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Abortion in the Curriculum

By Anne C. Krendl

The Accreditation Council for Graduate Medical Education (ACGME) instituted a policy earlier this month requiring all teaching hospitals to provide abortion training to their residents.

Under the new guidelines, hospitals must teach abortion techniques to all of its obstetrics and gynecology (OB-GYN) residents, except those who are morally or ethically opposed to the procedure.

Institutions who do not perform or support abortions are required to send their OB-GYN residents to other hospitals to be trained.

But the policy will have little effect on the joint OB-GYN residency program run by two of Harvard's teaching hospitals, Massachusetts General and Brigham and Women's, which already offers optional abortion training to their 36 residents.

Residents are given the option of training in dilation and evacuation, a procedure used to treat women who have experienced fetal death, miscarriage or who are having abortions.

Beth lsrael, the only other Harvard teaching hospital with an OB-GYN residency program, declined to comment.

Keren R. McGinity, special assistant of public affairs at Harvard Medical School, says the school will not be directly affected by this policy.

"There is no cross-over between residency programs and undergraduate medical education," she says. "We don't track all of the resident programs at all the different hospitals because the hospitals control those and have complete domain about everything having to do with the residency programs."

John C. Gienapp, executive director of the ACGME, says the policy is not actually new but just clarifies previous regulations which did not specifically mention abortion training.

"We don't believe it was a change in policy requirements," he says. "Now the requirements are explicit."

The current policy now reads, "Experience with induced abortion must be part of residency training, except for residents with moral or religious objections. This education can be provided outside the institution. Experience with management of complications of abortion must be provided to all residents..."

Gienapp says the policy was reworded in response to a lawsuit against the ACGME by a hospital claiming the regulations were too vague. The steady drop in the number of abortions performed in hospitals, despite continued demand for the procedure, also led to the change, he says.

According to a report compiled by the Alan Guttmacher lnstitute, a non-profit group which does research on reproductive issues, the number of abortion providers decreased by 8 percent between 1988 and 1992. And of the abortions that do occur, 93 percent of them take place in clinics or doctor's offices, not hospitals.

"I think that hospitals are afraid to perform abortions because it is such a controversial issue," says Jennifer R. Davis '97, Co-chair of Harvard-Radcliffe Students for Choice.

Gienapp says the policy has nothing to do with the controversy now surrounding President Clinton's nominee for surgeon general Dr. Henry W. Foster, who has acknowledged performing several abortions during his 30-year career as an OB-GYN.

While the new policy may not affect Harvard, Gienapp says implementation of the regulations has met resistance elsewhere.

"We've obviously been in dialogue with a number of Catholic hospitals that did not like the way the standard was being instigated," he says.

Judie A. Brown, president of the American Life League, a national anti-abortion group, says her organization has encouraged doctors and supporters across the country to contact the ACGME and voice their opposition to the decision.

"[Hospitals] should not be put in the position where they have to send residents elsewhere to learn something that is not moral or ethical," Brown says.

But Gienapp says the council has also received several letters from medical students voicing their support of the new policy.

"I definitely think it's a step in the right direction," says Christina A. Kowalewski '95, Co-chair of Harvard-Radcliffe Students for Choice. 'Over the past decade, the number of medical schools that have been teaching abortion has been reduced, and I certainly think the medical profession has an obligation to teach its rising physicians how to perform medical procedures."

Alice L. Kirkman, public information specialist for American College of Obstetricians and Gynecologists, says the organization strongly supported institution of the policy. "We believe that abortion training needed to get back into the mainstream of medical training," she says.

Sue, director of public affairs at Preterm, an abortion clinic in Boston, says incorporating abortion training into the medical curriculum should make it more acceptable to the public. Preterm policy prevents her from revealing her last name.

"It will make it no more important than any other surgical procedure, which is how it should be," she says.

The ACGME, Gienapp says, adopted the policy to make abortion a safer procedure through better training of physicians.

"Several women die each year going through a procedure that is relatively simple," Gienapp says.

Despite the controversy the policy may have stirred up, the ACGME expects hospitals to fully cooperate with its implementation, Gienapp says.

Hospitals that refuse to follow the revised guidelines can be put under review by the ACGME. In a worst case scenario, the council may strip the hospitals of their accreditation, says Gienapp.

OB-GYN residents must be trained in a program accredited by the ACGME to become board-certified and licensed to practice. And only accredited hospitals can qualify for federal reimbursements to fund its residency training.

Gienapp says hospitals will not face a large financial burden carrying out the policy's requirements. "[Learning the procedure] may just be incorporated into the course of their training," he says.

According to a report by the Guttmacher Institute, more than 50 percent of the pregnancies among American women are unintended pregnancies are terminated by abortion.

Abortion in the US

.More than 50% of the pregnancies among American women are unintended--1/2 of these are terminated by abortion.

.93% of abortions take place in clinics or doctor's offices, not hospitals.

.The number of abortion providers declined by 8% between 1988 and 1992 (from 2,582 to 2,380).

.In 1992, there were 1.5 million abortions in the United States. From 1973 to 1992, more than 28 million legal abortions took place in the United States.

.89% of abortions take place in the first trimester of pregnancy.

.The majority of women obtaining abortions are young: 56% are under age 25, including about 23% who are teenagers; only 22% are 30 and older.

.18-19-year-old women have the highest abortion rate--59 per 1,000 women.

.For every $1 spent by government to pay for abortions for poor women, about $4 is saved in public medical and welfare expenditures incurred as a result of the unintended birth.

Statistics courtesy of the Alan Guttmacher Institue.

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