Kalin Gregory-Davis is a fourth-year medical student at the University of Vermont. She has known since she started at Larner College of Medicine – Vermont’s only medical school – that she would like to be an abortion provider.
In fact, part of the reason she decided to go to medical school in Vermont is that the state is unlikely to restrict access to abortion. This is in contrast to Texas, Alabama or Louisiana, where significant restrictions have made it difficult to get training in abortion procedures, according to Pamela Merritt, CEO of Medical Students for Choice, an organization that helps medical students get training in how to terminates a pregnancy.
Through Gregory-Davis’ earlier years in medical school, she was able to learn something about abortion. One class in each of her first two years briefly covered the topic, then in her third year she applied for a clinical rotation in reproductive health at Central Vermont Medical Center in Berlin.
“I saw no abortions at Central Vermont Medical Center, and it was difficult for me because I wanted to, as someone who really cares about this,” Gregory-Davis said. So she reached out to a doctor in Plattsburgh, New York, and spent a day at Planned Parenthood with him. “But it was entirely me led,” she said.
Gregory-Davis has chaired the board of the Medical Students for Choice at UVM, where she organized movie screenings, discussion groups, and supplemental learning opportunities for her classmates. However, she said attendance was often not large, which she says medical students are simply incredibly busy.
She is now completing a rotation at an abortion clinic in New Mexico and said she feels grateful that she has been able to gain as much hands-on experience as she has. She said UVM always supported her when she was looking for opportunities from outside to train in abortion care.
Although she knows that Larner College of Medicine is ahead of many other medical schools in the country – where abortion procedures are sometimes not taught at all – she wished abortion had taken up more of the curriculum. Not just to learn the procedures, which are pretty simple, she said, but to navigate the complicated problems that swirl around.
“The impact of laws, racial inequality, different laws, and who influences them the most … these are important conversations for medical students to have,” Gregory-Davis said.
Year by year
The medical school at UVM has 479 students, of which about 10% go on to stay in obstetrics and gynecology, according to Lauren MacAfee, an assistant professor at Larner College of Medicine and the primary abortion provider at UVM.
About one-third of Larner graduates are now physicians in Vermont or have completed their residency in the state.
Based on the latest available figures, 1,300 abortions were performed in Vermont in 2017. In 2010, the state had 699 publicly funded abortions, all state-funded; no federal money was spent.
Vermont uses its own funds to cover all or most of the “medically necessary” abortions sought by low-income women under Medicaid.
MacAfee has spent the last five years incorporating abortion into the medical school curriculum in a more meaningful way.
Before MacAfee started on UVM, the only exposure medical students had to abortion at all was short-lived in their third year. Now abortion is discussed during each year of their education.
During their first year, all students take a class called Professionalism, Reflection, and Communication, which deals with physician-patient relationships. The class examines personal imbalances in medicine and how a patient’s identity informs care. In a class session, students discuss abortion. MacAfee describes it as an “ethical and political thing”, not specific training in how to perform the procedure.
In their second year, students take a class on reproductive health, which includes a 90-minute session outlining the basics of medical treatment involved in abortion.
“I’m also talking about the role of politics in medicine,” said MacAfee, who is chairing the session, “and we’re talking about how you provide this procedure, depending on the state where you live.”
“I do not do it to be pro- or anti- or anything … but just to highlight some of the differences (in) what it means for patients. It affects the patients who come in for this procedure,” he said. she.
In their third year, all students undergo an OB-GYN clinical rotation, where they may have the opportunity to see an abortion – depending on where they are posted and who happens to need care during the short time they are there. Because the University of Vermont does not have a particularly large number of abortion patients, students often will not see the procedure.
Finally, in their fourth year, MacAfee is offering an online family planning course for students interested in reproductive health. It includes “abortion, abortion, and conception care.” Students can take the course for either two or four weeks and have the chance to find out specific elements of family planning care.
“You can take a deep dive into emergency contraception, abortion – not just the medical piece, but sociopolitical components related to it,” MacAfee said.
MacAfee stressed that all abortion training is optional.
“We fully support opt-out and partial participation. We want to be supportive of students having the medical knowledge they need, but without compromising on any personal beliefs,” said MacAfee, who also stressed , that students’ grades are in no way affected if they decide to opt out of discussions about abortion.
