Mini-Courses

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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.

Abortion 101

Abortion is a common experience for people around the world; yet it is often excluded from the curricula of health professionals. Our aim is to fill in the gaps left by the exclusion of abortion from mainstream curricula.

Learning Objectives

Understand the difference between medication abortion and emergency contraception
Recognize that medication abortion and uterine aspiration are safe and highly acceptable to patients
Describe how medication abortion works
Understand why people seek abortion care later in pregnancy
Describe general factors associated with abortion pain and options for pain control
Understand the basics of how uterine aspiration, induction termination, and D&E are performed

EXPLAINED: Abortion Safety in the United States Lecture

Dr. Dan Grossman, of the University of California San Francisco, explains the most up-to-date research on abortion safety in the United States.

Download the EXPLAINED: Abortion Safety Facilitator Guide with Quiz.

Don’t have time for the full lecture? Watch the short series version and view the infographic.

The following links provided the research used in this video:

_{Forouzanfar MH, et al. (2015). “Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.“}

_{Grimes DA, et al. (2006). “Unsafe abortion: the preventable pandemic.“}

_{Grossman D, et al. (2014). “Change in abortion services after implementation of a restrictive law in Texas.“}

_{Raymond EG and DA Grimes (2012). “The comparative safety of legal induced abortion and childbirth in the United States.“}

_{Raymond EG, et al. (2014). “Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States.“}

_{Texas Policy Evaluation Project: Research Brief. (2016). “Change in number of physicians providing abortion care in Texas after HB2.“}

_{Upadhyay UD, et al. (2015). “Incidence of emergency department visits and complications after abortion.“}

_{Weitz T, et al. (2013). “Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver.“}

_{White K, et al. (2015). “Complications from first-trimester aspiration abortion: a systematic review of the literature.“}

_{White K, et al. (2016). “Women’s Knowledge of and Support for Abortion Restrictions in Texas: Findings from a Statewide Representative Survey.“}

Medication Abortion

Presented by: Lealah Pollock MD, MS

Family and Community Medicine
University of California, San Francisco

Please review the ACOG Practice Advisory for Updated Mifepristone REMS Requirements.

Click here to download this video lecture and here to download the lesson plan/facilitator guide with quiz.

Additional Resources

ACOG Guideline on First Trimester Abortion.

Citations

_{Teal, et al. Contraception. 2007}
_{Guttmacher Institute – State Laws & Policies}
_{Johnson JE. J Pers Soc Psychol, 1973}
_{Davis A. et al. JAMWA, 2000}

First Trimester Aspiration Abortion

Presented by: Sanithia L. Williams, MD
University of California, San Francisco

Click here to download this video lecture and here to download the lesson plan/facilitator guide with quiz.

Additional Resources

Society of Family Planning Guidelines on Cervical dilation before first-trimester surgical abortion (<14 weeks’ gestation).

Society of Family Planning Clinical Recommendations: Contraception After Surgical Abortion.

Citations

_{Jones 2017 AJPH}
_{The Safety and Quality of Abortion Care in the United States. http://www.nationalacademies.org/hmd/Reports/2018/the-safety-and-quality-of-abortion-care-in-the-united-states.aspx}
_{Achilles and Reeves. Contraception. 2011.}
_{Allen and Goldberg. Contraception. 2016.}
_{World Health Organization. Safe Abortion: Technical and Policy}
_{Guidance for Health Systems. 2012.}

Pain with Uterine Aspiration Abortion

Video Lecture Presented by:

Karen Meckstroth, 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.

Pain with Uterine Aspiration Abortion Slide Set

Slide Set from Video Lecture Presented by:

Karen Meckstroth, MD, MPH

University of California, San Francisco

Click to download Pain with Uterine Aspiration Abortion (pdf)

Abortion After the First Trimester

Video Lecture Presented by:

Eleanor Drey, MD, EdM

University of California, San Francisco

Click here to download this video lecture

Abortion After the First Trimester Slide Set

Slide Set from Video Lecture Presented by:

Eleanor Drey, MD, EdM

University of California, San Francisco

Click to download Abortion After the First Trimester (pdf)

RHAP zine: “Sam’s Medication Abortion”

Abortion Pill Training

Contraception

Clinicians can support patient autonomy and reproductive justice by using shared decision making to assist patients choose a contraceptive method that is the best fit for their preferences, lifestyle and reproductive goals and having the skills and knowledge to provide patients with the full range of contraceptive options.

