Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-03T00:48:02.692Z Has data issue: false hasContentIssue false

Chapter 14 - The Importance of Including Abortion in Undergraduate Medical Education

from Section II - Integration of Abortion into Graduate Medical Education

Published online by Cambridge University Press:  30 July 2021

By
Jody Steinauer  and
Teresa DePiñeres
Edited by
Uta Landy ,
Philip D Darney  and
Jody Steinauer
Uta Landy
Affiliation:
University of California, San Francisco
Philip D Darney
Affiliation:
University of California, San Francisco
Jody Steinauer
Affiliation:
University of California, San Francisco
Get access

Summary

Medical educators have a responsibility to train medical students in the competencies needed to improve the sexual and reproductive health (SRH) of their communities.Abortion is not only a core component of SRH care it is also common with 56 million annually worldwide. While abortion is very safe when provided by trained clinicians, almost half (45%) of abortions are practiced under unsafe conditions leading to an estimated 7 million complications and accounting for 8% of maternal deaths each year. According to the World Health Organization (WHO), unsafe abortion can be prevented by giving women access to legal abortion by trained, competent practitioners and timely emergency treatment of complications. Significant barriers to implementing abortion laws in these settings are the lack of properly trained health personnel and lack of abortion training in medical schools.This chapter begins with an overview of medical education standards and their relevance for sexual and reproductive health. It then reviews the literature about medical student education about abortion and includes a sample of regional and national organizational recommendations. It finally describes opportunities for inclusion of abortion in medical education, using the educational objective standards set by the World Federation of Medical Education.