Every fourth woman
In 2019, the U.S. Department of Health and Human Services accused UVM Medical Center of forcing a nurse to assist in an abortion procedure despite the nurse’s religious objections.
The Justice Department eventually filed a lawsuit in a federal court in the final days of the Trump administration, but under Biden, the course reversed and eventually the lawsuit dropped last summer.
That ordeal made the university concerned about ensuring that students can always opt out of abortion training at any level. Opting out of religious objections has always been an option, but some believe the procedure is common enough for medical students to at least have an abortion practice.
There were no figures available on how many Larner students have opted out of abortion training.
In the United States, one in four women will have an abortion at the age of 45, making it one of the most common medical procedures in the country.
“I think it should be something everyone needs to learn about to become a doctor,” Gregory-Davis said.
Allison Bates, director of medical abortion, sedation and ultrasound at Planned Parenthood in northern New England, supports students who opt out of practical abortion training, but believes that all students should at least be required to discuss one of the most common medical procedures in the world.
“They should have the framework and the ability to talk about it as an essential element of reproductive health care,” she said.
State Senator Ruth Hardy, D-Addison, who worked at Planned Parenthood before becoming a senator, supports the opt-out election, but hopes medical schools emphasize to students the importance of training in the procedure.
“There are cases where a woman will die if they do not have an abortion, so if you are an emergency room physician and you do not know how to do it, I think you are limited in your skills,” Hardy said. “I hope (medical schools) explain the reality to medical students that they may be in a situation where it is necessary and they may need to know how to do it.”
But others disagree.
“Maybe you went to medical school to save lives, not to be involved in things you feel are against your conscience, so (the medical field) will lose some excellent staff if they start imposing this training,” Mary said. H. Beerworth, CEO of Vermont Right to Life.
A national lack of education
UVM is considered one of the most abortion-friendly medical schools in the country, although that education is quite limited.
Lack of education in abortion care is a major problem nationwide, and the fact that UVM students have the opportunity to discuss the procedure themselves is unique.
Several factors can make it very difficult to get training in this simple and common procedure.
First, in states like Texas that have severe abortion restrictions, it is difficult for students to get a chance to witness an abortion because they are becoming more and more rare.
Another issue: medical schools with religious affiliations. Abortion violates Catholic medical principles, and schools affiliated with the Catholic Church cannot teach it.
Now, some state legislators are working to prevent publicly funded universities from joining organizations that perform abortions. It often happens under the radar, as was suggested in Missouri. House Bill 302 is still pending in the House Ways and Means Committee, billed as a proposal to amend “tax provisions.” But part of the bill would tax the grants to any university affiliated or referring students to train with an abortion provider.
“It’s an obvious example of what’s going on hidden in state legislatures across the country,” said Merritt, of Medical Students for Choice. Such bills, even if they are not passed, are probably a threat that schools are afraid to offer appropriate abortion training, she said.
“In states with legislative assemblies that are hostile to abortion, knowledge, the ever-present reality, is that if you work with an abortion provider for education and training, you could be punished – it’s a deliberate threat that is posed, and it is very difficult for universities not to react to that, ”Merritt said.
And without abortion training, some states are struggling to find enough providers.
“Without a provider pipeline, abortion is just a dish in the name,” Merritt said.
In 2020, the Guttmacher Institute characterized Vermont as a state that “leans supportively” in terms of abortion rights. With Proposition 5 en route through the Legislative Assembly this session, en route to voters next November, the state could be the first to make the right to “reproductive freedom” part of the state constitution.
The Vermont legislature has never seriously considered proposals that would restrict access to abortion in the state.
“I always use Vermont as a highlight in a state where we do not restrict access to abortion in the ways that other states do, and by codifying it, it really provides support not only to providers but to patients,” he said. MacAfee.
Still, MacAfee said, UVM has no current plans to expand its abortion training program.
Gregory-Davis would like to see more emphasis on the complicated sociopolitical climate around abortion, but is quite happy with what UVM is offering students now – especially compared to other states.
“In Vermont, I’ve been very lucky and felt supported. People have generally been like, ‘Yeah, we should learn about that,'” Gregory-Davis said.
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