In 1996, the Accreditation Council for Graduate Medical Education Obstetrics and Gynecology Programs required that “access to experience with induced abortion must be part of residency education.”1 In 2014, the American College of Obstetricians and Gynecologists recommended that “all obstetrics and gynecology residency programs provide training in comprehensive women's reproductive health care, including opt-out abortion training, in which training is routinely integrated into residency but residents with religious or moral objections can opt out of participation.”2 We present narratives from four residents, in this commentary, hoping to encourage a more nuanced discussion of abortion among obstetrician–gynecologists (ob-gyns). We will describe the aspects of our residency program that facilitate open dialogue and respect across diverse viewpoints and demonstrate that the clear distinction between being pro-life and pro-choice often breaks down when one is immediately responsible for the care of pregnant women.
The decision on the part of obstetrics and gynecology residents to opt in or out of abortion training is, for many, a complex one, often involving much soul-searching. In our residency program, a large majority of our 32 residents participate in abortion training. During a 6-week rotation, all residents complete a didactic curriculum on contraception, abortion, and miscarriage management. In addition, those who opt in perform abortions at a local clinic and in our hospital. Among residents who opt out of abortion training, most participate in an observational experience at the clinic.
Abortion is a frequent topic of conversation, and open discussion with faculty and peers about the training experience is encouraged. Prospective residents are told that all residents are expected to counsel about pregnancy options and provide preabortion and postabortion care. Residents may opt out of doing abortion procedures, but only for moral or religious reasons.
Mentoring is central to our residency program. Each intern is assigned three mentors–a midwife, a community physician, and a third-year resident. Although direct feedback is given on performance, there is a strong emphasis on emotional support. From the beginning, residents know they are cared for and are expected to be reflective and participate in difficult conversations. There is a values-clarification session on abortion for interns just before a formal meeting to declare their opt-in or opt-out status. All interns learn manual vacuum aspiration and provide miscarriage management in our emergency department. A faculty midwife meets with each second-year resident during his or her abortion training to give the resident an opportunity to process the experience. It was out of these conversations that this commentary piece was born. Four residents with wide-ranging views were asked to share their experiences in writing. In addition, it became clear that more opportunities for conversation would be welcome.
Formed by a core group of willing faculty and motivated residents, the Resident Abortion Providers Support Group provides a confidential, safe environment to share experiences and provide support. Meetings occur six to eight times per year and include discussions about journal articles, movies, and topics such as late-term abortions and the effects of family of origin on the decision to perform abortions. Residents report that, even if they do not attend a Resident Abortion Providers Support Group gathering, the conversation often continues the next day in the resident lounge. The residents are given much control over their residency experience and in shaping the climate of the program. As one intern put it, “the reputation is that everyone is kind to each other, so when we arrive we are met with kindness and support from coresidents and faculty. We are kind and supportive in return.”
Although the public debate surrounding abortion can be filled with incendiary rhetoric and passion on both sides, the residents often discover that the boundaries between pro-choice and pro-life beliefs are not so neatly divided. Residents train with colleagues who do not share their views, and they develop tremendous respect for these colleagues. Some residents struggle with the real-life experience of providing abortions, whereas others experience angst over lacking the skills to terminate a life-threatening pregnancy.
Two of the resident authors have undertaken abortion training and two have not. To provide anonymity, the order of authorship does not correspond to the order of narratives. The residents' stories reveal how their backgrounds influence their choice and views, how they experience providing or not providing abortions, how they reconcile the often competing values placed on fetal life and women's autonomy, and how being in a supportive residency has allowed them to explore the complexity of abortion.