Access to abortion training

Abortion training in family medicine residency programs

Interest in Medication and Aspiration Abortion Training among Colorado Nurse Practitioners, Nurse Midwives, and Physician Assistants.

Provision of medication and procedural abortion among Massachusetts obstetrician-gynecologists

Background: Access to safe and effective abortion services plays a vital role in safeguarding women's reproductive health, ultimately contributing to their overall well-being. This is particularly relevant in Bangladesh, where the legality of abortion is contingent upon specific circumstances. Therefore, ensuring women have the autonomy to choose between safe and effective termination methods becomes crucial. Objective: The study aims to see explore the efficacy, safety, and accessibility of mifepristone-misoprostol regimen and surgical abortion methods within the context of Bangladesh. Methods: This investigation employed a cross-sectional observational design, conducted within the Department of Obstetrics and Gynecology at Dhaka National Medical College in Bangladesh. The study spanned one year, commencing in March 2023 and concluding in February 2024. To ensure a representative sample of the patient population seeking abortion services, consecutive sampling was utilized. This approach involved recruiting all patients admitted during the designated timeframe who fulfilled the pre-established inclusion and exclusion criteria. Ultimately, the study enrolled 104 participants, a sample size determined by the number of admissions fitting the criteria within the one year. Results: The study found no significant difference in age distribution between women choosing medical or surgical abortion, with both groups mainly consisting of women aged 18-25. Overall complication rates were similar, but medical abortion had a higher need for additional procedures and longer stays, while surgical abortion required more bleeding observation. Pain experiences differed significantly, with no women in the medical group reporting no pain and a higher prevalence of moderate pain compared to surgical abortion. Women undergoing medical abortion were slightly more likely to experience complications overall, and primigravid women (first pregnancy) were significantly more likely to experience complications than multigravid women. Conclusion: Our findings suggest comparable safety profiles for both surgical and medical abortion procedures within the studied population. This indicates that surgical abortion can be a safe and effective option alongside medical abortion, potentially expanding the range of choices offered to women.

Randomized comparison of efficacy and acceptability of medical versus surgical abortion

Ob/Gyn training in abortion care: results from a national survey

Abortion induced by drugs is now a viable alternative to surgically induced abortion for U. S. women. Women's willingness to use these new methods of medical abortion hinges on the extent to which they prove acceptable, however. Among 304 women participating in a clinical trial of medical abortion, 186 received a methotrexate-induced abortion and 118 were offered the option of a medical abortion but chose a surgical procedure instead. Study participants completed self-administered questionnaires before the abortion and again at a follow-up visit. Women in the medical and surgical abortion groups did not differ significantly with regard to demographic and other background characteristics: Their mean age was about 27, more than two-thirds were white, and three-quarters were unmarried and worked either part-time or full-time. However, women's ratings of seven attributes of abortion methods were significant predictors of choosing a medical abortion: Women were more likely to choose medical abortion if they placed greater importance on a method that was nonsurgical, one that resembled a miscarriage or one that could take place at home (odds ratios, 2.0-3.3). Conversely, women were less likely to choose medical abortion if they valued methods that were quick, that did not involve painful cramping or seeing blood or blood clots and that needed a doctor or nurse to be present (odds ratios, 0.3-0.5). Compared with those who had a surgical abortion, women who had a methotrexate-induced abortion expected more bleeding (mean scores, 3.5 vs. 3. 1) and reported more pain (3.4 vs. 2.9), heavier bleeding (3.4 vs. 2.5) and bleeding of longer duration (3.3 vs. 2.6). The overwhelming majority of women in the medical and surgical abortion groups reported that they were either very or somewhat satisfied with their abortion method (81% and 82%, respectively), would recommend it to others (82% and 78%) and would choose the method again (89% and 93%). Factors affecting the choice of abortion method appear to be numerous and complex. Providers need to be sensitive to differences in women's values and life circumstances when counseling them about an abortion method. In particular, providers should incorporate into their counseling sessions what women need to know about the characteristics of abortion methods and help women to identify what is the best option for them.

