Abortion in the International Context

Video Lecture Presented by:

Teresa DePiñeres, MD, MPH

University of California, San Francisco
Click here to download this video lecture 

Lecture can be viewed with subtitles in Spanish or French. French translation was made possible by the Safe Abortion Action Fund and International Planned Parenthood Federation. Click the Closed Captions button on video lectures to access subtitles. 

Cleland J, Ali MM. Reproductive consequences of contraceptive failure in 19 developing countries. Obstet Gynecol 2004 Aug;104(2):314-20.
Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol 2012 Feb;119(2 Pt 1):215-9.
Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J. Legal abortion worldwide: incidence and recent trends. Perspect Sex Reprod Health 2007 Dec;39(4):216-25.
www.unpopulation.org. World Abortion Polices 2007. 2007
www.unpopulation.org. World Contraceptive Use 2009. May 2009.
Guttmacher 2008
Center for Reproductive Rights 2013
CDC 1995
Boland 2010

Abortion in the International Context Slide Set

Week1- International (DePineres)

Slide Set from Video Lecture Presented by:

Teresa DePiñeres, MD, MPH
Senior Technical Advisor Fundacion Orientame and ESAR

Click to download Abortion in the International Context

Abortion and its Multiple Contexts

IERH acknowledges the importance of inclusive language as a component of patient-centered care and we are working to improve our content. Read more here.

Video Lecture Presented by:

Carolyn Sufrin, MD, PhD
Johns Hopkins School of Medicine

Click here to download this video lecture 

Lecture can be viewed with subtitles in Spanish or French. French translation was made possible by the Safe Abortion Action Fund and International Planned Parenthood Federation. Click the Closed Captions button on video lectures to access subtitles. 

Duden B. The women beneath the Skin: A Doctor’s Patient in Eighteenth-century Germany. Cambridge, MA: Harvard UP; 1998.
Ginsburg F, Rapp R. The politics of reproduction. Annu Rev Anthropol 1991;20:311-43.
Institute G. Guttmacher Institute: Home Page. 2015.
Weir L. Pregnancy, Risk and Biopolitics: On the Threshold of the Living Subject. USA and Canada: Taylor & Francis e-library; 2006.

Abortion and its Multiple Contexts Slide Set

Week1-MultipleContexts (Sufrin)

Slide Set from Video Lecture Presented by:

Carolyn Sufrin, MD, PhD
Johns Hopkins School of Medicine

Click to download Abortion and its Multiple Contexts (pdf)

Week 1 Introduction to Abortion: Quality Care and Public Health Implications

Presented by: Jody Steinauer, MD, MAS
University of California, San Francisco

Click to download this video lecture 

Week 1 Introduction: Abortion in the United States and Around the World Slide Set

Week1- Intro to the Course (Steinauer)

Slide Set from Video Lecture Presented by:

Jody Steinauer, MD, MAS
University of California, San Francisco

Click to download Introduction to the Course and Week One: Abortion in the United States and Around the World (pdf)

Changing the Conversation: Contraception

Think of a typical medical student or resident: mid to late twenties, a dedicated student with ambitious career plans, likely to be highly-motivated to avoid pregnancy until the opportune, pre-determined moment. These are not universal characteristics, and yet, as family planning practitioners and educators, concerns about contraceptive efficacy often dominate the care we give to patients.

Our teaching should help develop empathy in future clinicians to help them see that their own attitudes about pregnancy may not be aligned with their patients. As patient-centered practitioners, their first priority should be meeting the needs of each individual in their exam room, not working on population-level public health goals.

At the North American Forum on Family Planning last month, we were excited to see two plenary sessions highlighting opportunities to reframe the way we think about patient’s attitudes toward pregnancy and choices within the context of preference-sensitive health care decisions. Here is part 1, check back next week for part 2.

