ed-resources_photo_lo-resOur educational resources are used by a wide range of health care professionals, from those who provide direct abortion care to those who offer referrals, information, and resources to their patients who need abortions. These resources cover numerous topics related to surgical and medical abortion care, including clinical, training, counseling, and administrative issues.

Medical Abortion

When the U.S. Food and Drug Administration approved mifepristone, also known as RU-486 or the abortion pill, for early abortion in September 2000, it was a historic milestone for American women and for all involved in the provision of abortion care. NAF has played a key role in educating health care providers and the public about this abortion option.

Our Early Options medical education program educates and instructs health care professionals, including physicians, nurse-midwives, nurse practitioners, physician assistants, counselors, nurses, and office staff, in the safe and effective administration of mifepristone and misoprostol for early medical abortion.

We educate through conferences, workshops, lectures, and multimedia educational resources. The Early Options program also includes educational materials for women considering a medical abortion.

Mifepristone was developed during the early 1980s by a team of researchers working for the French pharmaceutical company Roussel Uclaf under the direction of Étienne-Émile Baulieu. While investigating glucocorticoid receptor antagonists, the team discovered compounds that blocked the similarly shaped progesterone receptor. Further refinement led to the production of RU-486, the medication that is now known as mifepristone.

Early Clinical Studies

Clinical testing of mifepristone as a means of inducing medical abortion began in France in 1982. Results from these trials showed that when used as a single agent, mifepristone induced a complete abortion in up to 80% of women up to 49 days’ gestation.1 By adding small doses of a prostaglandin analogue a few days later to stimulate uterine contractions, investigators discovered that they could induce a complete medical abortion in nearly 100 percent of women. 2,3

Worldwide Experience

In 1988, France became the first country to license the combination of mifepristone and a prostaglandin analogue for abortion during early pregnancy. Since then, this means of medical abortion has been approved in nearly thirty countries worldwide including Austria, Belgium, China, Denmark, Great Britain, Israel, Norway, Russia, South Africa, Sweden and Taiwan. In September 2000, the U.S. Food and Drug Administration (FDA) approved the use of mifepristone in the United States. Millions of women worldwide have used mifepristone and a prostaglandin analogue to terminate pregnancy with impressive safety and efficacy. 1

Bringing Mifepristone to the United States

While France first licensed the use of this combination of drugs in 1988, the politics of abortion delayed the introduction of mifepristone in the United States. Initial research in the United States was interrupted when Roussel Uclaf, the French manufacturer, stopped supplying the drug. In 1989 the FDA, under pressure from the first Bush administration, banned the import of mifepristone for personal use. President Clinton signed an executive order shortly after his inauguration in early 1993 to encourage the testing, licensing, and manufacturing of mifepristone and similar medications in the United States. Roussel Uclaf donated the U.S. patent rights for mifepristone to the Population Council, a private nonprofit research organization.

The Population Council conducted clinical trials using mifepristone in combination with the prostaglandin analogue misoprostol for medical abortion. (Misoprostol is widely available as Cytotec®.) Efficacy results and safety profiles from these studies and clinical trials in France led the FDA to grant “approvable” status for this combination medical abortion regimen in 1996. For final approval, the FDA requested further information on issues such as how the drug would be manufactured and distributed. Danco Laboratories, LLC, a women’s health pharmaceutical company, was granted an exclusive license from the Population Council to manufacture, market, and distribute mifepristone in the United States. However, it was difficult for Danco to identify a manufacturer willing to become involved in the politically charged area of abortion, which led to substantial delays in final approval. Ultimately, Danco secured a manufacturer for production of mifepristone in accordance with FDA manufacturing standards. In September 2000, the FDA approved the mifepristone and misoprostol combination for medical abortion.

The Methotrexate Alternative

During the extended struggle to make mifepristone available in the United States, some physicians began to study the use of low doses of methotrexate in combination with misoprostol for medical abortion. Results were comparable to the rates seen with mifepristone and misoprostol up to 49 days’ gestation (complete medical abortion, 94% to 96%; incomplete medical abortion completed with surgical abortion, 2% to 4%; and ongoing pregnancy requiring surgical abortion, 1% to 3%). The methotrexate/misoprostol regimen, however, generally takes longer to effect abortion and the timing of bleeding is less predictable than with mifepristone and misoprostol.4,5 While not approved in the United States as an abortifacient, methotrexate is approved for other indications, so physicians can prescribe this medication legally for the “off-label” evidence-based indication of abortion.

Mechanism of Action

Mifepristone blocks the progesterone receptor, leading to changes in the endometrial blood supply.6,7 In contrast, methotrexate inhibits DNA synthesis and primarily affects rapidly dividing cells. In early pregnancy, methotrexate interferes with the process of implantation through its effect on trophoblastic tissue.8 The net effect of mifepristone and methotrexate – detachment of the trophoblast from the uterine decidua – is the same. Mifepristone also softens the cervix to facilitate expulsion of the pregnancy. The prostaglandin analogue misoprostol accelerates the process of expulsion by stimulating uterine contractions as well as softening the cervix.9

Eligibility for Medical Abortion with Mifepristone and Misoprostol

The clinical trials conducted in the United States and France that formed the clinical basis of the new drug application (NDA) for mifepristone involved a single oral dose of 600 mg of mifepristone followed 48 hours later by a 400-µg dose of misoprostol administered orally. Using this regimen, the highest rates of complete abortion (about 95%) are seen in women up to 49 days’ gestation.10,11

For this reason, FDA-approved indications specify this gestational age as the “cut-off” for eligibility for medical abortion. Research conducted independently of the NDA has demonstrated the safety and efficacy of several evidence-based alternative regimens of mifepristone and misoprostol. These include a lower dose of mifepristone, different administration of misoprostol, home use of misoprostol, and flexibility in the timing of the regimen. These evidence-based alternative regimens are widely accepted clinical practice, but were not under consideration as part of the FDA’s initial approval process.

Contraindications to medical abortion with mifepristone and misoprostol include allergy to either of these medications, chronic systemic use of corticosteroids, chronic adrenal failure, coagulopathy or current therapy with anticoagulants, confirmed or suspected ectopic pregnancy or an undiagnosed adnexal mass, inherited porphyrias, and the presence of an intrauterine device (removal of the IUD eliminates this contraindication). In addition, women who do not have access to a telephone or who could not arrange transportation to a medical facility should not have a medical abortion, as they would not be able to secure appropriate care in the event of an emergency.

Side Effects and Complications

Side effects are expected with medical abortion. Some side effects, such as pain and bleeding, result from the abortion process itself. Side effects of the medications include nausea, vomiting, diarrhea, fever, and chills. In most cases, side effects can be managed with appropriate counseling and symptomatic treatments, such as oral analgesics for pain. Complications of medical abortion are rare; vaginal bleeding requiring transfusion occurs in approximately 1 in 500 cases. 4 Uterine infection (endometritis) is also rare because medical abortion usually does not require insertion of an instrument into the uterus. Approximately 2%-5% of women undergoing medical abortion will require vacuum aspiration to complete the abortion, to control bleeding, or to abort a continuing pregnancy.4,12

Availability

Physicians interested in providing mifepristone abortion services are able to obtain the drug through selected distributors. Information on how to obtain mifepristone is available through the Danco Laboratories website, www.earlyoptionpill.com. Women and health care professionals who would like referrals to providers of mifepristone should contact the National Abortion Federation’s toll-free Hotline (800-772-9100).

Medical Abortion in the United States

It is unusual for a drug to be introduced with such a wealth of clinical experience available to providers. Abundant evidence from studies conducted in the United States and abroad indicates that medical abortion with mifepristone and misoprostol is safe, effective, and well-accepted by women.

