Learning how to perform an abortion is not ubiquitous across medical education.
A 2020 study from Stanford University found that half of medical schools in the U.S. offer just one lecture or include no formal training on abortion-related topics. And while offering abortion training is required by national accreditation boards, schools sometimes disobey that requirement — and students can opt out of the training, which could affect access to other needed procedures.
At Meharry Medical College, students can opt out of abortion education, which happens in the four specialized OB-GYN residency years following medical school. Vanderbilt University refused to comment on the matter, though the presence of a Ryan Residency program (an abortion curriculum provider) at the school suggests that it’s not a part of the curriculum, and must be sought out by students.
This falls in line with the American Association of Medical Colleges Accreditation Council’s stance — requiring access to abortion training for all obstetrics and gynecology residency programs, noting that students can choose not to participate in the training.
Dr. Howard Herrell is incoming chair of the Tennessee Chapter of the American College of Obstetricians and Gynecologists. He says it’s important that students learn the dilation and evacuation procedure, because it’s the same procedure used for a fetus that is no longer alive, a termination to save the life of the mother, or in some cases, to treat excessive bleeding or take a biopsy from the uterus. These scenarios for the termination of a pregnancy are frequently referred to university settings where residents can provide the services, he adds.
“Even if they morally object to doing them, they’ll still learn how, because enough women suffer pregnancy losses that need completion, at all gestational ages,” says Herrell. “A graduate from a residency program should be able to terminate a pregnancy.”
Pending the overturn of Roe v. Wade and Tennessee’s abortion trigger law going into effect, Herrell is concerned that gynecologists could face criminal charges for performing the dilation and evacuation procedure at all — causing a chilling effect on instruction as well.
“That’s a huge, vast gray area that on one hand has things like ectopic pregnancies — am I allowed to … do a surgery to remove an ectopic pregnancy before it ruptures and kills you?” he says. “To grayer areas like babies who are missing their brain, or mothers who have cardiac defects that if they choose to carry the pregnancy will give them a 50, 60, 70 percent chance of death.”
If their fetus has died, a pregnant person will still be able to get an abortion no matter the gestation, Herrell says. Even so, it’s hard to prove what the outcome would have been for a pregnancy with medical complications — plus, pregnant people all have different risk tolerance. This puts physicians in a precarious position, at the mercy of how their local district attorney interprets the law. He hopes to see state legislatures leave this decision up to the patient and the physician.
“Obstetrics is unique in that we’re balancing two interests,” Herrell says. “We have the health of the pregnancy, of the fetus, and we have the health of the mother. Sometimes those are at odds, and sometimes we make decisions that favor one party over the other, and we do that in a very gray murky area. That also needs to include your own desires and wants and beliefs.”
How a Roe v. Wade reversal would play out in Tennessee, and ways to support the right to choose in our state
