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Abortion Training of Doctors in OB-GYN residency programs

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bullet "An American woman's right to abortion was assured by the Supreme Court...But constitutional right or no, women cannot get abortions if there is nobody to perform them." 1

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Status of abortion training in 1992:

The percentage of U.S. Obstetric / Gynecologist (OB-GYN) residency programs that trained residents in surgical abortion declined from the late 1970s to the mid 1990s. A study by the Alan Guttmacher Institute in 1992 revealed that:

bullet Only 12% required surgical first-trimester abortion training as an integral part of their course. This was a decrease from 23% in 1985.
bullet Only 58% included such training as an elective.
bullet Only 7% offered routine training in second-trimester abortions. This was a decrease from 21% in 1985. 
bullet "More than 80% of programs in private, non-Catholic hospitals and public hospitals provided some form of abortion training in 1991-1992, but only 6% of programs in Catholic hospitals and no military programs did so." 2,3

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ACGME guidelines of 1996:

The Accreditation Council for Graduate Medical Education (ACGME) published a set of guidelines which recommended that all residents receive abortion training. "The ACGME is the private body responsible for establishing educational standards and evaluating and accrediting more than 7,300 medical residency programs throughout the United States. The ACGME is sponsored by and composed of representatives from the American Board of Medical Specialties, the American Hospital Association, the American Medical Association (AMA), the Association of American Medical Colleges and the Council of Medical Specialty Societies. Residency programs that are accredited by the ACGME must comply with a set of standards that its experts have deemed essential to graduate medical education." 4 

Their guidelines were implemented on 1996-JAN-1. They specified that:

"No program or resident with a religious or moral objection will be required to provide training in, or to perform, induced abortions. Otherwise, access to experience with induced abortion must be part of residency education. This education can be provided outside the institution. Experience with management of complications of abortion must be provided to all residents. If a residency program has a religious, moral or legal restriction which prohibits the residents from performing abortions within the institution, the program must ensure that the residents receive a satisfactory education and experience managing the complications of abortion. Furthermore, such residency programs:
  1. must not impede residents in their program who do not have a religious or moral objection from receiving education and experience in performing abortions at another institution; and 
  2. must publicize such policy to all applicants to that residency."

The guidelines affected "all public teaching hospitals which offer Ob/Gyn residencies because public hospitals cannot have moral or religious objections to a medical procedure which is protected by law without compromising the separation of church and state." 5

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Reactions by pro-life groups to the ACGME guidelines:

At last two pro-life organizations have gone on record as opposing the ACGME guidelines. In both cases, they appear to misrepresent or misunderstand those guidelines:

bullet Concerned Women for America (CWA) In its essay on abortion training, the CWA asked the question: "Should medical residents be forced to perform abortions?" They answered: "In essence, the National Abortion Federation and the Accreditation Council for Graduate Medical Education would place on each resident the burden of death." They appear to be unaware of the opting out clause in the guidelines which state that "No...resident with a religious or moral objection will be required to provide training in, or to perform, induced abortions." 6 We Emailed CWA on 2000-DEC-15, and pointed out this factual error. They never responded]
bullet American Association of Pro Life Obstetricians and Gynecologists (AAPLOG): In an essay opposing what the call "ACGME Mandatory Abortion Training" they state that ACGME "passed a revised 'Program Requirement for Residency Education in OB/Gyn' which specifically mandated that every OB/Gyn residency training program in the country must include induced abortion training, effective January 1, 1996." 7 (The emphasis was in the original). They also appear to be unaware of the opting out clause in the guidelines which state that "No program ...with a religious or moral objection will be required to provide training in, or to perform, induced abortions." At most, conservative Protestant or Roman Catholic hospitals merely need to release their students so that they can obtain abortion training at another facility. We attempted to Email AAPLOG, and pointed out this factual error. However, they do not provide an Email address on their web site.

This essay continues below.