References

  1. Creinin MD. Medical abortion regimens: Historical context and overview. Am J Obstet Gynecol. 2000; 183: S3-S9.
  2. Swahn ML, Cekan S, Wang G, Lujndstron V, Bygdeman M. Pharmacokinetics and clinical studies of RU 486 for fertility regulation. In: Baulieu EE, Siegel S, ed. The Antiprogestin Steroid RU 486 and Human Fertility Control. New York, NY: Plenum; 1985:249-258.
  3. Bydgeman M, Swahn ML. Progesterone receptor blockage. Effect on uterine contractility and early pregnancy. Contraception. 1985;32:45-51.
  4. Kahn JG, Becker BJ, MacIsaac L, et al. The efficacy of medical abortion: a meta-analysis.Contraception. 2000;61:29-40.
  5. Pymar HC, Creinin MD. Alternatives to mifepristone regimens for medical abortion. Am J Obstet Gynecol. 2000; 183: s54-s64.
  6. Gravanis A, Schaison G, George M, et al. Endometrial and pituitary responses to the steroidal anti-progestin RU 486 in post-menopausal women. J Clin Endocrinol Metab. 1985;60:156-163.
  7. Schindler AM, Zanon P, Obradovic D, Wyss R, Graff P, Herrmann WL. Early ultrastructural changes in RU-486-exposed decidua. Gynecol Obstet Invest. 1985;20:62-67.
  8. DeLoia JA, Stewart-Akers AM, Creinin MD. Effects of methotrexate on trophoblast proliferation and local immune responses. Hum Reprod. 1998;13:1063-1069.
  9. Koopersmith TB, Mishell DR Jr. The use of misoprostol for termination of early pregnancy.Contraception. 1996;53:238-242.
  10. Peyron R, Aubény E, Targosz V, et al. Early termination of pregnancy with mifepristone (RU 486) and the orally active prostaglandin misoprostol. N Engl J Med. 1993;328:1509-1513.
  11. Aubény E, Peyron R, Turpin CL, et al. Termination of early pregnancy (up to 63 days of amenorrhea) with mifepristone and increasing doses of misoprostol. Int J Fertil Menopausal Stud. 1995;40(suppl 2):85-91.
  12. Kruse B, Poppema S, Creinin MD, Paul M. Management of side effects and complications in medical abortion. Am J Obstet Gynecol. 2000; 183: S65-S75.

 

Surgical Abortion

Surgical abortion is one of the safest medical procedures available in the U.S. And yet, it is shrouded in images of the dangerous “back alley” days prior to the Roe v. Wade Supreme Court decision that struck down state laws banning abortion. Given this history, and the intersection of politics and medicine that occurs in the context of abortion, it is especially important for health care providers, women, and the public to have access to factual, scientifically based information about surgical abortion.

As the professional association of abortion providers that sets evidence-based standards for quality abortion care, NAF is committed to providing accurate information about abortion care.

The following provide health care professionals with the resources and educational opportunities needed to counsel their patients about surgical abortion and to provide this service. Many of the materials can be downloaded for free from this website.

Training Opportunities

NAF connects students, residents, physicians in practice, and other health care providers with abortion training that meets their needs, often with NAF member facilities. We also work with residency programs and clinics to forge abortion training partnerships that ensure residents have access to abortion training.

Publications

Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care, NAF
Edited by M Paul, ES Lichtenberg, L Borgatta, DA Grimes, PG Stubblefield, MD Creinin
More than 50 international experts contributed to this groundbreaking textbook, the first to address both medical and surgical abortion procedures. It is a must-have resource for any clinician who cares for women of reproductive age. More

NAF’s Clinical Policy Guidelines
An outcome-based approach to standard setting; ensures quality care in your facility. More

Accredited Conferences

Our Annual Meeting and Regional Workshops serve as venues for presentation of the latest abortion-related research and include all-day specialized seminars and clinical workshops, as well as sessions on all aspects of the provision of abortion care, including legal and policy issues. Learn more about our conferences. More

Abortion and Medicine

The history of the relationship between the medical profession and abortion is an unusual saga of a seeming rediscovery, from the eighteenth century onward, of the main elements of abortion practice which, in fact, were known to medical practitioners in antiquity. Although dilators, curettes, and even a rudimentary suction apparatus existed in the ancient world, “modern” abortion techniques – especially dilation and curettage – did not come into prominence until developments within the larger field of gynecology occurred during the mid nineteenth century.

Dilation and Curettage

The modern curette (from the French verb, curer, “to cleanse”) was developed in France in 1723 for general surgical use. Its specific application to the uterus is believed to have been developed in 1842 by J. Recamier, who is also credited with reintroducing the vaginal speculum into gynecology. During the 1870s the German physician Alfred Hegar created the dilator that bears his name, and dilation and curettage (D&C) became widely practiced during the last quarter of the nineteenth century.1,2

Although eventually the use of D&C for abortion proved more effective and safe than many of the herbal and other folk remedies in use in the nineteenth century, this method may have been more dangerous to women when performed by unskilled abortionists or without adherence to proper antiseptic techniques. As one writer has put it, “Puerperal (childbed) fever was the scourge of nineteenth century obstetrics and abortion.” 1,3

Vacuum Aspiration Abortions

Perhaps the most significant development in modern abortion technology was the introduction and widespread dissemination of the vacuum suction machine. In the modern era it was first described by the nineteenth century gynecologist James young Simpson2,4 and most significantly by the Russian physician S.G. Bykov in 1927. After falling into disuse in the Soviet Union, it was refined in subsequent years in China and Japan, reintroduced in Eastern Europe, and by the late 1960s became known to British and U.S. physicians.

The medical community in the United States was directly educated about the vacuum suction method at a landmark conference on abortion in 1968 sponsored by the Association for the Study of Abortion, one of the first medical abortion rights groups. The presentation on vacuum suction given by Franc Novak, an obstetrician-gynecologist from Yugoslavia, was enthusiastically received owing to the method’s obvious superiority over D&C in terms of safety and ease. As Novak stated, “When the gynecologist who knows only the conventional D&C method first sees the apparatus in action, he is impressed by the cleanness, apparent bloodlessness, speed, and simplicity of the operation. While a D&C gives the impression of crude artisan’s work, an abortion provided with suction gives the impression of a simple mechanical procedure.”5 Novak went on to report the lessened blood loss experienced by the patient and the dramatically lowered risk of uterine perforation compared to D&C.5 By the early 1970s vacuum aspiration had become the dominant method of first trimester abortion in North America and eventually in the rest of the developed world. Because of a lack of training and appropriate equipment, however, abortions in developing nations are still often done by sharp curettage, leading to higher injury rates.6

Three other significant innovations during the 1960s and 1970s were the use of local anesthesia (paracervical block) for abortion, development of the Karman cannula, and introduction of manual vacuum aspiration (MVA). The paracervical block, initially refined for abortion use by a father and son team of Yugoslavian physicians (M. and B. Beric), allowed suction abortion to be provided under local anesthesia.2 This advance dramatically affected abortion services offered in outpatient settings, including those provided in freestanding facilities.

The Karman cannula was developed by Harvey Karman, a California psychologist who became involved in illegal abortion provision during the 1960s. Composed of plastic rather than metal, which had been the standard, this soft, flexible cannula made early suction abortions possible with local or no anesthesia and made perforation far less likely.2.7 The Karman cannula became a crucial component of abortion services in the developing world and was adapted to the standard suction machines in the United States and elsewhere. Widespread adoption of the Karman cannula is perhaps the most vivid example of a larger phenomenon – the extent to which, as abortion rapidly became legalized during the late 1960s and early 1970s, the medical profession was compelled to seek the advice of a number of illegal abortion providers, both lay and physician.8

Manual vacuum aspiration was the key to the widespread practice of “menstrual extraction” or “menstrual regulation” starting during the late 1960s. Although there are slight differences between the “Del-Em” developed by U.S. feminist health activists and the “menstrual regulation kits” that continue to be manufactured and distributed by Ipas, both rely on a handheld vacuum syringe, a Karman or similar soft cannula, and a valve that prevents air from entering the uterus. In the United States menstrual extraction was used as a method of fertility regulation and a means of hygiene (i.e., to remove a woman’s monthly period at one instance).2,9 When abortion became legal in the United States, menstrual extraction became far less common.

