The integration of abortion into obstetrician-gynecologists' practice after comprehensive family planning resident training.

OBJECTIVES: To explore the impacts of routine family planning and abortion training during residency on abortion practice between three and ten years after residency. STUDY DESIGN: In 2018, we surveyed 771 graduated obstetrician-gynecologists at least three years after residency about their current abortion practice. Respondents consented to join a prospective cohort as part of routine, post-rotation evaluation of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning. We matched and then de-identified post-rotation and post-residency surveys, and conducted bivariate and multivariable analyses. RESULTS: Of 463 respondents (60% response rate), 188 (41%) reported that they provide abortions (median of eight abortions per month) in their current practice. Eighty-eight (19%) do not provide abortions but would if not restricted by their practice. One hundred-fifty respondents (32%) reported abortions are out of their practice scope or that someone else in their practice provides abortions, and 38 (8%) do not desire to provide abortion care. Two hundred twenty-six (54%) reported practice or hospital group restrictions to abortion care. In multivariable analyses controlling for demographics, training, attitude and practice factors; geographic location, practice restrictions and logistical barriers, among other variables, correlated with abortion practice (practice in the West: odds ratio (OR) 2.3; 95% confidence interval [CI], 1.3-4.2; p = 0.01; logistical barriers: OR 0.3, CI 0.1 to 0.7, p = 0.01; and practice restrictions OR 0.5, CI 0.3 to 0.8, p = 0.01). CONCLUSIONS: Nearly half of Ryan Program-trained obstetrician-gynecologists provide abortions. However, many barriers prevent the integration of abortion into practice. Healthcare providers and leaders should work to eliminate barriers to the provision of abortion care. IMPLICATIONS: Regardless of their intentions at the time of training, nearly half of Ryan Program-trained obstetrician-gynecologists provide abortions in practice, and another 19% would if not restricted by their practice. Integrated training is critical to abortion care, and efforts to overcome practice barriers could improve access to comprehensive health care.

Abortion training in U.S. obstetrics and gynecology residency programs.

The majority (72 percent) of U.S. residency programs in obstetrics and gynecology include first-trimester abortion techniques in their training. Programs affiliated with public hospitals or with private non-Catholic institutions are the most likely to provide such training, while Catholic-affiliated training programs and those at military hospitals are the least likely to do so. Approximately 23 percent of institutions include abortion training as a routine part of residency, and 50 percent offer it as optional training. The 28 percent of residency programs that offer no abortion training represents an almost fourfold increase since 1976. Although more of the large programs affiliated with public hospitals now include such training as a routine part of their residency programs, fewer of the private non-Catholic programs--where the largest proportion of residents are trained--do so. Consequently, the number of residents exposed to abortion training may have declined slightly over the past decade. Little difference exists between the proportion of programs that offer training in first-trimester techniques and the proportion that train in second-trimester techniques. Nine percent of programs report that all residents participate in first-trimester abortion training, and another 56 percent report that at least half of their residents do so. The participation rate is linked to the expectations of the program: Approximately 88 percent of programs that routinely incorporate abortion techniques in their training report that from one-half to all their residents participate, compared with about 55 percent of programs that offer the training as an option. Approximately 82 percent of programs teach abortion techniques up to at least 20 weeks' gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: 72% of US residency programs in obstetrics and gynecology include 1st-trimester abortion techniques in their training. Programs affiliated with public hospitals or with private non-Catholic institutions are the most likely to provide such training, while Catholic-affiliated training programs and those at military hospitals are the least likely to do so. About 23% of institutions include abortion training as a routine part of residency, and 50% offer it as optional training. The 28% that offer no abortion training represents an almost 4 fold increase since 1976. The total number of residents exposed to abortion training may have declined slightly over the past decade. 9% of programs report that all residents participate in 1st-trimester abortion training, and another 56% report that at least 1/2 of their residents do so. About 88% of programs that routinely incorporate such training report that from 1/2 to all of their residents participate, compared with about 55% of programs that offer the training as an option. Approximately 82% of programs teach abortion techniques up to at least 20 weeks' gestation. However, in only 10% of programs do residents collectively perform more than 10 abortions per week.