Learning Objectives

Understand how to counsel patients for contraception using shared decision making
Discuss the benefits, efficacy, and side effects of each contraceptive method
Describe which methods can be used for emergency contraception
Choose a method of emergency contraception that best meets the needs of each patient
Determine which forms of EC are most effective depending on patient preferences and BMI

Contraception 101

Presented by: Michalle Ramirez-McLaughlin, RN, MS, FNP-BC
University of California, San Francisco

Click here to download this video lecture, here to download the lesson plan/facilitator guide with quiz, and here to download the slides.

Additional Resources/Citations

Tiers of Efficacy Chart. Beyond the Pill.

CDC Medical Eligibility Criteria for Contraceptive Use.

Prescribing Emergency Contraception

Presented by: Shokoufeh Dianat, DO
University of California, San Francisco

Click here to download this video lecture and here to download the facilitator guide with quiz.

Click here to download the EC Decision Tree used in this video

Citation

_{Haeger et al. 2018; Glasier et al. 2011; Edelman et al. 2018; Kapp et al. 2015}

This is How I Teach: SDM with LARC Methods

Presented by:

Christine Dehlendorf, MD, MAS
University of California, San Francisco

This is How I Teach: No Touch Technique for Copper IUD

Presented by Suzan Goodman MD, MPH
National Training Director, Bixby Beyond the Pill Program
Associate Clinical Professor, UCSF

Module 1 – Introduction – Role in Patient Centered Care

Module 2 – FAB Terminology, Efficacy, and Research

Professional Responsibility

Research shows that clinical learners exhibit a decline in empathy after they begin interacting with patients which poses a threat to their ability to provide patient-centered care. Patient-centered care challenges doctors to be empathetic, respectful, and compassionate, even during difficult patient interactions or when they have moral objections to the patient’s health behaviors.

Learning Objectives

Understand the professional responsibilities of health-care providers caring for people seeking abortion
Recognize and appreciate appropriate and inappropriate applications of “conscience” in the setting of abortion care
Practice patient communication skills
Identify steps to take to enhance professionalism in personally challenging clinical encounter

EXPLAINED: Turnaway Study Lecture

Dr. Diana Greene Foster, of the University of California San Francisco, explains the most up-to-date research from the Turnaway Study.

Download the EXPLAINED: The Turnaway Study Video Companion Guide.

Don’t have time for the full lecture? Watch the short series version and view the infographic.

The following links provided the research used in this video:

_{Roberts SCM, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States. March 2014. Women’s Health Issues, (24)2:3211-218.}

_{Biggs MA, Gould H, Foster DG. Understanding why women seek abortions in the US. July 2013. BMC Women’s Health, 13:29.}

_{Foster DG, Gerdts C, Korenman S, Ralph L, Roberts SCM. Effect of being denied a wanted abortion on women’s socioeconomic wellbeing. APHA abstract. https://apha.confex.com/apha/144am/meetingapp.cgi/Paper/357932}

_{Foster DG, Raifman S, Biggs MA. Effect of abortion receipt and denial on women’s existing and subsequent children. APHA abstract. https://apha.confex.com/apha/144am/meetingapp.cgi/Paper/357832}

For more information, review the annotated bibliography.