Keywords

post-abortion careabortion policy
Type
Chapter
Information
Advancing Women's Health Through Medical Education
A Systems Approach in Family Planning and Abortion
 , pp. 143 - 150
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Haslegrave, M, Olatunbosun, O. Incorporating sexual and reproductive health care in the medical curriculum in developing countries. Reprod Health Matters. 2003;11(21):49–58. doi:10.1016/s0968-8080(03)02177-3CrossRefGoogle ScholarPubMed
Singh, S, Remez, L, Sedgh, G, Kwok, L, Onda, T. Abortion Worldwide 2017: Uneven Progress and Unequal Access. Washington, DC: Guttmacher Institute; 2018.CrossRefGoogle Scholar
Zane, S, Creanga, AA, Berg, CJ, et al. Abortion-related mortality in the United States: 1998–2010. Obstet Gynecol. 2015;126(2):258–265. doi:10.1097/aog.0000000000000945CrossRefGoogle ScholarPubMed
Ganatra, B, Gerdts, C, Rossier, C, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372–2381. doi:10.1016/s0140-6736(17)31794-4Google Scholar
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;123(9):1489–1498. doi:10.1111/1471-0528.13552CrossRefGoogle ScholarPubMed
World Health Organization. Preventing Unsafe Abortion: Evidence Brief. Geneva: World Health Organization Department of Reproductive Health and Research.Google Scholar
Benagiano, G, Pera, A. Decreasing the need for abortion: challenges and constraints. Int J Gynaecol Obstet. 2000;70(1):35–48. doi:10.1016/s0020-7292(00)00228-9Google Scholar
Dickson-Tetteh, K, Billings, DL. Abortion care services provided by registered midwives in South Africa. Int Perspect Sex Reprod Health. 2002;28(3):144–150.CrossRefGoogle Scholar
Stanhope, K, Rochat, R, Fink, L, Richardson, K, Brack, C, Comeau, D. Physician opinions concerning legal abortion in Bogota, Colombia. Cult Health Sex. 2017;19(8):873–887. doi:10.1080/13691058.2016.1269365CrossRefGoogle ScholarPubMed
World Health Organization. Safe Abortion: Technical and Policy Guidance for Health Systems. 2nd ed. Geneva: WHO; 2012. https://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf?sequence=1.Google Scholar
Shearer, JC, Walker, DG, Vlassoff, M. Costs of post-abortion care in low- and middle-income countries. Int J Gynaecol Obstet. 2010;108(2):165–169. doi:10.1016/j.ijgo.2009.08.037Google Scholar
WFME Global Standards for Quality Improvement: Basic Medical Education. London: World Federation for Medical Education; 2015.Google Scholar
Frenk, J, Chen, L, Bhutta, ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923–1958. doi:10.1016/s0140-6736(10)61854-5CrossRefGoogle Scholar
Mihciokur, S, Akin, A, Dogan, BG, Ozvaris, SB. The unmet need for safe abortion in Turkey: a role for medical abortion and training of medical students. Reprod Health Matters. 2015;22(44 Suppl 1):26–35. doi:10.1016/s0968-8080(14)43790-xCrossRefGoogle Scholar
O’Grady, K, Doran, K, O’Tuathaigh, CM. Attitudes towards abortion in graduate and non-graduate entrants to medical school in Ireland. J Fam Plann Reprod Health Care. 2016;42(3):201–207. doi:10.1136/jfprhc-2015-101244CrossRefGoogle ScholarPubMed
Provenzano-Castro, B, Oizerovich, S, Stray-Pedersen, B. Future healthcare professionals’ knowledge about the Argentinean abortion law. Int J Med Educ. 2016;7:95–101. doi:10.5116/ijme.56e0.74beGoogle Scholar
Al-Amoudi, SM, Al-Harbi, AA, Al-Sayegh, NY, et al. Health rights knowledge among medical school students at King Abdulaziz University, Jeddah, Saudi Arabia. PLoS One. 2017;12(5):e0176714. doi:10.1371/journal.pone.0176714Google Scholar
Sjostrom, S, Essen, B, Gemzell-Danielsson, K, Klingberg-Allvin, M. Medical students are afraid to include abortion in their future practices: in-depth interviews in Maharastra, India. BMC Med Educ. 2016;16:8. doi:10.1186/s12909-016-0532-5Google Scholar
Luleci, NE, Kaya, E, Aslan, E, Senkal, ES, Cicek, ZN. Marmara University medical students’ perception on sexual violence against women and induced abortion in Turkey. Balkan Med J. 2016;33(2):173–180. doi:10.5152/balkanmedj.2015.15230CrossRefGoogle ScholarPubMed
Medeiros, RDd, Azevedo, GDd, Oliveira, EAAd, et al. Opinião de estudantes dos cursos de Direito e Medicina da Universidade Federal do Rio Grande do Norte sobre o aborto no Brasil. Revista Brasileira de Ginecologia e Obstetrícia. 2012;34:16–21.Google Scholar
Kumar, R, Malik, S, Qureshi, A, et al. Comparative analysis of knowledge, attitudes and perceptions about induced abortions among medical and non-medical students of Karachi. J Pak Med Assoc. 2002;52(10):492–494.Google ScholarPubMed
Tocce, K, Sheeder, J, Vontver, L. Failure to achieve the association of professors in gynecology and obstetrics objectives for abortion in third-year medical student curriculum. J Reprod Med. 2011;56(11–12):474–478.Google ScholarPubMed
Cessford, TA, Norman, WV. Making a case for abortion curriculum reform: a knowledge-assessment survey of undergraduate medical students. J Obstet Gynaecol Can. 2011;33(6):580. doi:10.1016/s1701-2163(16)34905-2Google Scholar
Fernandes, KG, Camargo, RP, Duarte, GA, et al. Knowledge of medical abortion among Brazilian medical students. Int J Gynaecol Obstet. 2012;118(Suppl 1):S10–S14. doi:10.1016/j.ijgo.2012.05.004Google Scholar