Abortion counselling--a new component of medical care.

PIP: Focus in this discussion of abortion counseling is on: the purpose of counseling -- informed consent, decision making, patient education and preparation, emotional support; the underlying assumptions of counseling; who provides the counseling; and issues in abortion counseling. It is essential to establish that the woman consents to the abortion with a full understanding of her choices and the medical risks. Unless a woman is retarded, emotionally severely disturbed, or very young, there usually is little question about her competence to provide informed consent. The abortion counselor must be capable of distinguishing between "normal" feelings of ambivalence and genuine confusion. Once the woman has decided to have an abortion, the counselor needs to describe the method of abortion, explaining instruments, logistics, choice of anesthesia, and the types of sensations and reactions she can expect during and after the abortion. The use of simple, nonmedical language is preferable. Emotional support can be provided by establishing rapport with the patient, being empathetic, listening actively, giving permission to express feelings, and being nonjudgmental. Some major themes which consistently appear in counseling sessions are conflicts with the partner; guilt; ambivalence; anger; fear of pain, the medical procedure, and future childbearing; and concern about suitable birth control. Education and discussion can help to alleviate fears. answer contraceptive concerns, and ease decision making. The profession of abortion counselor was created in the US after the legalization of abortion. The counselor, usually a woman, may have a background or training in social work, psychology, sociology, counseling, or nursing. Counselors are trained at the abortion facility and may on occasion attend training seminars. Common areas of concern for the abortion counselor include the setting of counseling, the length of counseling, counselor stress, professional burnout, 2nd trimester counseling, and coping with special patients. The remainder of the discussion covers 2nd trimester abortion counseling and those patients who can present special problems for the counselor.^ieng

Administrative, counseling and medical practices in National Abortion Federation facilities.

A survey of members of the National Abortion Federation (NAF), most of them non-hospital facilities, responsible for performing almost half of the abortions in the United States, was carried out by the NAF in 1981. Among the principal findings were the following: Fifty-three percent of the NAF facilities are freestanding clinics operated for profit. Fifty-one percent are open more than 50 hours per week, and 77 percent are open six days a week; 86 percent are open on Saturdays. Seventy-five percent of the physicians performing abortions in these facilities are gynecologists. Counseling provided by specially trained abortion counselors is a unique contribution of abortion facilities to health-care delivery. Virtually all facilities employ counselors who are neither doctors nor nurses. Most NAF facilities have more counselors than nurses and more nurses than doctors. Counseling in virtually all facilities includes providing written as well as verbal information about the nature of the procedure and its medical risks; such information is given to the patient so that she can give informed consent for the abortion. Almost all facilities include information about contraception and about the options available to a woman with a problem pregnancy. Most offer counseling to the male, as well as the female partner, on the patient's request. Twenty-eight percent of facilities generally provide both individual and group counseling. Where only one type of counseling is provided, it is usually individual counseling.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: A survey of members of the National Abortion Federation (NAF), most of them nonhospital, and responsible for performing almost half of the abortions in the United States, was carried out by the NAF in 1981. Findings show that 53% operate for profit, they are open 5 days or more per week, and 75 percent of physicians in the clinics are gynecologists. There are more counselors than nurses and more nurses than doctors. Counseling is written and verbal; there is individual and group counseling. Minors are encouraged to involve parents but most facilities do not require the minors to do so. Pregnancy tests are usually required and most facilities do not require appointments or referrals. Abortions take place within a week of the pregnancy test. 20 to 25% of nonhospital facilities offer abortion in the second trimester but 83% of clinics and 62% of physicians performing abortion in their offices do so. Facilities use metal dilators (89%), laminara (15%), for 1st trimester abortions, for 2nd trimester D&E procedures, laminaria was used as often or more often. Contraceptive services are made available and followup visits are recommended. There is 24 hour contact in case of emergencies. NAF nonhospital clinics are more likely than nonmember clinics to provide abortion services primarily.