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Federal Government reaction to the ACGME guidelines:

Senate bill S-2280 included an omnibus appropriations bill for fiscal year 1996 which included an amendment in opposition to the ACGME guidelines. The amendment allowed OB/GYN residency programs to eliminate abortion training  without fear of losing federal funding. The amendment forbade:

 "discrimination by the Federal Government against any health care entity that refused to be involved in certain abortion-related activities. Further, if an accrediting agency denied a postgraduate physician training program accreditation due to its failure to be involved in one or more of those abortion-related activities, and if it would have granted accreditation but for that failure, the Federal Government would deem that program to be accredited for the purpose of licensing, certifying, or otherwise granting legal status to that program, and for the purpose of providing financial assistance or other benefits. These provisions barring discrimination and deeming accreditation would also apply to State and local governments that received financial assistance from the Federal Government for health-related activities.

Those supporting the amendment felt that secular and public institutions should not be forced to include abortion training in their residency programs; they should be permitted to opt out just as religious institutions are able to. Those opposing the amendment felt that as long as abortions are constitutional and legal, they should be safe. In order to be safe, medical training must be available. If secular and public institutions are required to offer abortion training, then pressure from pro-life groups "will be useless, and the right of women to procure safe, legal abortions will remain secure." The amendment passed with a vote of 63 to 37, pretty much on party lines. 9

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MSFC policy on abortion training:

Medical Students for Choice issued the following statement on abortion training. The date was not provided.

"Every medical provider will have patients who have had, currently want, or someday will seek an abortion. And physicians who do not perform abortions often have patients call them with questions following an abortion obtained elsewhere. They should know how to address the patient's concerns knowledgeably and comfortably.

MSFC encourages medical schools to include the following in their curriculum for all students:

bullet Didactic instruction on the public health,
social, and historical context of abortion;
bullet Medical and surgical abortion techniques;
bullet Pre- and post-abortion management; and
bullet Pregnancy-options and contraceptive counseling.

In addition, every medical school should provide students with the opportunity to observe abortion procedures, including pre-abortion counseling." 7

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Status of abortion training in 1998:

During 1998, researchers from the National Abortion Federation (NAF) surveyed all 261 OB-GYN residency programs. 179 responded, revealing that:

bullet 46% now include routine first trimester abortion training.
bullet 34% offer it as an elective.
bullet 44% offer routine training in second-trimester abortions.

The data were published in an article in the NAF's Family Planning Perspective magazine for 2000-NOV/DEC. The authors warn that the information might not be representative of all programs. Most of the 82 programs that did not respond to the survey may well not offer this training.

NAF executive director Vicki Sapporta commented: "This is very encouraging news in terms of women's access to abortion and their ability to continue to access abortion services in the future."

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Implications for the future:

There are a number of trends in the area of unwanted pregnancies and abortion. These lead to a reduction in the number of surgical abortions sought:

bullet An increasing number of pregnancies are being prevented through the use of emergency contraception (EC), commonly called "the morning after pill."
bullet An increasing number of abortions are being performed using medical, not surgical methods.
bullet There appears to be an increase in the use of oral sex in place of sexual intercourse by teens.
bullet There appears to be an increase in the number of teens who have decided to remain celibate, at least for a short period during their teenage years.

All four trends lessen the number of surgical abortions being performed.

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  1. "Abortion: The Doctors Return," The New York Times, 1995-FEB-16.
  2. Rita Rubin, "More med schools offer abortion training," USA Today, 2000-NOV-21, at:
  3. H.T. MacKay & A.P. MacKay, "Abortin training in Obstetrics and gynecology residency programs in the United States, 1991-1992," Family Planning Perspectives, Vol. 27, #3, 1995-MAY/JUN, Pages 112 to 115. Summary available at: 
  4. The National Abortion Federation, Residency Training in Abortion Practice, Questions and Answers, cited in 5.
  5. Beka Cook-Mac, "Abortion training in Ob/Gyn residency programs," at: 
  6. "Abortion training mandatory," CWA Library, 1998-APR-22, at: "Our policy on abortion training," MSFC, at:
  7. Daniel Martin, "AAPLOG opposes ACGME mandatory abortion training," at: 
  8. "Omnibus Appropriations/Abortion & Medical licensing-accreditation," at: 
  9. "National Abortion Federation: The voice of abortion providers" has a web site at: 
  10. "The American College of Obstetricians and Gynecologists: Women's health care physicians," has a web site at:

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 Home page > "Hot" topics > Abortion > Legal aspects > here

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Copyright 2000 and 2004 by Ontario Consultants on Religious Tolerance
Originally written: 2000-DEC-15
Latest update: 2004-MAR-16
Author: B.A. Robinson

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