In the panel entitled “Advancing the understanding of unintended pregnancy: Broadening our perspective to improve research and practice”, panelists explored the idea of pregnancy intendedness. The panel urged family planning experts and practitioners to take a step back from its focus on unintended pregnancy because pregnancy planning is not universal across the population. While it may be common among people with high levels of education and career ambition—like the physicians, clinicians, and health professionals dedicated to providing family planning care—it is decidedly foreign to many demographic groups. For many people, planning and time-based intentions seem irrelevant or unrealistic.

Many people are ambivalent about pregnancy; they neither desire pregnancy nor work hard to avoid it. Further, some enjoy the element of chance that many family planning practitioners have been trained to avoid at all costs both in their personal reproductive lives and for their patients. Ultimately, the data presented points to a need for a new framework for family planning that considers: 1) patients’ individual conceptualizations of pregnancy, 2) desire for effective contraception including acceptability of risk of pregnancy, and 3) whether an unexpected pregnancy would ultimately be a positive or negative outcome.

Within this context, the panelists urged practitioners to consider our movement’s drive to expand the use of LARC devices that may not meet the nuanced reproductive goals of many people. Instead, we should consider how we can help prevent unacceptable pregnancies while simultaneously supporting patients experiencing unexpected but welcome pregnancies to healthy outcomes.

Next week we will dig into the related session: “Prioritizing preferences in reproductive healthcare: the role of shared decision making.”

Global Maternal Newborn Health Conference

Last week, Innovating Education in Reproductive Health attended the first Global Maternal Newborn Health Conference in Mexico City. The meeting celebrated the achievements of the Millennium Development Goals and outlined current efforts to address maternal and newborn mortality worldwide. Leaders in the field, including Melinda Gates of the Bill and Melinda Gates Foundation and Hans Gosling (co-founder of the Gapminder Foundation) came together for the first major global meeting since the UN General Assembly agreed on the Sustainable Development Goals last month in New York.

The Innovating Education in Reproductive Health team had the opportunity to present at two sessions during the conference. The first was a papaya workshop skills demonstration where we highlighted the simplicity of the papaya workshop to teach crucial lifesaving clinical procedures such as first-trimester abortion, post-abortion care, and early pregnancy loss management. We also participated in the marketplace of ideas where we showcased our digital and hands-on tools for teaching family planning and maternal health.

Researchers, advocates, and healthcare providers presented panel sessions that discussed initiatives to address some of the most pressing needs in maternal and newborn health highlighting: the use of misoprostol to improve maternal outcomes, the impact of family planning on maternal and newborn health, ways to strengthen midwifery and midwifery education, and innovative approaches to improved health systems.

A panel titled “Improving Access and Quality of Safe Abortion Services: Global Lessons and Questions” outlined current trends in abortion among women worldwide. Consistent themes are threaded across a range of geographic settings notably: barriers to timely abortion care such as costs, access to trained providers, and stigma associated with abortion/women who have. Presenters identified outpatient manual vacuum aspiration and self-induction (through widely accessible misoprostol) as the key areas for future work.

We are so pleased at the opportunity to present our work as part of the community of practitioners dedicated to eradicating maternal and newborn mortality. This conference reminded us that while evidence-based clinical excellence is crucial to addressing the health needs of women worldwide, without patient-centered respectful care we will not be able to ensure healthy lives and promote well-being for all people regardless of gender.

The Global Maternal Newborn Health Conference was convened by the Maternal Health Task Force (MHTF) at the Harvard T.H. Chan School of Public Health, USAID’s flagship Maternal and Child Survival Program (MCSP), and Save the Children’s Saving Newborn Lives (SNL) program.

The Importance of Context: Teaching the History of Abortion in the United States

When you design a lecture for medical and nursing students on the history of abortion care in the United States, keep these three teaching points in mind.

 

1)   How their training and education has a direct impact women’s’ access to safe abortion.

2)   How the convergence of law and public health can hinder their practice.

3)   Referral to high quality abortion providers is a vital aspect of patient-centered care.