In the developing world menstrual regulation persists as a crucial strategy to circumvent anti-abortion laws. In Bangladesh, for example, although abortion is illegal the government has long supported a network of menstrual regulation clinics. Some other countries allow menstrual regulation because it presumably takes place without a technical verification of pregnancy.10

The technology of MVA is particularly suited for the developing world because it does not depend on the availability of electricity or anesthetics. Furthermore, with proper supervision and training, many public health officials assert that health care workers below the rank of physician can provide these procedures safely. Until anti-abortion politicians in the United States put a stop to the practice in 1973, the U.S. Agency for International Development (USAID) supplied thousands of menstrual regulation kits to developing countries.11

During the mid-1990s in the United States the medical community showed renewed interest in MVA as a method of early surgical abortion. This resurgence is due to technological advances that permit early pregnancy detection and a growing popular demand for safe, effective early abortion options, both surgical and medical. An innovator in the development of early surgical abortion services is Jerry Edwards, a physician, who developed a protocol in which women are offered an abortion using a handheld vacuum syringe as soon as a positive pregnancy test is received.12

The development of the vacuum aspiration method and the paracerical block made possible the creation of the freestanding abortion clinic, which was pioneered in the United States. Washington, DC and New York City had liberalized their abortion laws several years before the Roe v. Wadedecision, and clinics in these cities attracted women from all over the country. A prime rationale for these clinics was that they were able to offer safe outpatient abortion services at lower cost, and in a more supportive manner, than hospital-based services. The creation of the role of the “abortion counselor” – someone whose job it was to discuss the abortion decision with the patient, explain the procedure, and accompany her throughout the process – was a distinctive and lasting contribution of this early period in legal abortion.13,14 These clinics were also instrumental in pioneering a model of ambulatory surgery that became widely adopted by the medical profession.

Freestanding clinics remain the dominant form of abortion delivery in the United States, whereas in Europe and Canada abortions are more evenly apportioned between clinics and hospitals.6Notwithstanding the many benefits of the freestanding clinic system in the United States, it has contributed to the marginalization of abortion services from the rest of the medical establishment and has been vulnerable to attacks from anti-abortion extremists.8 In contrast, in European countries where abortions are delivered as part of national health care systems, there has been less difficulty finding abortion providers and far less anti-abortion activity at sites of abortion provision.

Reprinted from “Abortion in Historical Perspective” C Joffe in A Clinician’s Guide to Medical and Surgical Abortion, Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG (Eds). Philadelphia: Churchill Livingstone, 1999 with permission from Elsevier.

References

  1. Luker K. Abortion and the politics of motherhood. Berkeley: University of California. 1984
  2. Potts M, Diggory P, Peel J. Abortion. Cambridge (UK): Cambridge University. 1977
  3. Wertz R, Wertz D. Lying-in: a history of childbirth in America. New York: Oxford University Press. 1977
  4. David H. Abortion policies. In: Hodgson JE, ed. Abortion and sterilization: medical and social aspects. London: Academic Press. 1981:1-38
  5. Novak F. Experience with suction curettage. In: Hall R, ed. Abortion in a changing world. Vol. 1. New York: Columbia University. 1970:74-84
  6. Henshaw SK. Induced abortion: a world review, 1990. In: Butler JD, Walbert DF. Abortion, medicine, and the law. New York: Facts on File. 1992:406-436
  7. Karman H. The paramedic abortionist. Clin Obstet Gynecol 1972; 15:379-387
  8. Joffe C. Doctors of conscience: the struggle to provide abortion before and after Roe v. Wade. Boston: Beacon Press. 1995
  9. Chalker R, Downer, C. A woman’s book of choices: abortion, menstruation, RU 486. New York: Four Walls, Eight Windows. 1992
  10. Dixon-Mueller R. Innovations in reproductive health care: menstrual regulation policies and programs in Bangladesh. Stud Fam Plann 1988;19:129-140
  11. Dixon-Mueller R. Population policy and women’s rights: Transforming reproductive choice. Westport: Praeger. 1993
  12. Creinin MD, Edwards J. Early abortion: Surgical and medical options. Curr Probl Obstet Gynecol Fertil 1997;20:1-32
  13. Joffe C. The regulation of sexuality: Experiences of family planning workers. Philadelphia: Temple University. 1986
  14. Preterm Institute. Counselor’s manual: Individual and group techniques. Newton: Preterm. 1973
Women who are making decisions about pregnancy and who may be considering their abortion options need factual, unbiased information. Access NAF’s patient education resources. More

 

Quality Assurance and Improvement

NAF’s Clinical Services department provides individualized resources for NAF members. The Clinical Services department responds to member requests for educational resources on a case-by-case basis and covers topics included in the Clinical Policy Guidelines (CPGs) as well as systems analysis, patient care approaches, patient flow, customer service, administration, marketing, and management solutions.

NAF’s Clinical Services department uses the CPGs to provide a basis for ongoing quality assurance, help reduce unnecessary care and costs, provide ongoing medical education and encourage research. NAF’s CPGs allow for individual practitioner choices, patient care concerns, and provide a baseline of quality abortion care.

NAF’s Clinical Policy Guidelines (CPGs), the only evidence-based guidelines for abortion practice in North America, provide a basis for ongoing quality assurance in abortion care. The guidelines are developed based on rigorous review of the relevant medical literature and known patient outcomes. More

 

Online Learning Modules

NAF produces online learning modules and other resources for health care professionals. These courses are designed to provide training and orientation for all staff working in NAF member facilities. Clinicians can also earn CME/CE credits for completing the courses. NAF members can access the online learning modules through NAF’s Members-only Site.

We currently offer courses in:

  • 2017 Clinical Policy Guidelines for Abortion Care;
  • Infection Prevention: Principles and Instrument Processing;
  • Ultrasound: Introduction, Anatomy and Planes, Early Pregnancy Landmarks and Dating, and Performing a Systemic Scan; and
  • Medical Abortion: Patient Education, Provision, and Follow-up.

These courses are available exclusively to NAF members as a benefit of membership. For more info on joining NAF as an individual or organization, contact us at membership@prochoice.org.

Training Opportunities

NAF is committed to helping nursing and medical schools and residency programs work towards including abortion education in their core curricula, and connecting medical students, residents, and other health care providers with abortion training resources and opportunities.

In addition to the specific abortion training opportunities and resources NAF offers, this section also presents opportunities and resources from many of NAF’s collaborating organizations.

Despite the fact that abortion is one of the most common and safest surgical procedures,1 abortion training is not a standard component of the core curriculum in most medical schools across the United States. In fact, only 5% of all abortions in the United States are provided in hospitals,2 where most medical students and residents are trained. According to a growing body of information collected by Medical Students for Choice (MSFC):

  • 2/3 of the medical students in the United States spend less than 30 minutes of class time on all aspects of abortion;
  • only one out of five medical schools includes basic options counseling education in their curriculum; and
  • both infertility and Viagra receive more required class time – on average – than contraception or abortion.

There are specific support and training resources for medical students seeking education and experience in abortion and related comprehensive, reproductive health care.

NAF Placement

Many medical students interested in obtaining abortion training have had the opportunity to participate in elective rotations and clerkships with NAF member clinics and providers. These opportunities can provide medical students with exposure to and training not only in pregnancy options counseling, abortion procedures, and post-abortion care, but also in a range of other reproductive health services. These include pelvic exams, pap smears, breast exams, colposcopy, contraception, STI counseling and testing, and ultrasound. Find an abortion training opportunity near you.

Medical Students for Choice

Medical Students for Choice (MSFC) was established in 1993 by students working with NAF who were concerned about the national shortage of abortion providers, the lack of abortion education in medical schools and residency programs, and escalating violence against providers. MSFC’s 7000 student and resident members are working today to make reproductive health care, including abortion, a part of standard medical education and residency training.

Their efforts and programs include: student organizing; curriculum reform; annual meetings and regional conferences; leadership training; and funding for reproductive health externships. For more information visit Medical Students for Choice.

