Dr Jayne Kavanagh and Dr Patricia A. Lohr discuss the role of medical education and training in abortion, the barriers to providing it, and the work of the RCOG to create the next generation of providers. |
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Each year, there are 73.3 million abortions globally[1] of which an estimated 45% are unsafe.[2] This leads to the hospitalisation of 7 million women each year.[3]
Legalising abortion is one way to reduce unsafe abortion, but a willing and skilled workforce to provide or support abortion care is also key to ensuring access.
The World Health Organization identifies a wide range of health workers that can provide safe abortion, along with women and pregnant people’s ability to manage medication abortion themselves.[4]
In many countries, however, doctors remain central to abortion service delivery. Integration of education and training in abortion during undergraduate and post-graduate medical education is therefore essential. Unfortunately, despite the clear public and societal benefits of quality, legal and accessible abortion care, we know too well that this is often lacking.
At some stage in their career, every doctor - regardless of their chosen speciality - will encounter a person who has had or needs an abortion.
Exposing medical students to comprehensive abortion teaching, prepares them to provide competent, compassionate, ethically informed care when they see someone with an unwanted pregnancy. [5]
Gaps in education
When abortion is taught, it is often focussed on ethical and legal aspects, rather than on clinical training, further stigmatising it as an unusual or controversial subject rather than essential healthcare. The same is true for post-graduate training, even for fields such as obstetrics and gynaecology. [6]
Abortion education has the added benefit of helping trainees develop highly transferable skills such as medical and surgical uterine evacuation techniques relevant for miscarriage management, emergency uterine evacuation, ectopic pregnancy screening, ultrasound, contraception provision, and empathetic counselling.
However, numerous studies show that abortion is commonly omitted from medical school curricula around the world. Some countries do not even have official guidelines on the inclusion of abortion in their medical school curricula.
Where they do exist, there are often barriers to its provision, including shortages of curriculum time, lack of clinical opportunities, the perception that abortion is a sensitive topic, a shortage of experienced educators[7], and pressure from anti-abortion individuals and groups.[8]
In recent years the RCOG has tried to address these barriers at national and international level in numerous ways.[9]
It has published a national undergraduate curriculum in obstetrics and gynaecology and released a new RCOG core curriculum for post-graduate training.[10] The latter includes specific knowledge requirements for abortion including the law, pre-procedure assessment, methods (medication and surgical), identification of complications and aftercare.
In the last two years of training, all trainees in obstetrics and gynaecology can take the Advanced Skills Module (ASM) in The Safe Practice in Abortion Care.
Furthermore, the RCOG is working with NHS England to identify locations for advanced skills training in NHS hospitals and independent sector abortion clinics who provide most of the NHS funded care in England and Wales.
RCOG’s Making Abortion Safe team has also designed an open access eLearning module on clinical abortion care, which can be used by educators around the world.
The module includes a tutorial on Teaching healthcare students about abortion, that sets out how to advocate for comprehensive abortion education for medical, nursing and midwifery students. RCOG has published Best Practice Papers in abortion care and post-abortion care which can be used as useful educational resources.
If there is one group that recognises the importance of abortion teaching, it is medical students.
One medical student in a 2021 UK study captured the general feeling when they said “I feel like if we weren’t taught it properly, then that might mean that we aren’t prepared to help women who want or need abortions appropriately, without stigmatising them or making them feel guilty. So, although it is a sensitive topic, I do think it is very important that we address it …”.[11]
It's clear many view abortion care as an essential part of reproductive healthcare and want comprehensive teaching that prepares them to provide competent and respectful abortion-related care when they qualify.[12]
For more information:
The new RCOG website includes an “Abortion education hub” to provide a central location where learners can identify RCOG resources available for abortion education.[13]
To find out more about the Making Abortion Safe programme visit: https://www.rcog.org.uk/about-us/global-network/centre-for-womens-global-health/making-abortion-safe/
RCOG abortion care eLearning is available here: https://learningstore.rcog.org.uk/catalog?pagename=Making-Abortion-Safe
About the authors
Dr Jayne Kavanagh is the Clinical Education Lead for the RCOG Making Abortion Safe programme and Associate Professor at University College London.
Dr Patricia A Lohr is the Medical Director at BPAS and RCOG’s Abortion Education Advisor.
References
[1] Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020 Sep; 8(9):e1152-e1161. doi: 10.1016/S2214-109X(20)30315-6.
[2] WHO (World Health Organization), 2020. “Preventing Unsafe Abortion: Key Facts.” Website: who.int/ news-room/fact-sheets/detail/ preventing-unsafe-abortion, accessed 20 April 2022.
[3] Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG. 2016 Aug;123(9):1489-98.
[4] Abortion care guideline. Geneva: World Health Organization; 2022.
[5] Steinauer J, DePiñeres T. The importance of including abortion in undergraduate medical education. In: Landy U, Darney PD, Steinauer J (Eds). Advancing women’s health through medical education: A systems approach in family planning and abortion. Cambridge: Cambridge University Press; 2021. pp.143–50.
[6] Ibid
[7] Rennison C, Woodhead E, Horan, C Lohr PA, Kavanagh J. (2022) Abortion Education in UK Medical Schools. Journal of Sexual and Reproductive Health. DOI: 10.1136/bmjsrh-2021-201387
[8] Tey N, Yew S, Low W, Su’ut L, Renjhen P, et al. 2012. Medical students’ attitudes toward abortion education: Malaysian perspective. PLOS ONE 2012:7; e52116.
[9] Lohr, P., & Regan, L. (2021). Abortion Training and Integration in the United Kingdom. In U. Landy, P. Darney, & J. Steinauer (Eds.), Advancing Women's Health Through Medical Education: A Systems Approach in Family Planning and Abortion (pp. 336-343). Cambridge: Cambridge University Press. doi:10.1017/9781108884709.036
[10] Royal College of Obstetricians and Gynaecologists. Core Curriculum for Obstetrics & Gynaecology; 2019.
[11] Ibid
[12] Horan C, Ghassem Zadeh P, Rennison C, Hoggart L, Kavanagh J. 2022. A qualitative analysis of medical students’ attitudes towards abortion education in UK medical schools. Journal of Sexual and Reproductive Health https://pubmed.ncbi.nlm.nih.gov/35102002/
[13] https://www.rcog.org.uk/careers-and-training/training/curriculum/abortion-education-hub/