History of Services and Training since Legalization of Abortion: Successes and Challenges
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1 History of Services and Training since Legalization of Abortion: Successes and Challenges
2 Uta Landy, PhD National Director, Ryan Residency Training Program and Fellowship in Family Planning Bixby Center for Global Reproductive Health University of California, San Francisco, USA 70th Annual Obstetrical and Gynecological Assembly of Southern California Marriott Marina Del Rey, California - May 8, 2015
3 42 nd Anniversary of Abortion Legalization in the USA Focus on: Abortion Deaths in the USA, Safety Access Politics What is left out?
4 Abortion Training in USA After Legalization
5 Where Are Abortion Performed? No. of providers (defined as sites) 1,600 1,400 1,200 1, Abortion clinic Other clinic Hospital Physician's office Source: Jones et al., 2014
6 Academic Leadership In 1972, AJOG published A Statement on abortion by one hundred professors of obstetrics Focused on projected numbers of abortion, meeting the demand, and safety and service delivery recommendations.
7 We have had 40 years of medical progress but have witnessed political regression that the 100 professors did not anticipate.
8 100 Professors of Obstetrics and Gynecology 40 Years Later Signed by 79 chairs along with deans and professors from 37 states, as well as Puerto Rico and Washington, DC
9 US Training Mandate access to induced abortion must be a part of residency education. - Program Requirements for Residency Education in Obstetrics and Gynecology, Accreditation Council for Graduate Medical Education (ACGME), January 1996
10 American College of Obstetricians and Gynecologists (ACOG), 1995: We believe that abortion training needed to go back into the mainstream of medical training. Krendl, Abortion in the Curriculum, Harvard Crimson, March 1, 1995
11 Coats Amendment 1996 The Coats Amendment: residency programs will be deemed accredited by the federal government, or any state or local government that receives federal funds, even if programs fail to comply with abortion training accreditation requirements. In response to constituents' requests for clarification, the ACGME rewrote its guidelines to require that residency programs with a moral or religious objection to abortion not impede students from seeking abortion training elsewhere.
12 Abortion Training in USA After Legalization
13 Kenneth J. Ryan Residency Training Program founded in USA in 1999
14 Ryan Program Mission Formally integrate abortion and advanced contraception training into residency education Support departments in complying with the ACGME mandate Mainstream family planning education and services in teaching hospitals
15 80 Ryan Program Sites WASHINGTON OREGON NEVADA IDAHO MONTANA WYOMING NORTH DAKOTA SOUTH DAKOTA NEBRASKA MINNESOTA IOWA WISCONSIN MICHIGAN OHIO PENNSYLVANIA VERMONT NEW YORK MAINE NEW JERSEY NEW HAMPSHIRE MASSACHUSETTS RHODE ISLAND CONNECTICUT CALIFORNIA UTAH ARIZONA COLORADO NEW MEXICO KANSAS OKLAHOMA MISSOURI ARKANSAS ILLINOIS INDIANA TENNESSEE KENTUCKY WEST VIRGINIA VIRGINIA NORTH CAROLINA SOUTH CAROLINA DELAWARE MARYLAND WASHINGTON, DC Current Ryan Program GEORGIA TEXAS LOUISIANA ALABAMA MISSISSIPPI FLORIDA No Ob-Gyn Residency ALASKA HAWAII PUERTO RICO 80 programs in 34 states, 2 Canadian provinces and Puerto Rico 10/2014
16 Ryan Program Growth
17 30 Years of Abortion Services, Training and Research at UCSF San Francisco General Hospital
18 The Women s Options Center at SFGH
19 Educational Expectations 4 to 8 week rotation with an emphasis on contraception and abortion Hands-on experience and training Didactics incorporated into rotation Exposure to research and scientific inquiry One-on-one faculty mentorship
20 Outcomes of Ryan Program Training: Results from 10 year study Increased competence with all contraceptive methods Increased competence in gynecologic skills: anesthesia and analgesia, uterine sizing, ultrasound, treatment of fetal demise and management of abortion complications Steinauer J, Silveira M, Rebekah Lewis, et al. Impact of formal family planning residency training on clinical competence in uterine evacuation techniques. Contraception 2007;76(5):
21 The Ryan Residency Training Program Improved resident competence in contraception and uterine evacuation methods, even for partially participating residents Enhanced integration of uterine evacuation and contraception into mainstream medicine Steinauer J, Silveira M, Rebekah Lewis, et al. Impact of formal family planning residency training on clinical competence in uterine evacuation techniques. Contraception 2007;76(5):
