Medical students’ limited opportunities to train in abortion procedures are a major barrier to care in the United States. Many schools intentionally choose not to include abortion in the curriculum or only offer “opt-in” training. A national survey of medical schools in 2005 found that only 32 percent offered at least one abortion-related lecture during students’ third-year OB-GYN rotation, and only half of schools offered a fourth-year reproductive health elective that covered family planning and abortion.
Such restricted opportunities for abortion training are, of course, a result of institutionalized stigma, often forcing interested medical students to go above and beyond their school’s curriculum to learn abortion care clinical skills and reinforcing the shame surrounding this simple and common medical procedure.
But as bad as the situation is in the United States for medical students, it’s actually much worse in many international settings—including our own home countries. Michalina is in medical school in Poland, where abortion is not typically included in any OB-GYN class curricula. In fact, Poland’s government attempted to pass a total abortion ban just last year. Polish health-care providers who do manage to obtain training and offer safe abortions do so with great discretion; they risk being ostracized socially and professionally. And in Nicaragua, where Cecilia lived and worked until moving to the United States four years ago, a complete ban on abortion means medical schools offer zero training in this often lifesaving care.
Thanks to these kinds of policies, we have found that many medical students—from all parts of the globe—are in the dark about the fact that the procedure, when done safely and legally, has minimal risk of complications. Medical students without abortion training or knowledge go on to become doctors who cannot and will not perform the procedure, even in countries where it’s legal. Having internalized the stigma around abortion themselves, these doctors may refuse mid-career training on the procedure even if their community has a clear need for the service, and they may judge, scorn and turn away patients who seek safe abortions at health clinics—in turn giving people no other option than to seek unsafe, clandestine procedures.
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That’s why the International Federation of Medical Students’ Associations (IFMSA), one of the world’s oldest and largest student-run organizations, has partnered with Ipas, a global NGO dedicated to ending deaths and injuries from unsafe abortion, to develop a training for future health professionals on the importance of safe abortion access.
Our work together began in 2010 with a collaboration between Ipas Nigeria and the Nigerian Medical Students’ Association, which then evolved into a global-level partnership. IFMSA engages a network of more than one million medical students from 115 countries, and a total of approximately 4,000 students attend annual regional meetings held around the globe. To capitalize on the organization’s vast reach, together we created a training guide that IFMSA student leaders use at their regional meetings to offer a crash course on the public health issue of unsafe abortion and how health-care providers can be advocates for abortion access—regardless of whether they ever provide the service or where they work in the health system. Trainings began in 2013 at a regional meeting in Ethiopia, and Michalina, as a leader with IFMSA’s committee on sexual and reproductive health issues, has now helped facilitate six of these trainings in various regions.
Rather than offer clinical abortion skills training, we recognized that what many medical students need first is an opportunity to talk openly about the myths, misconceptions, and biases about abortion they’ve inherited from their respective cultures. Training participants explore how unsafe abortion affects women and societies and how practicing health professionals can reduce the many barriers to abortion care that patients face. A section of the training also demystifies clinical aspects of abortion care with an overview of safe procedure methods and the importance of patient-centered care. Finally, students learn strategies for advancing abortion rights and access, and practice skills like advocacy and peer education.
You can’t expect a roomful of strangers to instantly feel comfortable discussing such a stigmatized topic, so our training involves many participatory activities that allow students to clarify their own values and beliefs related to abortion and to challenge themselves by considering a variety of others’ perspectives—including those of fellow training participants, as well as people seeking abortions, their families, and the health professionals who provide them. One popular activity asks students to brainstorm all the many reasons why a person may want or need an abortion and then to discuss which reasons society deems more acceptable. The activity sparks conversations about differing cultural beliefs and the subconscious biases we all carry.
The “ah-ha!” moments that occur at these trainings are pretty remarkable. Students from the United States, carrying the burden of their country’s uniquely toxic political climate around abortion, are frequently shocked to discover the wide array of other students’ experiences. For example, students from Western Europe will note that immigrants in their countries struggle to access safe abortions due to factors like immigration status, language barriers, and lack of information, even though the procedure is legal and not highly stigmatized. Meanwhile students from some African nations all know of at least one woman whose life was claimed by unsafe, clandestine abortion—often obtained illegally.
Students are also regularly surprised to learn about the abortion laws in their own countries. Many simply assume tight legal restrictions on the procedure because of the way medical schools and health systems avoid the topic as if it’s forbidden. A group of students from Tunisia, for example, were shocked to learn in early 2015 that their country’s abortion law is quite progressive—and outraged that they had been uninformed. After participating in our training, they started a project to educate other Tunisian medical students about the abortion law and other policies that advance reproductive health and rights.
Perhaps the most rewarding part of these trainings—and we’ve seen it again and again—is when students begin our workshop staunchly opposed to abortion and leave committed to abortion rights advocacy and excited to educate their peers at home on the topic. We’ve been careful not to impose a particular view on abortion in the exercises that comprise our training, and we hear routinely from students that they didn’t feel pushed to adopt a particular outlook. Rather, they feel grateful for the opportunity to have open, honest dialogue—often for the first time. This dialogue, they say, allows them to dispel myths and better understand what their role might be in supporting access to safe, legal abortion in the future.
The first step to ending abortion stigma is education—and making people conscious of the problem. IFMSA regional meetings for the 2015-16 academic year kicked off in Rwanda in December, where we trained 13 medical students from across Africa. In January, we trained 42 students at the Americas regional meeting in Uruguay, and another ten students at the Eastern Mediterranean regional meeting in Jordan. We expect similarly robust and stimulating conversations in the trainings to come this spring. And we hope that region by region, year after year, we are laying the groundwork on a global scale for more pro-choice health systems with providers who advance, rather than restrict, women’s sexual and reproductive health and rights.