In Med Schools, the Abortion Curriculum Has Left the Classroom

Originally posted at RH Reality Check.

As recently as six or seven years ago, abortion was included in my medical school's curriculum, but no longer. The comprehensive curriculum I naively expected that would provide medical students with the knowledge to meet the common needs of their female patients simply does not exist. At a party last weekend I asked a few second years, four twenty-three-year-old men, to report back to me if they hear the "A" word at any time this semester. They gleefully dubbed themselves the "Medical Student Moles for Choice." Abortion is a shadow that wisps in and out of medicine, much like the quiet shadow of abortion in many women's lives, not addressed directly, not discussed in coffee shops or over family dinner.

Medical school is, in many ways, a language school. Someone told me once that a medical student learns over 20,000 new words in their first two years of school, and in addition to the new vocabulary, I soon became capable of saying things over dinner that one should never say. "Rectum" no longer induces giggles and "vagina" is boring, not sexy or empowering. And yet, the word "abortion" is still said with a pause, a nod, a little quieter than the rest of the sentence. I'm happy when we talk about it at all: for me, the problem is the deafening silence. That a procedure more common than an appendectomy would never be named: In the halls of science and healthcare, that to me is an abomination.

At one time at my medical school, a state institution of strong reputation in the Deep South, the physician responsible for the classroom teaching in women's reproductive health, "Dr. L," included a full hour lecture on the medicine and science of abortion care in the OB/Gyn curriculum. She included her own stories of patients, the hooks on which we medical students hang all this physiology and chemistry in our overtaxed memories. Even so, the students of this relatively conservative locale responded with powerfully reproachful marks on the course feedback forms. As student feedback influences not only the next year's teaching of any course but also the tenure and performance assessment of the teachers, physicians, themselves, Dr. L. was forced to remove the lecture. During the following few years, including my turn with her, she managed to sneak in ten minutes on abortion safety when discussing contraception. "Abortion is safe," was the message I heard, "but if you have a problem with it, you better be sure you know how to offer your patients appropriate birth control."

The real blow didn't come until the following year. Dr. L. moved on to another institution. With her went any mention of the science and medicine of abortion; the ethics class debate on the subject remains. This is how abortion education disappears from our medical schools - subtly and quietly. The students come and go, teaching physicians come and go, and few of us notice this loss from the classroom, the laboratory, the hospital room.

Is it hopeless? Of course not. I have a dream curriculum, and I believe it can be attained. Including questions on abortion and other aspects of comprehensive reproductive healthcare in national medical board exams would re-enforce to medical schools that the subject should and must be taught. Recommended curricula from professional bodies like ACOG (the American College of OB/Gyns) could encourage directors of curricula at both the medical school and residency level to include abortion care requirements. Specific line item requirements from the national accreditation bodies could remind medical school deans every eight years that abortion is part of normal medical care. Until that day comes, with the support of Medical Students for Choice, we students will continue to fight for our own education. At the University of Alabama at Birmingham, we've invited abortion providers to talk with us about their careers and to teach us about the practicalities of the abortion procedure and running a practice, shadowed providers at a local clinic, and lobbied the administration for permanent, sustainable curricular change.