Dr. Barnett A. Slepian Memorial Fund

On October 23, 1998, an anti-choice terrorist shot and killed Dr. Barnett A. Slepian, an abortion provider in Buffalo, New York. In the wake of his murder, Mrs. Slepian requested that donations be made to the Pro-Choice Network of Western New York. The outpouring in response to Dr. Slepian’s tragic murder inspired the Pro-Choice Network to collaborate with the Community Foundation for Greater Buffalo to establish a fund which would not only honor his memory, but would also have a positive impact on reproductive choice.

The Dr. Barnett A. Slepian Memorial Fund makes training grants to medical students, residents and healthcare professionals who are committed to include abortion in their medical practice, view the option of abortion as an integral part of comprehensive care for women, and refuse to allow political extremists to dictate patient care.

Medical Student Mentoring

Physicians for Reproductive Choice and Health (PRCH) has collaborated with Medical Students for Choice to form the Physician-Student Support Network (PSSN) to support pro-choice medical students and residents. Through the PSSN collaboration, pro-choice PRCH members have the opportunity to share a wide range of experiences in reproductive health and offer students a chance to ask questions about professional practice, training and patient care. This diversity of perspectives fuels a dialogue providing medical students with various models of how to be active as pro-choice physicians. Visit PRH for more information.

Improving Reproductive Health Medical Education

The Reproductive Health Model Curriculum: Originally developed by the American Medical Women’s Association/ Reproductive Health Initiative and now managed by the Association of Reproductive Health Professionals (ARHP), the Reproductive Health Model Curriculum is used in fourth-year electives in medical schools throughout the country. The Curriculum covers topics such as abortion, contraception, sexually transmitted diseases, primary care for infertility, and psychosocial factors including physician/patient communication. The Curriculum is available for download free of charge on ARHP’s website: www.arhp.org/curriculum. A listing of Curriculum electives at U.S. medical schools is available at www.arhp.org/electives.For more information or to find out how you can encourage your administration to incorporate reproductive health topics in your school’s curriculum, contact ARHP at curriculum@arhp.org.

Additionally, A Medical Student’s Guide to Improving Reproductive Health Curricula (PDF file, 585K) is a resource to assist medical students interested in reforming their school’s curriculum. This publication was originally produced by AMWA and Medical Students for Choice and is now a joint publication of the Association of Reproductive Health Professionals (ARHP) and Medical Students for Choice (MSFC). Please follow the link above to access this guide online. For more information or for assistance with curriculum reform, contact ARHP at curriculum@arhp.org or MSFC at msfc@ms4c.org.

References

  1. Henshaw SK, Unintended pregnancy in the United States, Family Planning Perspectives, 1998, 30(1):24-29 & 46.
  2. Finer LB and Henshaw SK, Abortion incidence and services in the United States in 2000, Perspectives on Sexual and Reproductive Health, 2003, 35(1):6-15.
Although abortion training has historically been affiliated with residency training in obstetrics and gynecology, it is far from being routinely offered or easily accessible in all programs.

In 1995 the Accreditation Council for Graduate Medical Education (ACGME) acknowledged that abortion training opportunities had dropped to a dangerous level and adopted clear new guidelines that explicitly set forth the expectation that abortion training would be available to all ob-gyn residents. The new standard (Section V, A, 2, e), adopted on July 31, 1995 for implementation beginning January 1, 1996, reads:

“No program or resident with a religious or moral objection shall be required to provide training in or to perform induced abortions. Otherwise, access to experience with induced abortion must be part of residency education. Experience with management of complications of abortion must be provided to all residents. If a residency program has a religious, moral, or legal restriction that prohibits the residents from providing abortions within the institution, the program must ensure that the residents receive satisfactory education and experience in managing the complications of abortion. Furthermore, such residency programs (1) must not impede residents in the programs who do not have religious or moral objections from receiving education and experience in providing abortions at another institution and (2) must publicize such policy to all applicants to those residency programs.”

In 1998, the National Abortion Federation surveyed ob-gyn residency programs across the United States, generating some early data that cautiously suggest a possible increase in the number of programs providing abortion training. Of the 179 programs that responded for the study (out of 261 accredited programs), 46% reported routinely offering first trimester abortion training, and 34% reported offering it as an elective. Seventy-four (74) percent of programs reported offering second trimester training – 44% routinely and 29% as an elective.

Over the past several years, abortion training is also becoming more available in Family Medicine residency programs. In 2002, the Society of Teachers of Family Medicine (STFM) Group on Abortion Training and Access surveyed all 480 family practice residency program directors regarding the availability of abortion training in their programs. Of the 337 programs responding, 11 programs fully integrated abortion training into the curriculum, 4 made abortion training available through an established elective, and 3 allowed residents to find and set up an elective for themselves.

Abortion training is appropriate for a broad spectrum of health care providers, including those who specialize in ob-gyn, family medicine, emergency medicine, internal medicine, and adolescent/pediatric medicine. Many organizations, including the National Abortion Federation, are committed to helping interested residency programs identify means for integrating abortion services and training into their curricula, and providing technical assistance and support.

NAF is committed to helping interested medical students and residents identify and obtain abortion training. NAF can help medical students to identify residency programs with abortion training opportunities, or help residents identify elective opportunities where they may not be as easily accessible.

Residency Training Programs

In 1998 the National Abortion Federation surveyed accredited, ob-gyn Residency Programs in the U.S. to assess the availability of abortion training. A similar survey was conducted of Family Medicine Residency Programs by the STFM Group on Abortion Training and Access in 2002. Information and assistance finding a residency training program with accessible abortion training.

Elective/Supplemental Training

Abortion training, when not routinely offered in a residency program, can still be obtained during residency through independent electives. Many NAF members are committed to training residents to ensure future generations of abortion providers can continue to deliver the highest quality services to women. As a part of this commitment, many NAF clinics host resident trainees during elective time in their residency training.

Obtaining abortion training in a NAF clinic presents incredible opportunities:

  • Comprehensive Skill Building – Residents learn patient counseling, pelvic exams, ultrasound, uterine sizing, surgical technique, pain management, and management of complications. In addition, patient volume in clinics presents opportunities for training to competency, and residents are able to develop increased sensitivity toward abortion patients.
  • High-Quality Medical Care – NAF membership is comprised of a number of nationally recognized researchers, clinicians, and educators. All NAF clinics certify compliance with NAF’s Clinical Policy Guidelines, the standards of care in the delivery of abortion services.
  • Compliance with Accreditation Council for Graduate Medical Education (ACGME) abortion training requirements – While the ACGME mandate provides an exception for residency programs with religious or moral objections, it still requires that “experience with management of complications of abortion must be provided to all residents.” This experience can easily be obtained in a NAF clinic.Read the ACGME’s abortion training requirements for resident education in ob-gyn and other abortion training provisions (PDF file, 48K)
  • Fulfillment of CREOG Educational Objectives – The Council on Resident Education in Obstetrics and Gynecology (CREOG) has identified areas of care in which all residents must have experience. Experience in these areas – history taking, physical examination, diagnostic studies, diagnosis, management and follow-up – can be readily obtained in NAF clinics.

More information about abortion training with NAF members and training opportunities outside your core residency curriculum

Medical Students for Choice Residency Guide

As a part of their commitment to make reproductive health care, including abortion, a part of standard medical education and residency training, Medical Students for Choice (MSFC) maintains ob-gyn and Family Practice Residency Guides. These online guides were created to provide a forum for medical students, residents, and residency program directors to share information about the availability of abortion training in various U.S. and Canadian residency programs. Find your residency program and add information about your experience to the online Residency Guides by visiting Medical Students for Choice.

Family Medicine Residency Guide

RHEDI, Reproductive Health EDucation In Family Medicine, is housed within the Department of Family and Social Medicine at Montefiore Medical Center in the Bronx, New York, and also maintains a Family Medicine Residency Guide. To find a list of family medicine residencies that offer comprehensive training which includes didactic and clinical training in contraception, pregnancy options counseling, hands-on abortion training, and pre- and post-abortion care visit RHEDI.