Physicians’ Professional Responsibilities in Abortion Care

Video Lecture Presented by:

Jody Steinauer, MD, MAS

University of California, San Francisco

Click here to download this video lecture

_{Opinion AC. ACOG Committee Opinion No. 385. The Limits of Conscientious Refusal in Reproductive Medicine. American College of Obstetricians and Gynecologists; 2007.}

_{Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, conscience, and controversial clinical practices. N Engl J Med 2007 Feb;356(6):593-600.}

_{Johnson BR, Kismödi E, Dragoman MV, Temmerman M. Conscientious objection to provision of legal abortion care. Int J Gynaecol Obstet 2013 Dec;123 Suppl 3:S60-2.}

Physicians’ Professional Responsibilities in Abortion Care Slide Set

Slide Set from Video Lecture Presented by:

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

Click to download Physicians’ Professional Responsibilities in Abortion Care (pdf)

Nursing Roles in Abortion Care

Video Lecture Presented by:

Amy Levi, PhD, CNM, WHNP-BC

University of New Mexico

Additional Resources

Revised code of Ethics in 2015

The ICN code of Ethics for Nurses

Click here to download this video lecture

_{Abortion Train. 20 Cavendish Square London: Royal College of Nursing; 2008}

_{Who we are. 2015 [cited; Available from: http://www.icn.ch/who-we-are/who-we-are/}

_{Association AN. Code of Ethics for Nurses. 2015 [cited; Available from: http://www.nursingworld.org/codeofethics}

Nursing Roles in Abortion Care: Clinical Responsibility and Professional Ethics Slide Set

Slide Set from Video Lecture Presented by:

Amy Levi, PhD, CNM, WHNP-BC
Albers Professor of Midwifery
University of New Mexico

Click to download Nursing Roles in Abortion Care: Clinical Responsibility and Professional Ethics (pdf)

Conscientious Provision and Refusal of Abortion Care

Video Lecture Presented by:

Lori Freedman, PhD, MA

University of California, San Francisco

Additional Resources

Guttmacher state laws and policy regarding conscientious refusal in the United States

FIGO guidelines on conscientious objection

Center for Reproductive Rights Law and Policy, Guide on Conscientious Objection (International Perspective)

Click here to download this video lecture

_{ACLU. MISCARRIAGE OF MEDICINE: THE GROWTH OF CATHOLIC HOSPITALS AND THE THREAT TO REPRODUCTIVE HEALTH CARE. [cited 2015; Available from: https://www.aclu.org/report/miscarriagemedicine-growth-catholic-hospitals-and-threat-reproductive-health-care?redirect=religion-beliefreproductive-freedom/miscarriage-medicine-growth-catholic-hospitals-and-threat}

_{Chavkin W. Conscientious objection to the provision of reproductive healthcare. Int J Gynaecol Obstet 2013 Dec;123 Suppl 3:S39-40.}

_{Freedman LR, Landy U, Steinauer J. When there’s a heartbeat: miscarriage management in Catholicowned hospitals. Am J Public Health 2008 Oct;98(10):1774-8.}

_{Freedman LR, Stulberg DB. Conflicts in Care for Obstetric Complications in Catholic Hospitals. 2012:1- 10.}

_{Institute G. State Policies in a Brief: Refusing to Provide Health Services. 2015 [cited; Available from: http://www.guttmacher.org/statecenter/spibs/spib_RPHS.pdf}

_{Harris LH. Recognizing conscience in abortion provision. N Engl J Med 2012 Sep;367(11):981-3.}

_{Lithwick D. Why Should We Worry About Religious Conscience Clauses? 2013 2013-10-03T10:35:11Z.}

_{Lynch HF. Conflicts of Conscience in Health Care: An Institutional Compromise: MIT Press.}

_{http://www.usccb.org}

_{Dickens, Conscientious Commitment, 2008.}

Conscientious Provision and Refusal of Abortion Care Slide Set

Slide Set from Video Lecture Presented by:

Lori Freedman, PhD

University of California, San Francisco

Click to download Conscientious Provision and Refusal of Abortion Care Slide Set (pdf)

Abortion in the Primary Care Setting

Video Lecture Presented by:

Christine Dehlendorf, MD, MAS

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

Citations:

_{Jones RK, Jerman J. Abortion incidence and service availability in the United States, 2011. Perspect Sex Reprod Health 2014 Mar;46(1):3-14.}

_{Robert Graham Center}

_{O’Connell K, Jones HE, Simon M, Saporta V, Paul M, Lichtenberg ES. First-trimester surgical abortion practices: a survey of National Abortion Federation members. Contraception 2009 May;79(5):385-92.}