In the past 3 years alone, states across the country enacted over 200 restrictions on women’s ability to access abortion. They require physicians to disregard evidence-based protocols and interfere with physicians’ professional duties to place the primacy of the patient above all else.

When abortion is illegal, or inaccessible, women continue to have abortions at the same rate as when abortion is legal and accessible. The difference is, illegal and inaccessible abortion drastically increases maternal morbidity and mortality. In fact around the world, approximately 44,000 women die every year as a result of unsafe abortion.

To understand the current restrictions on abortion, medical students need an understand abortion access from a historical context. How have the current restrictions come to pass? What are the major milestones? And what impact do restrictions have on patient- centered care, and why do they matter?

Six Tips for Starting an Abortion Provider Support Group at your Home Institution

The decision whether or not a resident trainee should become an abortion provider is often fraught with emotion and inner conflict. The recent article “Four Residents’ Narratives on Abortion Training: A Residency Climate of Reflection, Support, and Mutual Respect” recounts four individual experiences of residents confronted with this decision. Personal and societal conflicts often impact an individual after he/she has decides to become an abortion provider. Creating an infrastructure within a residency program to allow learners to discuss their thoughts and feelings regarding abortion training may provide much needed support and community.

The ob-gyn residency program at Women & Infant’s Hospital/Brown University in Providence, RI provides this community to residents through a group called Resident Abortion Provider Support group (RAPS).

Given the success of our support group we would like to offer 6 tips for initiating an abortion training support group at your training program.

(1) Its all about the providers

Creating a support group is about focusing on providers. Although this group of individuals will likely get involved with outreach and activism, the focus of your support group should be on the issues that surround being an abortion provider. This can be difficult. As physicians and caregivers we spend most of our time focused on patients; stepping back and focusing on our peers and ourselves is often not a priority and therefore can be a challenge. We suggest working hard to keep your support group goals set on discovering and discussing the joys and challenges of being an abortion provider.

(2) Talk, talk, talk

Growth comes from discussion. Encourage discussion in any way possible; read articles, watch movies, meet after cases. This can be done as a whole group or as break-outs. Support is not always scheduled and in fact most often happens on the fly.

(3) Be inclusive

Although including only those who have little qualms regarding abortion provision can seem attractive and less challenging in terms of structuring a support group, it can take away from the value of the support, discussion and an inclusive community. Encouraging all caregivers to have a voice allows for more colorful and meaningful conversations and helps you explore the boundaries of being a provider.

(4) Keep it safe

The down side of all-inclusiveness can be the loss of a “safe space”. The ultimate goal of an abortion provider support group should be a safe place for providers to express themselves. Fostering this will depend on your particular members and their comfort level, but may include having “provider only” events to allow for frank and honest communication that may not otherwise be possible in front of those who are non-providers.

 (5) Meet often

Residents have busy schedules and it’s challenging to have regular meetings. Having long periods between meetings can dilute the sense of community and cause providers who are uncomfortable seeking out much needed dialog feel isolated for long periods of time. Providing a dependable forum for discussion is key to having trainees feel supported.

 (6) Be flexible and include supporters!

The needs of your residents will change over time. Poll your members on the issues that are important to them and enlist their help in determining where to focus your discussion. In addition, including understanding and dedicated faculty members can be an excellent source of support for the residents. Speaking with those who are outside of residency and in the “real world” can provide important points of view regarding abortion provision.

RAPS was founded by Janet Singer, a Nurse Midwife at Women & Infant’s Hospital as well as several other devoted and supportive faculty members and residents. From its creation the purpose of RAPS was to allow learners training to provide abortions a safe forum to discuss their feelings and views.

About the authors: This article was written by Drs. Jen Villavicencio (PGY3) and Martha Kole (PGY3) from Women and Infants Hospital at Brown University. You can reach Dr. Villavicenio directly at JVillavicencio@Wihri.org if you have any further questions regarding the content in this article.