RHEDI also provides other articles about abortion in Family Medicine training.

Dr. Barnett A. Slepian Memorial Fund

On October 23, 1998, an anti-choice terrorist shot and killed Dr. Barnett A. Slepian, an abortion provider in Buffalo, New York. In the wake of his murder, Mrs. Slepian requested that donations be made to the Pro-Choice Network of Western New York. The outpouring in response to Dr. Slepian’s tragic murder inspired the Pro-Choice Network to collaborate with the Community Foundation for Greater Buffalo to establish a fund which would not only honor his memory, but would also have a positive impact on reproductive choice.

The Dr. Barnett A. Slepian Memorial Fund makes training grants to medical students, residents and healthcare professionals who are committed to include abortion in their medical practice, view the option of abortion as an integral part of comprehensive care for women, and refuse to allow political extremists to dictate patient care.

To learn more information about the Dr. Barnett A. Slepian Memorial Fund and to submit an application, go to Buffalo Womenservices.

NAF’s 1998 survey of abortion training in obstetrics and gynecology residency programs in the U.S. (PDF file, 167K) suggested an increase in the availability of abortion training. However, it is clear that the number of abortion providers in North America is not only steadily declining, but an inadequate number of abortion providers remain to deliver these much-needed services.

There is no single solution to the shortage of abortion providers. Although most abortions in the U.S. are currently provided by gynecologists, a growing number of clinicians from family medicine are not only pursuing abortion training, but translating that training into direct abortion services in their professional practices. Practitioners in internal medicine, emergency medicine and adolescent and pediatric medicine also have occasion to see women with unplanned pregnancies or in need of abortion care or follow-up care.

NAF works to facilitate the availability and accessibility of abortion training for future generations of providers as part of our commitment to ensuring safe, legal, and accessible abortion care to promote health and justice for women. This section identifies programs and resources specifically designed for – or for use with – the development of new abortion training opportunities in medical schools, residency programs, teaching hospitals, freestanding clinics, and independent medical practices.

NAF’s Residency Training Workshop

As part of the Residency Training Program, NAF convenes a Residency Training Workshop approximately every two years. The workshop itself is a single, full-day meeting of approximately 20 representatives from clinics and residency programs, representing a wide spectrum of experience with training residents in abortion. The most desirable situation is one in which a clinic representative and a residency program representative from the same area come together. This allows them during the workshop to begin developing an initial framework of ideas and strategies on-site, with the assistance of their peers.

The focus covers a variety of issues associated with creating and sustaining training programs in local clinics. Different models of training programs will be presented, and discussion will address administrative and clinical issues from the perspectives of both the residency program and the clinic. Specific topics addressed include finding and selecting trainees, licensing and malpractice insurance, identifying trainers, developing the curriculum, evaluating trainees, and cost(s) of training. The day is divided into faculty presentations of various training models, break-out groups, and round table discussions.

Request more information about NAF’s next Residency Training Workshop.

Resources for Developing an Abortion Training Program

Developing an abortion training program at your site does not mean that you have to reinvent the wheel. A number of resources are already developed and available for use as references, guides, or models you can adapt to fit your site or program needs. You can download or order NAF publications and resources online:

Get more information on training opportunities.

Bridging the Gap Between Abortion Training and Abortion Provision: Recommendations from a National Symposium

In October 2000, the National Abortion Federation (NAF), Planned Parenthood of New York City (PPNYC), the Consortium of Planned Parenthood Abortion Providers (CAPS), and The Access Project convened a national symposium to discuss best practices in abortion training and to consider strategies to ensure that the resources invested in abortion training result in actual increases in the number of qualified abortion providers.

The symposium focused on evaluating progress to date in a wide range of formal and informal training programs, and considering future directions for training. It provided the first opportunity for providers of abortion training and services to come together to develop strategies for translating abortion training into positive, personal commitments to service delivery on the part of trainees, and equipping trainees with skills for navigating and overcoming the barriers to becoming abortion providers.

We present the key findings and recommendations of the Symposium participants in this report (PDF file, 283K) as a resource for organizations and individuals engaged in the important work of abortion training and abortion service provision as we continue to collaborate and seek creative and meaningful solutions that ensure access to high-quality abortion services for women who need them.

NAF’s Clinical Training Resources

NAF has developed a number of resources to address the many aspects of abortion training, including a clinical training curriculum and the most comprehensive and up-to-date textbook on abortion practice. For a complete listing of NAF’s Clinical Training Resources, visit our Clinical and Professional Training Publications.

A number of other organizations have developed resources for abortion training, as well, and have made some of these resources available on the web. Here are several resources NAF suggests:

  • Advancing New Standards in Reproductive Health (ANSIRH) – You can access a free copy of ANSIRH Program’s Early Abortion Training Workbook
  • American Medical Women’s Association – Reproductive Health Initiative – This program offers a number of reproductive health education tools, including a Reproductive Health Model Curriculum and educational tools for each content area of the curriculum
  • The Access Project – This site offers a host of resources to help clinicians initiate and integrate early abortion methods into their existing scope of practice
  • Association of Professors of Obstetrics and Gynecology (APGO) – APGO’s Women’s Healthcare Education Resource Network has developed new resources for teaching and evaluating women’s health care competencies in medical education. These are particularly significant as medical education is shifting towards stronger evaluation of learning objectives and outcomes.
  • ACGME Outcome Project – The ACGME Outcome Project is designed to enhance resident education through outcomes assessment. While this information is not abortion-specific, NAF encourages trainers and programs to incorporate the competency areas identified by the ACGME into the development of an abortion training program, and endeavor to create rigorous assessment and evaluation tools for their trainees.

Articles on Abortion Training

NAF has compiled a bibliography of published and peer-reviewed articles about abortion training. While the list is not a comprehensive resource of all abortion-training related publications, it includes the most significant peer-reviewed articles that have been published to date. These articles address abortion as a component of medical education in medical school, ob-gyn residency programs, and family medicine residency programs. As new studies are completed and published, NAF continues to update this resource, so continue to check back for the most recent literature.

Kenneth J. Ryan Residency Training Program in Abortion and Family Planning

The Kenneth J. Ryan Residency Training Program in Abortion and Family Planning was founded in 1999 to provide technical and financial assistance to obstetrics and gynecology departments working to comply with ACGME and other abortion training mandates. The goal of the program is to increase and improve abortion and family planning training opportunities for ob-gyn residents in the United States and Canada. To ensure resident competence, they offer support in instituting a formal dedicated rotation, either by establishing an outpatient abortion service within the teaching hospital or linking with a freestanding clinic in the community.

The Ryan Program can offer:

  • start-up funding for faculty and staff salaries, consultants, equipment and renovations;
  • technical assistance for the development of business plans, training staff, protocols and site evaluations;
  • expert speakers for Grand Rounds presentations on a range of topics related to abortion;
  • hands-on training for faculty and residency in manual uterine aspiration;
  • site visits with established programs; and
  • identification of potential faculty from a pool of graduating family planning fellows.

For more information, or if you are interested in participating in the Ryan Residency Training Program, contact:

Uta Landy, PhD, Ryan Program Director
The Ryan Residency Training Program
University of California, San Francisco
Center for Reproductive Health Research & Policy
3333 California Street, Suite 335, Box 0744
San Francisco, CA 94143-0744
Phone: (415) 502-4091
Email: ulandy@itsa.ucsf.edu

NAF works to connect interested and motivated medical students, residents, and other health care professionals with abortion training resources and opportunities as part of our commitment to ensuring safe, legal, and accessible abortion care to promote health and justice for women. To request more information about any of the training programs or resources you have found on these pages, please contact NAF at 202-667-5881 or email your request to naf@prochoice.org.

