Providing Providers: Abortion Training for Physicians in the United States, 1920-2007

by Ayres, Soledad Tarka

This work was designed to investigate the teaching of induced abortion to allopathic medical doctors in the twentieth-century United States. Elective termination of pregnancy is an extremely common procedure in the United States (1). While abortions have been and continue to be performed by nurses and midwives as well as by physicians, the training of medical doctors is of particular interest. Their lengthy formal training and historical stature as a highly educated group have garnered a respect in the public eye and an image as safe and knowledgeable providers, even where abortion training might have been lacking. This project aimed to determine the exposure of medical students and residents to abortion procedures in their routine course of training. A literature search was conducted, including journal articles, books, and conference proceedings from 1920 to 2007. Particular attention was paid to reports of medical student and resident didactic and clinical experience with abortion. Resident experience with management of incomplete abortions was considered as an additional source of procedural experience prior to legalization. The most surprising finding was that residents might have had greater procedural experience prior to legalization of abortion. In the era of illegal abortion, many women presented to hospitals with incomplete abortions, which were managed using techniques that could also be employed to interrupt a stable pregnancy. Residents thus had more procedural training and experience with complications. Once abortion was legalized, these cases dropped dramatically. Since most abortions took place and continue to take place in freestanding outpatient clinics, training physicians have little exposure. So while training in pregnancy options counseling may now be available where it was previously lacking, the technical skills needed to provide safe and effective terminations may be more difficult for residents to acquire.