Ryan Program directors report significant barriers to abortion training after Dobbs

Key takeaways:

• Program directors reported limitations for first- and second-trimester abortions at teaching hospitals after Dobbs.
• Most program directors noted they were able to provide some abortion care for medical reasons.

Ryan Program directors noted limitations on provided abortion services at training hospitals with differences in services, restrictions and colleague support based on state-restrictive status, according to a survey published in O&G Open.

The Kenneth J. Ryan Residency Training Program in Abortion and Family Planning, known as the Ryan Program, is a national initiative to integrate and enhance family planning training for OB/GYN residents. As of October 2022, it supported 114 U.S. programs, each with routine training but with varying capacities to offer abortion services within their hospitals, Jema K. Turk, PhD, MA, MPA, director of evaluation in the department of obstetrics, gynecology and reproductive sciences at the Ryan Residency Training Program, and colleagues wrote in O&G Open. “The overturning of Roe v. Wade has led to significant barriers in abortion access, particularly in restrictive states where teaching hospitals face more limitations,” Turk told Healio. “This underscores the urgent need for better integration of abortion services and training in hospital settings.”

Turk and colleagues administered an annual survey to 91 Ryan Program faculty directors from 19 Western, 15 Midwestern, 17 Southern and 40 Northeastern programs with a Ryan designation for 2 years or more in October 2022. The survey asked close-ended questions regarding abortion care and pregnancy loss services at respondents’ respective hospitals and perceptions of restrictions and colleague support.

Overall, 36 programs were located in abortion-restrictive states.

In-hospital services for women requiring abortion or experiencing pregnancy loss varied, with 86.7% of directors reporting the availability of mifepristone on outpatient and 84.4% on inpatient formularies. In addition, 82.2% of directors could offer patients manual uterine aspiration in outpatient clinics, 65.6% in EDs and 25.6% could provide moderate sedation for in-clinic aspiration.

Directors in protective vs. restrictive states were more likely to have dedicated abortion care service and dedicated operating room block time for abortion cases.

In total, 34.1% of directors reported limitations on abortion care provided during the first-trimester and 37.4% reported limitations on care provided for second-trimester abortions. This varied significantly by region and state-restrictive status. Most directors indicated being able to provide abortion care for medical reasons such as pregnancy loss, pregnancy or health complications or fetal anomaly.

Most directors reported that chairs (78%) and residency program directors (84.6%) were “extremely supportive” of abortion care training and services. Perceptions of support from nurses varied with “extreme support” reported by 61.5% for clinic nurses, 30.8% for operating room nurses, 8.8% for labor and delivery nurses and 28.6% for anesthesia staff. These reports did not vary based on state-restrictive status.

According to Turk, despite most people understanding that state abortion restrictions impact abortion care, few consider the impact on training for OB/GYN residents who will provide abortion care.

“We need more investigative research into the long-term effects for residents who are not getting the required training, as well as the decisions they make about where and how they will practice,” Turk said. “Near 70% of programs in restricted states face significant restrictions in first-trimester care, where the vast majority of terminations occur. If residents aren't trained to competence, access to safe abortion will be in jeopardy.”

For more information:

Jema K. Turk, PhD, MA, MPA, can be reached at jema.turk@ucsf.edu.