 

Cultural Competency

In the United States, women of reproductive age form a rainbow of racial and ethnic groups, hail from different socioeconomic classes, live in cities and on farms, and were born in any of nearly 200 countries. These women visit reproductive health providers every day. For health care professionals trained in Western medicine and reared in a Western culture, it may seem an impossible task to understand the wide array of diversity in patient populations. However, achieving cultural competence is vitally necessary to ensure the highest quality of care for every woman seeking reproductive health care.

Cultural competency refers to one’s ability to understand and appreciate cultural differences and similarities within, among, and between different groups. By increasing their level of cultural awareness, abortion providers and clinic staff can tailor their service delivery to ensure that it is more appropriate, relevant, and effective. It is imperative that clinicians and staff have an understanding of the impact of language and culture on health care delivery in order to efficiently organize services that meet the needs of both the institution and a diverse patient population.

It is imperative that providers, clinicians, and clinic staff understand and embrace the importance of building personal and organizational cultural and linguistic competency.

In April 2003, the National Abortion Federation invited experts on cultural and linguistic competence to train reproductive health care providers and activists about how to develop a culturally competent workplace and to provide strategies for addressing the concerns and specific needs of women of color, low-income women, and immigrant women. Read Developing Cultural Competence in Reproductive Health Care: Understanding Every Woman (PDF file, 2.2 MB).

Three key recommendations were identified by seminar participants to assist providers and clinic staff in building cultural competency:

  • Incorporate the challenge of cultural competence into the philosophy, staffing and budget of your organization.
  • Expand your affiliations with local and national service, education, and advocacy organizations concerned with the needs of women from diverse backgrounds.
  • Improve your ability to communicate with clients and provide a welcoming environment for all women, including non-English speaking women.

Incorporate the challenge of cultural competence into the philosophy, staffing and budget of your organization.

The first step is to incorporate the value of cultural competence into the basic philosophy of your organization and systematically evaluate which aspects of your organization would benefit from developing cultural competence.

What you can do:

  • Identify the different communities served by your organization. Once you have determined the different groups among your clientele, research the unique barriers faced by women in each of these communities.
  • Talk to other nonprofit organizations in the area or poll your clients about how you might better serve them.
  • Assess your staff and the structure of your organization. Does your staff come from the communities they serve?
  • When you are hiring, write job descriptions that include language to reflect your commitment to cultural and linguistic competence.
  • Recruit job candidates from communities of color by placing advertisements for open positions in venues besides the local newspaper.
  • Once you make a hiring decision, incorporate cultural competence into your protocols for training and evaluating new staff. During the orientation for new employees, share information about underserved women in your community.
  • Create an annual employee feedback survey that includes questions about the cultural and linguistic competence of the organization, both at the level of client services and among the staff.
  • Changing the hiring and staffing patterns of your organization should include formal training in cultural competence. Some NAF member clinics devote at least one day a year to training, and every staff member is required to attend.

Developing cultural competence requires an investment of both time and financial resources. Although the amount of money required to create outreach programs and train staff is not necessarily a significant sum, it does need to be incorporated into your organization budget, for instance as a line item for staff training or for the development of translated materials. This is the only way to ensure that your philosophical commitment to cultural and linguistic competence becomes a reality. Regardless of where you start, the simple act of stating the problem will make it possible to identify solutions that will benefit the women you serve.

Expand your affiliations with local and national service, education, and advocacy organizations concerned with the needs of women from diverse backgrounds.

As part of reaching out to different groups in your community, seek out opportunities to establish new affiliations with organizations serving women of color, low-income, and immigrant women. These affiliations might begin as informational meetings between members of your staff and representatives of these groups, or they might be as formal as co-sponsoring conferences and events. This will allow your organization to build meaningful relationships with the communities you serve, which will provide you with more insights about culturally influenced health behaviors and how best to meet the needs of these constituencies and your clients.

What you can do:

  • Find out how women can travel to your organization using public transportation by locating the nearest bus line.
  • Increase the visibility of your organization by co-sponsoring events in your community. Sign on with charity walks for breast cancer research or the American Heart Association. Contact the local medical school and find out if students have organized mobile clinics that your organization can contribute to with volunteers or supplies.
  • Celebrate Black History Month or International Women’s Day at your organization with poster displays or special events.
  • Network and develop relationships with religious pro-choice organizations.
  • Engage in educational outreach to underserved communities. For example, you could give presentations about reproductive health and sexuality to teens in local high schools and community colleges.

In addition to learning from and working with the people in your community, you might also be in touch with other reproductive health organizations that have made efforts to develop culturally competent care. One example of this kind of networking is the SisterSong Women of Color Reproductive Rights Collective, which began in 1997 when the Latina Roundtable on Health and Reproductive Rights convened meetings for sixteen organizations representing four women of color communities – African American, Asian and Pacific Islander, Latina, and Native American.

NAF was a co-sponsor for the first annual SisterSong conference in Atlanta, GA in November 2003, where hundreds of women of color activists and allies gathered to discuss the concerns and address the reproductive health care needs of women in diverse communities. The primary function of the collective is to lend mutual support in initiating and enhancing local programs to foster increased awareness of reproductive health care for women of color. Visit the SisterSong website.

The women who come to you for services do so out of a particular need, but they cannot be reduced to that need. The more that you are able to learn about who they are and how they live, you will be in a better position to provide appropriate care.

Improve your ability to communicate with clients and provide a welcoming environment for all women, including non-English speaking women.

Regardless of the measures your organization takes to develop a deep understanding of different groups in your community, this endeavor will be wasted if you are not able to communicate with your clients. Linguistic competence in the realm of client materials is essential to your ability to provide quality care. Immigrant women, women who do not speak English, and women with limited education need client materials in different languages using basic vocabulary.

What you can do:

  • Create pictographs to convey information without the necessity of words.
  • Work on translating the most important materials first, like pre-appointment guides and counseling information. This will provide a basic level of communication about what your client can expect.
  • To assess your linguistic and cultural competence, add questions to a post-operative form in which you ask your clients directly about their experiences with your services and staff.
  • Hire multi-lingual staff, and work with interpreters on an as-needed basis. Interpreters can be found via local translation services listed in your phonebook. Several clinics have also successfully used graduate students at universities.
  • Even if staff members are not fluent in a particular language, the ability to say a few welcoming words in the client’s language builds trust and puts the client at ease.

Along with transforming written and verbal communications between staff and clients, take time to evaluate the physical aspects of your organization. Do the posters in your waiting area include images of women of different ages and ethnicities? Are the posters filled with words or do they contain pictures as well?

The goal is not to completely transform into a culturally and linguistically competent organization in one day, but to make incremental changes on a variety of levels to make sure that all women who enter your door will find some reflection of themselves inside.

The preceding was excerpted from the NAF publication Developing Cultural Competence in Reproductive Health Care: Understanding Every Woman (PDF file, 2.2 M) ©2004.

Everybody is different, and these differences take many forms which include, but are not limited to:

Ethnicity and Culture – the sources of the customs, language, and sense of identity that people with similar roots often share.

Geographic background – the neighborhood, city, region, or country that shapes an individual’s life and values.

Life experiences – which include family backgrounds, values, and traditions, as well as school, work, travel, recreation, and hobbies.

Beliefs – including one’s religion, outlook, and philosophy of life.

Physiology – which determines gender and physical abilities.

Working styles – the importance of teamwork and conflict resolution, leadership qualities, and communication styles.

How we respond to these differences will determine the success of the relationship between a patient and her provider.

Source: Hearts & Hands. Edition No. XIII. 2000, April. Ronald McDonald House Charities.

Need more information on how to implement cultural competency programming into your clinic? Here are some great resources:

Organizations Addressing Cultural Competence

American Medical Student Association

AMSA’s Resource Center offers a variety of publications, self-assessment tools, project guides, online resources, and training opportunities focusing on cultural competency. The majority of their publications are written, edited, or compiled by AMSA members in conjunction with national projects.