Background In the United States, new regulations on access to abortion and, in some cases, penalization of physicians who provide abortions, have been established on a state-by-state basis. The American College of Obstetricians and Gynecologists recommends that medical schools include abortion training in their curriculum. It is still unknown if the Dobbs decision will limit medical students' abortion training and/or discourage them from pursuing a career in obstetrics. The goal of this study was to investigate the attitudes of medical students toward abortion following the Dobbs decision and their beliefs about its possible effect on future medical education and practice. Methods This cross-sectional, observational study collected data from students enrolled in a Florida, United States osteopathic medical school using an anonymous online questionnaire from February to March 2023. The questionnaire contained 35 items that addressed medical students' attitudes towards a range of potential implications on medical training due to the new abortion restrictions. Hypothesis testing was performed using Spearman's rho correlation and multivariate linear regression to explore the relationship between the predictor variables (concerns about future practice regarding abortion, religiosity, and acceptability of abortion based on gestation age) and the predicted variable (attitudes about abortion). Data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 28.0, Armonk, NY). Results In total, 158 participants completed the questionnaire; 91 (57.6%) were women. The mean age was 25.8 (range 21-37 years). Using a stepwise regression analysis, only the variables shown to be statistically associated (per Spearman's rho bivariate correlation) with the predicted variable (abortion attitudes) were entered into the model (i.e., concerns about abortion education and future practice, religiosity, and abortion acceptability based on gestational age). A significant regression equation was found (F(3,134) = 205.750, p < 0.001, R2 = 0.822, R2 adjusted = 0.818). The percentage of variance in the scores accounted for by the model was 82%. Higher levels of feeling that the abortion ban would negatively affect their training and future practice, greater religiosity, and acceptability of abortion at later gestation ages were statistically significant predictors of more positive attitudes toward abortion in this sample of osteopathic medical students. Conclusions The results suggest that the attitudes of medical students toward abortion are related to multiple factors, including concerns about future abortion training, religiosity, and the week of pregnancy acceptable for a woman to have an abortion. Findings also highlight the attitudes of medical students in response to more restrictive abortion legislation, emphasizing their desire for possible curricular enhancements to safeguard their training and education.

A Retrospective Cost-Effectiveness Analysis of Mifepristone-Misoprostol Medical Abortions in the First Year at the Regina General Hospital.

Factors influencing women's levels of satisfaction with first-trimester surgical abortion

To prevent subsequent unintended pregnancy, contraception should be initiated soon after surgical and medical abortion. Evidence regarding the safety of postabortion contraception, especially for longacting reversible methods, has accumulated in recent years. This review seeks to provide up-to-date recommendations about the provision and timing of contraception after surgical and medical abortion. Recommendations are based on the US Medical Eligibility Criteria (MEC) or on the authors' review of the current literature for topics that the MEC does not address. Contraceptive counseling at the time of abortion should be collaborative. All reversible contraceptive methods are safe to begin immediately after surgical abortion, barring concern for surgical complications or underlying medical contraindications. After medical abortion, the implant may be initiated immediately, combined hormonal contraception may be initiated shortly thereafter, and the intrauterine device may be placed once the abortion is complete. Further research is needed to determine the optimal timing of depot medroxyprogesterone acetate initiation after medical abortion. Abortion is an important opportunity for contraceptive counseling and provision. Clinic policies and insurance coverage should maximize access to all contraceptive methods, including long-acting reversible methods.

The barriers to comprehensive abortion care in Australian metropolitan tertiary hospitals are under-researched. Previous work has suggested that negative practitioner attitudes and lack of training may play a large role; however, this remains poorly understood. The aim was to survey doctors practicing obstetrics and gynaecology to better understand their views, training experience and confidence in abortion care. The method involved a cross-sectional study via an anonymous survey at a single metropolitan tertiary hospital not providing substantive abortion services in Melbourne, Australia. Inclusion criterion was obstetric and gynaecology medical staff working at that hospital. Data were collected regarding views, training experiences and confidence in first-trimester medical and surgical abortion, and second-trimester surgical abortion. Data were analysed according to levels of training, categorised as RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) Fellows, prevocational/vocational trainees and general practitioner specialists. Sixty-one valid responses were received from 90 eligible participants (response rate 68%). An overwhelming majority (96%) supported abortion services. The majority of RANZCOG Fellows felt confident performing first-trimester surgical abortion (89%) and first-trimester medical abortion (71%); however, only half felt confident performing second-trimester surgical abortion (50%). Prevocational/vocational trainees were overall less confident but overwhelmingly expressed interest in gaining further experience in abortion. Doctors are generally confident in providing first-trimester abortion services (medical or surgical) in the metropolitan tertiary setting. However, further work is required to understand ongoing barriers to comprehensive abortion care. There may also be a skills shortage for second-trimester surgical abortion, requiring significant improvements in abortion training.