Fayers, T, Crowley, T, Jenkins, JM, Cahill, DJ. Medical student awareness of sexual health is poor. Int J STD AIDS. 2003;14(6):386–389. doi:10.1258/095646203765371268CrossRefGoogle ScholarPubMed
Veazey, K, Nieuwoudt, C, Gavito, C, Tocce, K. Student perceptions of reproductive health education in US medical schools: a qualitative analysis of students taking family planning electives. Med Educ Online. 2015;20:28973. doi:10.3402/meo.v20.28973CrossRefGoogle ScholarPubMed
Smith, KG, Gilliam, ML, Leboeuf, M, Neustadt, A, Stulberg, D. Perceived benefits and barriers to family planning education among third year medical students. Med Educ Online. 2008;13:4. doi:10.3885/meo.2008.Res00250Google Scholar
Hogmark, S, Klingberg-Allvin, M, Gemzell-Danielsson, K, Ohlsson, H, Essen, B. Medical students’ knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India. BMJ Open. 2013;3(12):e003739. doi:10.1136/bmjopen-2013-003739CrossRefGoogle ScholarPubMed
Suphanchaimat, R, Boonthai, N, Tangthasana, S, Putthasri, W, Tangcharoensathien, V, Chaturachinda, K. A survey of manual vacuum aspiration’s experiences among the new medical graduates in Thailand. Reprod Health. 2013;10:49. doi:10.1186/1742-4755-10-49Google Scholar
Espey, E, Ogburn, T, Chavez, A, Qualls, C, Leyba, M. Abortion education in medical schools: a national survey. Am J Obstet Gynecol. 2005;192(2):640–643. doi:10.1016/j.ajog.2004.09.013Google Scholar
Steinauer, J, LaRochelle, F, Rowh, M, Backus, L, Sandahl, Y, Foster, A. First impressions: what are preclinical medical students in the US and Canada learning about sexual and reproductive health? Contraception. 2009;80(1):74–80. doi:10.1016/j.contraception.2008.12.015CrossRefGoogle ScholarPubMed
Tey, NP, Yew, SY, Low, WY, et al. Medical students’ attitudes toward abortion education: Malaysian perspective. PLoS One. 2012;7(12):e52116. doi:10.1371/journal.pone.0052116CrossRefGoogle ScholarPubMed
Biggs, MA, Casas, L, Ramm, A, Baba, CF, Correa, SV, Grossman, D. Future health providers’ willingness to provide abortion services following decriminalisation of abortion in Chile: a cross-sectional survey. BMJ Open. 2019;9(10):e030797. doi:10.1136/bmjopen-2019-030797Google Scholar
Fitzgerald, JM, Krause, KE, Yermak, D, et al. The first survey of attitudes of medical students in Ireland towards termination of pregnancy. J Med Ethics. 2014;40(10):710–713. doi:10.1136/medethics-2013-101608CrossRefGoogle ScholarPubMed
Joffe, C. The crisis in abortion provision and pro-choice medical activism in the 1990s. In Abortion Wars: A Half Century of Struggle, 1950–2000. Berkeley: University of California Press; 1998:320–334.Google Scholar
Evans, ML, Backus, LV. Medical students for choice: creating tomorrow’s abortion providers. Contraception. 2011;83(5):391–393. doi:10.1016/j.contraception.2011.01.019CrossRefGoogle ScholarPubMed
O’Shea, M. Education in abortion care in Ireland: Medical Students for Choice (MSFC) taking a lead. TSMJ. 2017;35(41).Google Scholar
Espey, E, Ogburn, T, Leeman, L, Nguyen, T, Gill, G. Abortion education in the medical curriculum: a survey of student attitudes. Contraception. 2008;77(3):205–208. doi:10.1016/j.contraception.2007.11.011Google Scholar
Steele, R. Medical students’ attitudes to abortion: a comparison between Queen’s University Belfast and the University of Oslo. J Med Ethics. 2009;35(6):390–394. doi:10.1136/jme.2008.026344Google Scholar
Guiahi, M, Maguire, K, Ripp, ZT, Goodman, RW, Kenton, K. Perceptions of family planning and abortion education at a faith-based medical school. Contraception. 2011;84(5):520–524. doi:10.1016/j.contraception.2011.03.003Google Scholar
Burton, R. UK medical students should be taught how to manage unwanted pregnancy. BMJ. 2018;362:k3800. doi:10.1136/bmj.k3800Google ScholarPubMed
Undergraduate Training in O&G. London: Royal College of Obstetricians & Gynaecologists; 2020. rcog.org.uk/en/careers-training/specialty-training-curriculum/undergraduate-training-in-og/Google Scholar
APGO. APGO Medical Student Educational Objectives. 2019. https://cdn.ymaws.com/apgo.site-ym.com/resource/resmgr/apgo-11th-ed-mso-book.pdfGoogle Scholar
Obeso, V, Brown, D, Aiyer, M, et al. (Eds.). Core Entrustable Professional Activities for Entering Residency: Toolkits for the 13 Core EPAs. Washington, DC: Association of American Medical Colleges; 2017.Google Scholar
Gonzalez Velez, AC. “The health exception”: a means of expanding access to legal abortion. Reprod Health Matters. 2012;20(40):22–29. doi:10.1016/s0968-8080(12)40668-1CrossRefGoogle ScholarPubMed
ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. doi:10.7326/0003-4819-136-3-200202050-00012CrossRefGoogle Scholar
Pomerantz, T, Turk, J, Simonson, K, Steinauer, J, Landy, U. Integrated training for residents in family planning and abortion – do medical students benefit? Involvement in Ryan Residency Program Family Planning and Abortion Training. Poster presentation. 2014.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×