The Center for Cross-Cultural Health

This Minneapolis, MN, organization provides community profiles in Minnesota including: Hmong, Nuer, Russian Jewish, Bosnian, Vietnamese, and Ukrainian. They publish the Cross Winds newsletter, Six Steps Toward Cultural Competence, and Caring Across Cultures: the Provider’s Guide to Cross-Cultural Health Care. Find resource links and more.

Cross Cultural Health Care Program

The program offers cultural diversity and cultural competency training, interpreter training, and translation services.

Diversity Rx

Promotes language and cultural competence to improve the quality of health care for minority, immigrant, and ethnically diverse communities.

National Advocates for Pregnant Women

The mission of NAPW is to secure the human and civil rights, health, and welfare of pregnant and parenting women while protecting children from punitive and misguided state policies. They advocate on behalf of all women, especially those who are most marginalized: women of color, low-income women, and women who use drugs.

The National Center for Cultural Competence

NCCC’s mission is to increase the capacity of health and mental health programs to design, implement, and evaluate culturally and linguistically competent service delivery systems.

U.S. Department of Health and Human Services’ Office of Minority Health

The Office on Minority Health produced a final report, National Standards for Culturally and Linguistically Appropriate Services in Healthcare (PDF file, 565K, requires free Adobe Reader), detailing standards for producing culturally and linguistically appropriate health care services (CLAS).

Assessment Tools

Cultural Assessment Tool

Produced by the University of Michigan Health System, this is a cultural assessment tool to help providers understand where patients derive their ideas about disease and illness. Assessments help to determine beliefs, values, and practices that might have an effect on patient care and health behaviors.

Cultural Competence Clinic Assessment Tool

This booklet offers a self-test for clinic staff to gauge their current level of cultural competence. For a copy, write to: by Success by 6/United Way of Minneapolis and Hennepin Medical Society Center for Cross-Cultural Health, W-227, 410 Church Street, Minneapolis, MN 55455.

Cultural Competence in Primary Health Care: Self-Assessment

Developed by the Georgetown University Child Development Center’s National Center for Cultural Competence, this self-assessment tool helps to gauge the degree to which an organization is effectively addressing the needs and preferences of culturally and linguistically diverse groups.

Multicultural Organizations

SisterSong Women of Color Reproductive Justice Collective

The collective is made up of local, regional, and national grassroots organizations representing four major ethnic populations/indigenous nations in the United States: African-Americans, Asian-Americans, Latinas, and Native Americans. SisterSong is committed to educating women of color on reproductive and sexual health and rights and working towards the access of health services. They develop information and resources that are culturally and linguistically appropriate through the integration of the disciplines of community organizing, self-help, and human rights education.

National MultiCultural Institute

NMCI’s mission is to work with individuals, organizations, and communities in creating a society that is strengthened and empowered by its diversity.

Culturally Specific Organizations

African-American

African American Women Evolving

AAWE’s mission is to increase the activism and leadership of black women around reproductive health.

Black Women’s Health Imperative

The Black Women’s Health Imperative, the new name of the National Black Women’s Health Project, is a leading institution fostering African-American health education, research, advocacy, and leadership development.

California Black Women’s Health Project

The project advocates for policies that promote and improve the physical, spiritual, and emotional well-being of black women and girls in California. It seeks to empower women to take control and become active participants in improving their health status through education, self-help, and advocacy.

National Medical Association

The NMA promotes the collective interests of physicians and patients of African descent and carries out their mission by serving as the voice of physicians of African descent and a leading force for parity in medicine, elimination of health disparities, and promotion of optimal health.

SisterLove, Inc.

Founded in 1989, SisterLove sponsors transitional housing and support services, the Women’s AIDS Prevention Project, education on reproductive health, the CareWorks Volunteer Program, and other services for women of color in the Atlanta area.

Arab-American

National Arab-American Medical Association

NAAMA is a nonprofit, non-political, educational, and charitable organization for medical professionals of Arab descent.

Asian-American/Pacific Islander

Asian and Pacific Islanders for Reproductive Health

APIRH works with the Asian and Pacific Islander Community, particularly in the western United States, to educate and assist with access to reproductive health.

Asian & Pacific Islander American Health Forum

APIAHF is a national advocacy organization dedicated to promoting policy, program, and research efforts for the improvement of health status of all Asian-American and Pacific Islander communities.

Asian Women’s Health Clinic

Located in Canada, Asian Women’s Health Clinic was established to address cultural and linguistic barriers limiting access to preventive health services for Chinese women.

Kokua Kalihi Valley Comprehensive Family Services

A nonprofit organization whose mission is to be an agent for healing and reconciliation in the Kalihi Valley community on the island of Oahu.

Latina/Hispanic

National Alliance for Hispanic Health

The Alliance is the nation’s oldest and largest network of Hispanic health and human services providers. Members deliver quality services to over 12 million persons annually.

National Center for Latinos with Disabilities

NCLD serves three primary constituencies: individuals with disabilities, their families, and professionals who work with these individuals and their families. 1921 S. Blue Island Ave., Chicago, IL 60608, (312) 666-3393 voice, (312) 666-1788 TTY

National Hispanic Medical Association

NHMA was organized in 1994 to address the interests and concerns of 26,000 licensed physicians and 1,800 full-time Hispanic medical faculty dedicated to teaching medical and health services research.

National Latina Institute for Reproductive Health

NLIRH’s mission is to ensure the fundamental human right to reproductive health care for Latinas, their families and their communities through education, advocacy, and coalition building.

National Latina Health Organization

A national advocacy and education organization, NLHO advocates for Latina issues at both the national and local levels, providing health information, referral services, and a resource center.

Native American/Indigenous

Indigenous Peoples Task Force

Formerly the Minnesota American Indian AIDS Task Force, its mission is to strengthen the health and education of native people.

Native American Women’s Health Education Resource Center

Founded in 1988 on the Yankton Sioux Reservation, NAWHERC programs address reproductive health, fetal alcohol syndrome, domestic violence, child development and youth wellness. Additionally, NAWHERC runs a battered women’s shelter, food pantry, diabetic nutrition program, organizes community health fairs, and publishes the Wicozanni Wowapi Newsletter.

The Wise Women Gathering Place

The Gathering Place is a women’s reproductive health resource center, which provides a book and video library along with internet-access computers for clients to use in their personal research. It is staffed by experienced midwives who provide assistance providing health care information when needed, as well as classes about childbirth, pregnancy, breast-feeding, relationship development, and alternative methods of health care.

Immigrants

AmASSI Center

AmASSI’s mission is to serve the diverse African immigrant community with culturally affirming services focusing on advocacy, health, well-being, self respect, responsibility, leadership development, HIV/AIDS prevention, diversity, education, critical thinking, and other health and human services needs.

American International Health Alliance

AIHA maintains a searchable Directory of Translated Materials – health and medical documents. This is a directory of more than 400 health-related materials that have been translated into languages of the former Soviet Union and Central and Eastern Europe.

Ayuda

Ayuda is a domestic violence, legal, and advocacy organization working with Hispanic immigrants.

Ethiopian Community Development Council

Through offices in the United States, ECDC conducts educational and social service programs that help newcomers resettle in their new communities and acculturate; recover from past trauma; gain personal independence and economic self-sufficiency; and quickly become able participants and productive, contributing members of American society.

Mexican American Legal Defense & Education Fund

MALDEF’s mission is to foster sound public policies, laws and programs to safeguard the civil rights of the 40 million Latinos living in the United States and to empower the Latino community to fully participate in our society.

The Provider’s Guide to Quality and Culture

This site provides information in a variety of areas including: understanding immigrant, refugee, and minority populations; common health problems in selected minority, ethnic, and cultural populations; common beliefs and cultural practices; non-verbal communications; relating to a patient’s family; culturally competent organizations; and expanded information for five cultural groups. Take the Quality and Culture Quiz to examine your own cultural competence.

The World-wide Web Virtual Library Migration and Ethnic Relations

This complete list of resources contains an alphabetical list of all resources included in the WWW Virtual Library on Migration and Ethnic Relations.