BackgroundInduced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are to provide an overview of complications of medical and surgical abortions and to evaluate the impact of bacterial screening to prevent postabortal infections.MethodsAll women who underwent induced abortion at Skaraborg Hospital between 2008 and 2015 are included in the study. Bacterial screening for chlamydia, gonorrhea, mycoplasma, and bacterial vaginosis was performed prior to the abortions. Abortion complications, categorized as bleeding, infection, or incomplete abortion were assessed in women who came in contact with the gynecological clinic within 30 days after the procedure.ResultsA total of 4945 induced abortions were performed during the study period. Nearly all, 4945 (99.7%) were eligible for inclusion in the study. Medical abortions < 12 weeks were the most common procedure (74.7%), followed by surgical abortions (17.5%), and medical abortion > 12 weeks (7.8%). Complications were registered in 333 (6.7%) of all abortions. Among medical abortions < 12 weeks, the complication frequency increased significantly, from 4.2% in 2008 to 8.2% in 2015 (RR 1.49, 95% 1.04–2.15). An incomplete abortion was the most common complication related to medical abortions < 12 weeks. Of all women who tested positive for one or several bacteria at the screening and therefore received antibiotics, 1.4% developed a postabortal infection. Among those who tested negative at the screening, 1.7% developed infectious complications.ConclusionsThe share of complications related to medical abortions < 12 weeks increased significantly during 2008–2015 without any evident cause. Women who tested positive for one or several bacteria upon screening and received antibiotics experienced almost an equal proportion of postabortal infections compared to women who tested negative upon screening. The screening process seems to fulfill its purpose of reducing the risk of infectious complications.

Depending on availability, many Australian women seeking an abortion will be faced with the choice between surgical or medical abortion. Little is known about the factors that influence Australian women's choice of method. Through the perspectives of abortion service providers, this study aimed to explore the factors that contribute to Australian women's decision to have a surgical or medical abortion. In 2015, in-depth interviews were conducted with fifteen Victorian-based key informants (KIs) directly providing or working within a service offering medical abortion. Ten KIs were working at a service that also provided surgical abortion. Interviews were semi-structured, conducted face-to-face or over the telephone, transcribed verbatim and analysed thematically. KIs described varying levels of awareness of medical abortion, with poorer awareness in regional areas. When it comes to accessing information, women were informed by: their own research (often online); their own experiences and the experiences of others; and advice from health professionals. Women's reasons for choosing surgical or medical abortion range from the pragmatic (timing and location of the method, support at home) to the subjective (perceived risk, emotional impact, privacy, control, and physical ability). Women benefit from an alternative to surgical abortion and are well-placed to choose between the two methods, however, challenges remain to ensure that all women are enabled to make an informed choice. KIs identify the need to: promote the availability of medical abortion; address misconceptions about this method; and increase general practitioner involvement in the provision of medical abortion.

Medical or drug-induced abortion has been proven as an effective means for termination of pregnancy. However, training of providers in the use of misoprostol has been limited. The current article aims to identify the degree of knowledge on medical abortion among Brazilian medical residents in Gynecology and Obstetrics. A multicenter cross-sectional study was performed with residents regularly enrolled in residency programs in Gynecology and Obstetrics in 21 teaching hospitals. A self-responded questionnaire was used. Correct responses to each of the alternatives were identified, and a binary response variable (≥ P70, < P70) was defined by the 70th percentile of the number of questions on misoprostol. Four hundred and seven medical residents returned the questionnaire, of which 404 were completed and three were blank. The majority (56.3%) of the residents were 27 years or younger, females (81.1%), and single or not living with a partner (70%). Two-thirds (68.2%) were in the first or second year of residency. Only 40.8% of the participants answered 70% or more of the questions correctly. In the multivariate analysis, enrollment in the third year of residency or greater (OR = 2.18; 95%CI: 1.350-3.535) and having participated in treatment of a woman with induced or probably induced abortion (OR = 4.12; 95%CI: 1.761-9.621) were associated with better knowledge on the subject. Among Brazilian medical residents in Gynecology and Obstetrics, knowledge on medical abortion is very limited and poses an obstacle to proper care in cases of legal termination of pregnancy.