The Abortion Curriculum Has Left the Classroom

Louisa Pyle

In the reproductive health curriculum I dream of at night, students who do not wish to comprehensively serve their patients are forced to defend their position. Quite simply, this is a curriculum where abortion is included where appropriate, just like any other common, safe procedure.

As recently as six or seven years ago, abortion was included in my medical school's curriculum, but no longer. The comprehensive curriculum I naively expected that would provide medical students with the knowledge to meet the common needs of their female patients simply does not exist. At a party last weekend I asked a few second years, four twenty-three-year-old men, to report back to me if they hear the "A" word at any time this semester. They gleefully dubbed themselves the "Medical Student Moles for Choice." Abortion is a shadow that wisps in and out of medicine, much like the quiet shadow of abortion in many women's lives, not addressed directly, not discussed in coffee shops or over family dinner.

Medical school is, in many ways, a language school. Someone told me once that a medical student learns over 20,000 new words in their first two years of school, and in addition to the new vocabulary, I soon became capable of saying things over dinner that one should never say. "Rectum" no longer induces giggles and "vagina" is boring, not sexy or empowering. And yet, the word "abortion" is still said with a pause, a nod, a little quieter than the rest of the sentence. I'm happy when we talk about it at all: for me, the problem is the deafening silence. That a procedure more common than an appendectomy would never be named: In the halls of science and healthcare, that to me is an abomination.

At one time at my medical school, a state institution of strong reputation in the Deep South, the physician responsible for the classroom teaching in women's reproductive health, "Dr. L," included a full hour lecture on the medicine and science of abortion care in the OB/Gyn curriculum. She included her own stories of patients, the hooks on which we medical students hang all this physiology and chemistry in our overtaxed memories. Even so, the students of this relatively conservative locale responded with powerfully reproachful marks on the course feedback forms. As student feedback influences not only the next year's teaching of any course but also the tenure and performance assessment of the teachers, physicians, themselves, Dr. L. was forced to remove the lecture. During the following few years, including my turn with her, she managed to sneak in ten minutes on abortion safety when discussing contraception. "Abortion is safe," was the message I heard, "but if you have a problem with it, you better be sure you know how to offer your patients appropriate birth control."

The real blow didn't come until the following year. Dr. L. moved on to another institution. With her went any mention of the science and medicine of abortion; the ethics class debate on the subject remains. This is how abortion education disappears from our medical schools – subtly and quietly. The students come and go, teaching physicians come and go, and few of us notice this loss from the classroom, the laboratory, the hospital room.

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Is it hopeless? Of course not. I have a dream curriculum, and I believe it can be attained. Including questions on abortion and other aspects of comprehensive reproductive healthcare in national medical board exams would re-enforce to medical schools that the subject should and must be taught. Recommended curricula from professional bodies like ACOG (the American College of OB/Gyns) could encourage directors of curricula at both the medical school and residency level to include abortion care requirements. Specific line item requirements from the national accreditation bodies could remind medical school deans every eight years that abortion is part of normal medical care. Until that day comes, with the support of Medical Students for Choice, we students will continue to fight for our own education. At the University of Alabama at Birmingham, we've invited abortion providers to talk with us about their careers and to teach us about the practicalities of the abortion procedure and running a practice, shadowed providers at a local clinic, and lobbied the administration for permanent, sustainable curricular change.

And what kind of curricular change would we endorse? No medical student can expect to graduate proficient in any single surgical technique, including abortion. But medical schools do spend four years preparing us to do anything in medicine, and preparation requires at minimum that one can say the word. The ethics of abortion can be discussed. Along with lectures on infertility and ovarian cancer, there would be lectures on the medical facts, the evidence-based medicine, of abortion. Specific training would be required on options counseling, just as we learn specific phrasing for eliciting a sexual history, or helping a patient quit smoking. The pharmacology of mifepristone (medical abortion), Plan B, and hormonal contraceptives would be used to help students understand the complexity of hormonal changes that result in the menstrual cycle. Electives would be available in the history of women's reproductive control, family planning, and abortion. And lastly, as part of the OB/Gyn rotation completed by every medical student, they would observe an abortion (with an opt-out option only), just as they observe birth, assist in C-sections, and perform routine Pap smears. This is the reproductive health curriculum I dream of at night, where students who do not wish to comprehensively serve their patients are forced to defend their position. Quite simply, this is a curriculum where abortion is included where appropriate, just like any other common, safe procedure.

