More than a year after the U.S. Supreme Court overturned Roe, many have expressed concern about the training of obstetricians and gynecologists, particularly in states that face civil and criminal penalties for providers who perform abortions. But researchers at the University of California, San Francisco’s Program in Person-Centered Reproductive Health have found that there is cause for concern about the training of family physicians even in ban states.
A study published in the November-December issue of Annals of Family Medicine found that 29%, or 201,693, of the accredited family medicine residency programs in the United States are in states with abortion bans or significant abortion restrictions. The study used publicly available data from the American Medical Association to conduct the analysis and found that 3,930 of the 13,541 residents lived in states where abortion is prohibited or highly restricted.
This has implications for family doctors, who are often tasked with helping patients manage early pregnancy loss or miscarriage, as well as patients who manage abortions themselves at home with medication. Each of these patients may require follow-up by a family physician, the study concluded.
States Newsroom spoke with one of the lead researchers, Dr. Christine Dehlendorf, about the study’s findings. His answers have been edited for clarity and brevity.
States Newsroom: Why did you think it was important to do this research?
Dr. Christine Dehlendorf: We just wanted to portray what reality was. That was less than what was seen in previous analyzes of OB housing (which showed that about 45% were ban or heavily restricted states), but it was based on assumptions about what bans would look like post-Dobbs. It’s an evolving map that we know abortion policy changes daily, weekly, monthly, so this is a moment that tells us that already a significant portion of the population is influencing their education.
Residents in these programs do not have access to comprehensive reproductive health education because they do not experience it within their state. They can’t see abortions, they can’t do them, they can’t learn how to care for patients after an abortion the way they could work in a state where abortion is not restricted.
SN: What does that mean for these residency programs?
Dehlendorf: This means that residency programs must be very intentional about their curriculum and look for ways for residents to gain experience in reproductive health care, including ways for them to receive training abroad.
In typical family medicine residency programs, you have your routine primary care curriculum followed by specialty rotations (eg, dermatology or other specialties) where you get more of your own time for that subject. Restricting abortion affects education in both contexts. You don’t see people who have recently had an abortion and can help manage the aftercare, such as bleeding, and you can’t provide abortion medication. You cannot see patients who have had an abortion in the hospital.
So residency programs need to think about how people would be exposed in the absence of this natural way, how they can replace and supplement the curriculum to make sure people are exposed. The residency experience is for a while, and the reality is that they care for these patients regardless of whether they are in states with abortion restrictions.
SN: What support can family physicians offer to those who experience a miscarriage or are self-administering an abortion?
Dehlendorf: People need to be able to go to primary care doctors if they have questions like bleeding or other side effects. Early pregnancy loss is a very common experience, and the skills to manage it and first pregnancy abortion are very similar.
SN: How concerned are you that these programs are not providing this training?
Dehlendorf: I am very concerned that programs are not paying enough attention to this gap in their new curriculum, and as a result, their residents are not receiving comprehensive training, and it is negatively impacting their future patients.
Patients receive less patient-centered care. Ideally, primary care providers should be able to care for people throughout the reproductive health cycle. If we can’t do that, it means that care is fragmented in a way that it doesn’t need to be. It also means that some of these patients receive no treatment at all, and some receive less treatment.
SN: Who might be most affected by this lack of education?
Dehlendorf: We know that family physicians provide care in areas where there are no other health professionals and are a safety net for rural or urban underserved communities without access to specialty care. These providers must be able to provide the full practice of family medicine, including full reproductive health care. These are the communities most likely to be affected.
SN: What can be done to support these educational opportunities?
Dehlendorf: From an educational lens, it is imperative that people in abortion states receive funding for educational opportunities in non-abortion states.
SN: What other implications might this have for family medicine?
Dehlendorf: Prior to Dobbs, there was no recognition of the critical role that abortion access played in many of our medical institutions and health care systems, including the fact that we prescribe drugs that can cause birth defects knowing that abortion could be available to the patient if needed. There have been cases where people have been denied these drugs due to lack of access to them.
All these things affect our lives and our health. It’s multi-faceted, and we’re only just beginning to see the effects that’s going to affect the system and how it’s failing to meet the needs of people in places where abortion is restricted.
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