Controversies in OB/GYN: Should all residents be trained to do abortions?

May 1, 2005

Yes. It's critical to ensuring better care for women.

The legalization of abortion in the US made a profound, positive impact on the public health of women. Before 1973, an estimated 800,000 women underwent illegal abortion annually.3 The vast majority of these abortions were unsafe and killed thousands of women each year. After legalization, the number of abortion-related deaths in the US immediately decreased as the number of safe, legal abortions increased. Elective abortion is now a very safe surgical procedure, far safer than childbirth, and 88% of all elective abortions occur before 12 weeks' gestation.4

In 1995, responding to the decline in training and providers, the Accreditation Council for Graduate Medical Education (ACGME) added the requirement that abortion training must be offered in all ob/gyn residency programs. Programs do not necessarily have to provide abortions at their hospitals, but they must make training available to residents. In a survey administered since the ACGME policy change, only 46% of program directors stated that routine first-trimester training was offered in their residency programs, indicating that it is omitted in most programs, despite the ACGME initiative.6

Programs must make training available for residents, not only because that is ACGME policy, but because it will ensure better care for women if the number of ob/gyns trained and willing to do abortions increases. Abortion should be integrated into all ob/gyn departments. It is not enough to make the abortion training available at a distant clinic on the weekends for only residents who are determined to seek it out; it should be a routine part of clinical training. When training is routine, a greater proportion of residents choose to participate. Even when other factors such as religion and geographic location are accounted for, exposure to abortion training increases the chances that graduating residents will provide abortions for their future patients.

Abortion training, like all aspects of abortion, is controversial and has sparked public debate. Of course, a resident who feels that abortion is morally wrong should be able to opt out of performing abortions. We believe, however, that such residents should still learn about abortion care; the training will teach them unique skills they might not learn elsewhere, including the ability to offer supportive and nonjudgmental pregnancy options and contraception counseling, preoperative work-up for outpatient surgery, management of medical and surgical abortion complications, pregnancy dating, conscious sedation and pain management for office surgery, and early pregnancy ultrasonography. If they are not exposed to these important skills, they may be at a disadvantage in caring for patients, and their future patients may suffer. Despite personal religious beliefs, the graduating ob/gyn should be able to counsel patients in a nonjudgmental manner, and refer them for appropriate care.