Medicine today is "evidence-based." Treatments must be proven, tested, and extensively evaluated – the application of the scientific method for the benefit of consumers of medicine. In this way we protect our patients from damaging or unproven treatments. But in my medical school experience, it is very specifically the evidence surrounding abortion care that is omitted. We would like to think that medicine is a special place, constituted exclusively with those passionate about healing, not judging. The fact is, medicine is a community of human beings, every member carrying their own perspectives and prejudices. Our lack of abortion education has little to do with the choice of institution, or location, and everything to do with the universal issues of politics and fear.

Every activist for choice faces possible retaliation and danger; it is a risk we know well. In medicine, however, a relatively benign level of sidelining can suddenly block a physician, or nurse, or any healthcare provider from the community altogether. Without sanction from the professional field, in the form of a practice license, or training opportunity, or job, we cannot offer ourselves to the women and families we are here to serve. By nature an outspoken person, I sometimes now choose silence myself, thinking to the far-flung future, and my someday patients. Sometimes, without the support I get from my fellow students through Medical Students for Choice, I suspect my anxiety would win and I would never speak up at all.

I'm listening to Ani DiFranco's "Hello Birmingham." The song is for me a sort of lullaby, sung from the city of Buffalo to my city, Birmingham, recognizing the anti-choice violence survived by both cities. I listen to it when I'm angry, or moreover, when I need to remember to be angry. I turn it on when I find myself becoming numb to the norms of silence and misinformation. Sometimes, I turn it on when I get afraid, when I wonder if someone has me on a hit list. Would they even bother? I'm only a student. I have not yet performed an abortion, not yet had the chance to walk away from a day's work knowing I have changed someone's life, gave them myself, my hands, my years of training, as the tool they need to empower themselves, take back their control, perhaps just begin to unravel this one moment in their life. I cannot imagine any greater privilege.

News Politics

Anti-Choice Democrats: ‘Open The Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

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Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

News Politics

NARAL President Tells Her Abortion Story at the Democratic National Convention

Ally Boguhn

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates.

Read more of our coverage of the Democratic National Convention here.

Ilyse Hogue, president of NARAL Pro-Choice America, told the story of her abortion on the stage of the Democratic National Convention (DNC) Wednesday evening in Philadelphia.

“Texas women are tough. We approach challenges with clear eyes and full hearts. To succeed in life, all we need are the tools, the trust, and the chance to chart our own path,” Hogue told the crowd on the third night of the party’s convention. “I was fortunate enough to have these things when I found out I was pregnant years ago. I wanted a family, but it was the wrong time.”

“I made the decision that was best for me — to have an abortion — and to get compassionate care at a clinic in my own community,” she continued. “Now, years later, my husband and I are parents to two incredible children.”

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Hogue noted that her experience is similar to those of women nationwide.

“About one in three American women have abortions by the age of 45, and the majority are mothers just trying to take care of the families they already have,” she said. “You see, it’s not as simple as bad girls get abortions and good girls have families. We are the same women at different times in our lives — each making decisions that are the best for us.”

As reported by Yahoo News, “Asked if she was the first to have spoken at a Democratic National Convention about having had an abortion for reasons other than a medical crisis, Hogue replied, ‘As far as I know.'”

Planned Parenthood Federation of America President Cecile Richards on Tuesday night was the first speaker at the DNC in Philadelphia to say the word “abortion” on stage, according to Vox’s Emily Crockett. 

Richards’ use of the word abortion was deliberate, and saying the word helps address the stigma that surrounds it, Planned Parenthood Action Fund’s Vice President of Communication Mary Alice Carter said in an interview with ThinkProgress. 

“When we talk about reproductive health, we talk about the full range of reproductive health, and that includes access to abortion. So we’re very deliberate in saying we stand up for a woman’s right to access an abortion,” Carter said.

“There is so much stigma around abortion and so many people that sit in shame and don’t talk about their abortion, and so it’s very important to have the head of Planned Parenthood say ‘abortion,’ it’s very important for any woman who’s had an abortion to say ‘abortion,’ and it’s important for us to start sharing those stories and start bringing it out of the shadows and recognizing that it’s a normal experience,” she added.

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates. In April, Clinton called out moderators for failing to ask “about a woman’s right to make her own decisions about reproductive health care” over the course of eight debates—though she did not use the term abortion in her condemnation.