Abortion training is a required component of US ob-gyn graduate medical education training and recommended in family medicine training. While individual residents may choose to opt out of training in certain conditions – namely personal or religious conflicts- this chapter describes the importance of facilitating participation of residents up to their comfort level in order to learn the essential and transferable skills in the provision of women’s health care.   This chapter describes the history of partial participation and provides evidence from multiple studies which have found that learners who object to abortion but partially participate in training in family planning and abortion gain important clinical and professional skills and appreciate the training. It describes various protocols and guidance for teaching leadership to support partial participation, specifics on setting clear expectations, and suggestions for when to facilitate discussions for residents who aren’t certain about the participation level, or plan to opt out.

Abortion has been available in Sweden, since 1975, on request and without regards to reason, for up to 18 weeks’ gestation and in specific circumstances through 21 +6 weeks’ gestation. Abortion care is viewed as core component of obstetric and gynecological and midwifery care. Medical students in Sweden all receive theoretical training and are offered clinical rotation to abortion care. Similarly, all students in midwifery receive theoretical training in abortion and some clinical training. Core competencies for the registered nurse-midwives include the ability to care for women in abortion care including post abortion contraceptive counselling and provision. For residents in obstetrics and gynecology, training in abortion care is mandatory. Not permitting conscientious objection for any professional cadre guarantees prompt access to services for women seeking abortion care in Sweden, consistent with the principle that abortion is a right and a core service to which access should not be delayed.

Abortion is generally a simple, safe procedure; providing it in a general academic obgyn setting poses unique opportunities and challenges for patients, providers and learners. This chapter reviews options and considerations and provides resources for starting and improving a teaching abortion service, including guidelines, patient education, and important relationships to consider. The family planning teaching services at UCSF and UCSF’s Zuckerberg San Francisco General Hospital are presented as two different service and teaching examples. Abortion services can raise challenges with policies, insurance, scheduling, clinic safety and staff refusals to take care of patients. Patients face their own challenges to seek care, such as stigma, travel, poverty, and intense emotions, and many have experienced domestic violence and sexual assault. Residents and students need to address their personal emotions in addition to learning clinical skills. Providing patient-centered abortion services, particularly for patients who cannot be seen elsewhere, is an issue of equity that makes it highly valuable learning opportunity.