation in many places is still subject to abortion politics,”

explains Carole Joffee, a sociologist and author of two books on the history of abortion rights. Institutional barriers, from state funding, to religious affiliations, and anti-choice legislation, are all factors that prevent proper abortion education in medical schools.

In many states, including Arizona, Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, Pennsylvania, and Texas, it is illegal for publicly funded institutions, including state universities, to perform abortions.

Likewise, many hospitals, health facilities and medical schools are run by or closely affiliated to anti-choice religious organizations, many of which require physicians sign contracts saying they won’t provide abortions, even at a different clinic, while part of the staff.

This is especially troubling because, despite an individual’s or an organization’s stance on abortion, The American College of Obstetricians and Gynecologists states that it is within the scope of a family doctor’s practice to be able to perform abortions. Doctors should at least be factually–not ideologically–knowledgeable about the procedure, whether they ever intend to perform one or not.

Unfortunately, even gynecologists, the doctors who specialize in women’s reproductive health, are falling exceptionally behind in this area. According to a 2011 paper published by family practitioner and researcher at the University of Chicago, Debra Stulberg, 97 percent of OB-GYNs encountered patients seeking abortions, yet only 14 percent provided them.

This also makes it that much more difficult for residents at said practices who are interesting in learning abortion techniques to receive the education they desire and deserve.

“The tactic on the religious right to stigmatize abortion has translated beyond just making it hard for women to seek abortion,” says MSFC Executive Director, Lois Backus . “Hospitals, medical schools, others who you would think might be neutral or even take a pro-reproductive-health stance, often are just afraid—afraid of protests, afraid of attention. They would rather just fly beneath the radar.”

Luckily, while abortion education is faltering in medical schools, formal abortion training, as well as destigmatization of the procedure amongst students and residents, is on the rise, thanks to Backus’ organization Medical Students for Choice (MSFC). Founded in 1993, MSFC was created as a way to create awareness amongst medical students of the lack of family planning information they received in their education.

Backus explains, “In the over 20 years that we’ve been here, MSFC has directly been responsible for the growth of a robust community of mentors and teachers as well as a growth in the respect with which abortion care education is viewed.”

Unfortunately, while MSFC can now help give medical students direct access to abortion and other family planning training, receiving the education is still a struggle for many students, who must use up elective slots in their class schedule or participate in “externships” in order to acquire the training. What’s more, some students risk criticism and backlash from their very own professors, who might even use their ideologies about abortion to jeopardize students’ residency possibilities.

“Medical school is a rigidly hierarchical culture and it is, in most places, dramatically resistant to controversy,” says Backus. “And so students who are viewed as lightning rods for controversy can be subtly, and not so subtly, punished by the hierarchy.”

Political, religious, or moral leanings aside, abortion is a medical procedure–sometimes a life-saving one–that should be looked at seriously and treated professionally by all who consider themselves a part of the medical field. Patients’ struggles to access the procedure is a troubling issue all on its own. But censoring and even prohibiting science and fact-based information taught to students in higher education is a problem that should be upsetting to all academics and medical professionals.

In the words of Jody Steinauer, MSFC founder and associate clinical professor of obstetrics and gynecology at the University of California at San Francisco, “Of course we have to fight for this. How can we let politics and stigma determine what future physicians are learning?“