22 Resident Self-Assessed Competence Mean competence significantly increased* 1 not at all competent to 5 very competent MedAB MUA EUA Pre-Rotation Post-Rotation * p< for all comparisons Steinauer J, Silveira M, Rebekah Lewis, et al. Impact of formal family planning residency training on clinical competence in uterine evacuation techniques. Contraception 2007;76(5):
23 The Fellowship in Family Planning Only subspecialty training program in the United States focused on research and clinical skills in contraception and abortion Developing Tomorrow s Leaders in Reproductive Health
24 Fellowship in Family Planning Advanced clinical training in contraception & abortion Masters of Public Health or Masters of Science Funded research project Global health placement Advocacy, psychosocial and leadership training Post-fellowship academic career support
25 31 Fellowship in Family Planning Sites WASHINGTON OREGON NEVADA IDAHO MONTANA WYOMING NORTH DAKOTA SOUTH DAKOTA NEBRASKA MINNESOTA IOWA WISCONSIN MICHIGAN OHIO PENNSYLVANIA VERMONT NEW YORK MAINE NEW JERSEY NEW HAMPSHIRE MASSACHUSETTS RHODE ISLAND CONNECTICUT CALIFORNIA UTAH COLORADO KANSAS MISSOURI ILLINOIS INDIANA KENTUCKY WEST VIRGINIA VIRGINIA DELAWARE MARYLAND WASHINGTON, DC ARIZONA NEW MEXICO OKLAHOMA ARKANSAS TENNESSEE NORTH CAROLINA SOUTH CAROLINA TEXAS LOUISIANA ALABAMA MISSISSIPPI GEORGIA FLORIDA ALASKA HAWAII 31 Fellowship sites in 17 states and Washington, D.C. 9/2014
26 Integration into Academic Medicine Fellowship in Family Planning Research Training Clinical services Expert family planning faculty
27 Our Challenges: Intimidation and continuing stigma Attitudes of other specialists, nurses, and support staff Politicians dictating medical practice
28 : Abortion Restrictions OR WA MT ND MN NH VT ME ID WY SD WI MI NY CA NV AZ UT CO NM NE KS OK IA MO AR IL MS IN KY TN AL PA OH WV VA NC SC GA MA RI CT NJ DE MD DC TX LA AK State legislature enacted major restriction on access to abortion in 2014 FL September 15, 2014 HI State legislature enacted major restriction on access to reproductive rights in abortion between
29 Legislative Barriers To Access Mandatory ultrasounds Biased counseling Parental consent Waiting periods Insurance bans No local provider Adapted from Guttmacher
30 Hospital Initiated Restrictions Confining abortions to OR instead of procedure room Requiring sign-off/ approval for all abortions Restricting abortion further than state mandates Not allowing abortions at the hospital Contractually forbidding physicians from doing abortions on own time. Least Restrictive Most Restrictive
31 Federal Legislative Attacks on Abortion Training Foxx Amendment (2011)-Failed Prohibited the use of funds provided for graduate medical education from being used to provide abortion or training in the provision of abortion.
32 State Legislative Attacks on Abortion Training Arizona (2011)-Passed Prohibits expending public money for training in abortion and eliminates tax credits for donations to pro-abortion groups.
33 State Legislative Attacks on Abortion Training Kansas (2013-Passed) Prohibits abortions by public employees (i.e. attendings and residents) in public facilities.
34 Legislative Attacks on Abortion Training: State North Carolina (Proposed 2015) Increases waiting period to 72 hours, removes health exceptions past 20 weeks Prohibits abortions except in cases of life endangerment, rape, or incest at University of North Carolina and Eastern Carolina University. Prohibits training or supervision of abortion care by any doctors affiliated with UNC and ECU Requires board certification in ob-gyn
35 Hope for the Future Ryan Residency and Fellowship programs create systematic training for future generations - Ensuring a competent work force Producing research that informs both practice and policy Creating advocates for political change
36 Leadership Development 4,243 residents trained through Ryan Program 305 graduated, current, and incoming fellows 205 peer-reviewed articles in 2014 New generation of experts in clinical care, research, teaching and policy
37 A New and Growing Family of the next Generation of Family Planning Experts and Leaders
38 Thank you! Questions?
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