_{Paul M, Nobel K, Goodman S, Lossy P, Moschella JE, Hammer H. Abortion training in three family medicine programs: resident and patient outcomes. Fam Med 2007 Mar;39(3):184-9.}

_{Westfall JM, Sophocles A, Burggraf H, Ellis S. Manual vacuum aspiration for first-trimester abortion. Arch Fam Med 1998 Nov-Dec;7(6):559-62.}

_{Godfrey EM, Rubin SE, Smith EJ, Khare MM, Gold M. Women’s preference for receiving abortion in primary care settings. J Womens Health (Larchmt) 2010 Mar;19(3):547-53.}

_{Rubin SE, Godfrey E, Gold M. Patient attitudes toward early abortion services in the family medicine clinic. J Am Board Fam Med 2008 Mar-Apr;21(2):162-4.}

_{Shochet T, Trussell J. Determinants of demand: method selection and provider preference among US women seeking abortion services. Contraception 2008 Jun;77(6):397-404.}

_{Herbitter C, Greenberg M, Fletcher J, Query C, Dalby J, Gold M. Family planning training in US family medicine residencies. Fam Med 2011 Sep;43(8):574-81.}

_{Dehlendorf CE, Grumbach K. Medical liability insurance as a barrier to the provision of abortion services in family medicine. Am J Public Health 2008 Oct;98(10):1770-4.}

Abortion in the Primary Care Setting Slide Set

Slide Set from Video Lecture Presented by:

Christine Dehlendof, MD, MAS

University of California, San Francisco

Click to download Abortion in the Primary Care Setting (pdf)

Medical Student Professional Responsibility

This web-based Medical Student Professional Responsibility Module is intended to help learners develop skills to manage their own judgmental feelings in patient interactions by encouraging empathy, compassion, or acceptance. This exercise was developed as a values clarification exercise for use with medical students. The Digital Interactive Family Planning Module is designed for individual use on smartphones, tablets, and computers. This module can complement a group setting or be used as a stand-alone tool.

Immediate Steps for Trans-Friendly Teaching and Writing

RHAP Birth Control Across the Gender Spectrum

This resource explains different birth control methods for people across the gender spectrum, with a focus on the effects of different forms of birth control on those taking gender-affirming hormones such as testosterone.

Find this resource here!

Structures & Self: Advancing Equity and Justice in Sexual and Reproductive Healthcare

As we face these times of fear and uncertainty it is especially important that we combat misinformation and challenge racist, nationalistic rhetoric and narratives within our communities, our healthcare systems, and ourselves. Understanding our own implicit biases and having a clear understanding of how social, political, and economic structures impact health are important in addressing inequity and ensuring that the healthcare setting is equipped to provide safe and compassionate care. Find the visual glossary for this course here!

Learning Objectives

Learners will become familiar with historical context and implications for disparities in sexual and reproductive health. This video will review how the history of oppression, contributes to current health inequities.
Learners will explore how the structures of power and oppression manifest within healthcare systems and impact sexual and reproductive health outcomes.
Learners will identify implicit bias, privilege, and fragility regarding patient interactions, their relationship to structures of oppression, and practices for self-reflection and self-care.
After learners have recognized their privilege, they will identify ways to center a justice framework and structural analysis as a tool to promote optimal health outcomes.

Own Our Legacy

Recognize Structures of Oppression

Check Yourself

Take Action

Reproductive Justice 101 Webinar

Co-hosted by SisterSong and RHEDI, this webinar will provide: an introduction to the Reproductive Justice framework and its core principles; a brief history of reproductive oppression; and a deeper understanding of intersectionality.

Click here for more community education resources from RHEDI!

The Framework: Counseling for Patient-Centered Abortion Care

Abortion is essential healthcare. As we navigate a new reality with COVID-19, we must continue to prioritize patient autonomy and recognize patients as experts in their own lives. This intentional approach requires the provision of care that is respectful of and responsive to individual patient preferences, needs, and values and empowers people to take charge of their own health.

Learning Objectives

Recognize areas in your practice where you may experience a judgmental reaction to patient statements, questions and decisions.
Apply conversational techniques for maintaining a positive relationship with patients who make decisions about health care with which you may disagree.
Compare and contrast different words and phrases that are used in options counseling.
Analyze alternative responses to patient statements.
Practice techniques for talking with patients about their pregnancy decisions

Decision Counseling for Positive Pregnancy Test Results

Video Lecture Presented by:
Alissa Perrucci, PhD, MPH
San Francisco General Hospital, Women’s Options Center
Click here to download this video lecture

_{Backline. 2015 [cited; Available from: http://yourbackline.org/}

_{Rachel Herndon, MSW, Adoption Connection}

Decision Counseling for Positive Pregnancy Test Results

Slide Set from Video Lecture Presented by:

Alissa Perrucci, PhD
University of California, San Francisco

Click to download Decision Counseling for Positive Pregnancy Test Results (pdf)

The Framework: The Patient Has the Answer

The Patient has the Answer Summary: Only the patient is the expert in their life and needs.

The Framework: Liberation

Liberation summary: Healthcare providers may have bias favoring a particular decision, but the patient owns the decision and ultimately it does not impact the providers life.

Additional Resource

Abortions Welcome is a spiritual companion including meditations, rituals, stories, and scripture curated for different parts of the abortion process.

The Framework: Not A Failure

Not a Failure Summary:

A patient who returns for a second or greater abortion indicates that the clinic and staff provided high-quality service and supported the patient.
Viewing repeat patients as “failures” contributes to abortion shame and stigma.

The Framework: The Approach

The Approach Summary :

Patient-centered counseling uses this approach: Listen, don’t assume, self-reflect.
Patients and providers may not share understanding of complex medical terms.

Mini-Courses

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.

Abortion 101

Learning Objectives

EXPLAINED: Abortion Safety in the United States Lecture

Medication Abortion

Additional Resources

Citations

First Trimester Aspiration Abortion

Additional Resources

Citations

Pain with Uterine Aspiration Abortion

Pain with Uterine Aspiration Abortion Slide Set

Abortion After the First Trimester

Abortion After the First Trimester Slide Set

RHAP zine: “Sam’s Medication Abortion”

Abortion Pill Training

Contraception

Learning Objectives

Contraception 101

Additional Resources/Citations

Prescribing Emergency Contraception

Citation

This is How I Teach: SDM with LARC Methods

This is How I Teach: No Touch Technique for Copper IUD

Module 1 – Introduction – Role in Patient Centered Care

Module 2 – FAB Terminology, Efficacy, and Research

Professional Responsibility

Learning Objectives

EXPLAINED: Turnaway Study Lecture

Physicians’ Professional Responsibilities in Abortion Care

Physicians’ Professional Responsibilities in Abortion Care Slide Set

Nursing Roles in Abortion Care

Additional Resources

Nursing Roles in Abortion Care: Clinical Responsibility and Professional Ethics Slide Set

Conscientious Provision and Refusal of Abortion Care

Additional Resources

Conscientious Provision and Refusal of Abortion Care Slide Set

Abortion in the Primary Care Setting

Abortion in the Primary Care Setting Slide Set

Medical Student Professional Responsibility

Immediate Steps for Trans-Friendly Teaching and Writing

RHAP Birth Control Across the Gender Spectrum

Find this resource here!

Structures & Self: Advancing Equity and Justice in Sexual and Reproductive Healthcare

Learning Objectives

Own Our Legacy

Recognize Structures of Oppression

Check Yourself

Take Action

Reproductive Justice 101 Webinar

The Framework: Counseling for Patient-Centered Abortion Care

Learning Objectives

Decision Counseling for Positive Pregnancy Test Results

Decision Counseling for Positive Pregnancy Test Results

The Framework: The Patient Has the Answer

The Framework: Liberation

Additional Resource

The Framework: Not A Failure

The Framework: The Approach

RHEDI Patient-Centered Pregnancy Options Counseling