Linguistic Education and Translation Resources

AT&T Language Line

The AT&T Language Line offers 24-hour-a-day access to interpretations of more than 140 languages, over the phone, within minutes. To reach an interpreter from the United States or Canada, call 800-628-8486. The Language Line also provides software, localization, translation, and multinational document management services.

Certification of Medical Interpreters

Cross Cultural Health Program details the factors needed and accepted standards of receiving medical interpreter certification.

Society of Medical Interpreters

SOMI is dedicated to promoting professionalism and excellence in interpretive services to enhance the provision of health and social services to ethnic communities.

Word2Word Language Resources

This site is dedicated to breaking down of language barriers and assisting the users who have the desire to learn language, a need to communicate between languages, and for those who work with languages as a profession.

Articles and Fact Sheets

Cultural Aspects of Caring for Refugees

This article addresses the cultural barriers faced by refugees seeking medical treatment, as well as recommendations to create a better and productive medical experience. (American Family Physician, March 1998).

Language Barriers Hinder Access to Women’s Reproductive Health Care

Eliminating language barriers is critical to the health and well-being of millions of people. If a woman is unable to communicate with her health care provider, she is less likely to receive appropriate health care.

Medical Care for Immigrants and Refugees

This article by Thomas Gavagan, MD, MPH, and Lisa Brodyaga, JD, describes medical conditions associated with immigrants, as well as specific screening recommendations, including history, physical examination and laboratory tests, and some of the challenges encountered by family physicians caring for refugees. (American Family Physician, 1998).

Minority Health Care Providers: The Need to Increase the Number, Diversity, and Distribution

A dearth of minority and women’s health care providers exists in the U.S. The situation is particularly acute in predominantly minority neighborhoods and regions. As a result, women of color are less likely to obtain the reproductive health care they need.

Pocket Guide to Minority Health Resources

The Pocket Guide to Minority Health Resources is an easy-to-use guide published by the Office of Minority Health. The guide lists phone numbers and addresses of OMH regional coordinators, public health service minority liaisons, federal information centers and clearinghouses, and national organizations, categorized by target population.

Books and Publications

Betancourt JR, Green AR, Carrillo JE. Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches, Final Report. New York, NY: The Commonwealth Fund, October 2002.www.cmwf.org.

Byrd WM, Clayton LA. An American Health Dilemma. In: Volume 1- A Medical History of African Americans and the Problem of Race; and Volume 2 – Race, Medicine, and Health Care in the United States 1900-2000, New York, NY: Routledge, 2000.

Fadiman A. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York, NY: Farrar, Straus, and Giroux, 1997.

Hedrick H, ed. Cultural Competence Compendium. Chicago, IL: American Medical Association, 1999.

Helman CG: Culture, Health and Illness, Fourth Edition. Oxford: Oxford University Press, Heinemann, 2000.

Huff RM, Kline MV, eds. Promoting Health in Multicultural Populations: A Handbook for Practitioners. Thousand Oaks, CA: SAGE, 1999.

Like RC, Steiner RP, and Rubel AC. Recommended core curriculum guidelines on culturally sensitive and competent health care. Family Medicine, 1996: 28:291-98

McCullough-Zander K, ed. Caring Across Cultures: The Provider’s Guide to Cross-Cultural Health, Second Edition. Minneapolis, MN: The Center for Cross-Cultural Health, 2000.

Mutha S, Allen C, Welch M. Toward Culturally Competent Care: A Toolbox for Teaching Communication Strategies. San Francisco, CA: Center for the Health Professions, University of California, San Francisco, 2002.

Roberts, Dorothy, JD. Killing the Black Body. New York, NY: Random House Value Publications, 1999.

Salimbene S. What Language Does Your Patient Hurt In?™ A Practical Guide to Culturally Competent Patient Care from Other Cultures. Amherst, MA: Diversity Resources, 2000.

Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. New York, NY: Institute of Medicine, 2002.

Spector RE. Cultural Diversity in Health & Illness, Fifth Edition. Upper Saddle River, NJ: Prentice-Hall, 2000.

 

Curricula

In a concerted effort to help ob-gyn and other residency programs throughout the United States and Canada integrate abortion training into their core or elective curricula, NAF published a comprehensive abortion training curriculum in 1995. A second edition was published in 2005. Several other abortion-training curricula and supplemental training resources have been developed, some for specific audiences or specialty areas, and others more generally adaptable.

In the late 1980s NAF began to hear from our member clinics that they were having trouble locating physicians to work on a full- or part-time basis providing abortion care. The volume of these reports grew, substantiating our fears that we were witnessing more than a local or short-term phenomenon.

In response, in the fall of 1990 NAF convened a national symposium, co-sponsored by the American College of Obstetricians and Gynecologists (ACOG), to explore the emerging crisis in abortion service delivery. The goal of the symposium was to identify the key issues and problems behind the abortion provider shortage and to delineate strategies to ameliorate the problem. Attendees included physicians, physician assistants, administrators, teachers, researchers, and representatives from ACOG, the Accreditation Council of Graduate Medical Education (ACGME), and the Council on Resident Education in Obstetrics & Gynecology (CREOG).

The conclusions and recommendations from this symposium were reported by NAF in Who Will Provide Abortion? Ensuring the Availability of Qualified Practitioners (order a copy). One of the key problems identified was a lack of training in residency programs for new physicians.

Policy recommendations for increasing the number of physicians trained to provide abortions focused both on residency programs and clinic work settings. Symposium participants suggested that abortion would only be regularly available when it was finally routinely included in all obstetrics-gynecology residency programs as a standard part of training. Outpatient abortion facilities were encouraged to establish formal linkages with residency training programs and to create incentives, such as research and compensation opportunities, for residents to train at community-based outpatient facilities.

To aid in the integration of abortion training in residency programs and clinics, NAF developed aClinical Training Curriculum in Abortion Practice in 1995. In 2005, NAF updated the curriculum to include new data and current practices, as well as techniques of manual vacuum aspiration and medical abortion.

Clinical Training Curriculum in Abortion Practice, 2nd Edition

Module 1 – Pregnancy Verification and Estimation of Gestational Age

Errors in the evaluation of pregnancy duration are one important cause of abortion complications. Understanding the use of human chorionic gonadotropin (hCG) tests and diagnostic ultrasound, both independently and in combination, is essential for the accurate estimation of gestational age and for the evaluation of pregnancy location and integrity. In this and other modules, gestational age is computed by menstrual dates (weeks since the start of the last menstrual period), rather than conception dates (weeks since fertilization).

Module 2 – Counseling and Informed Consent

This section provides an overview of approaches used for counseling patients seeking abortions and for obtaining informed consent. It is written with the understanding that counseling is a developed skill that requires a certain level of training and experience. The techniques for and content of pregnancy-options counseling and pre-abortion counseling are somewhat different subjects that require unique skills. In many cases, the trainee may not routinely provide counseling on pregnancy options to the patient and thus may not be required to develop special skills in this area. However, the trainee should be familiar with the content of pregnancy options counseling and must be familiar with pre-abortion counseling as well as the special considerations that apply in obtaining informed consent for abortion.

Module 3 – Selection of Appropriate Procedure

This section provides an overview of the various methods of abortion. It describes when each is generally employed and the settings in which each may be medically appropriate. Induction techniques of mid-trimester abortion are covered in some detail in this section, because they are not included elsewhere in the curriculum. This module is not intended to dictate an exclusive course of management. Variations in patient needs and available resources may justify alternative approaches.

Module 4 – Medical Abortion Screening, Regimens, Management & Follow-up

Medical abortion presents another option for early pregnancy termination. Some women will prefer this method because it enables them to avoid instrumentation; or because they perceive it to be more “natural,” easier, or better in some other way than vacuum aspiration; or because part of the abortion process can occur outside a medical setting. Mifepristone/misoprostol regimens and methotrexate/misoprostol have been extensively studied and are documented to be safe and effective for first-trimester terminations to 63 days and 49-56 days gestation (also referred to as LMP), respectively. Due to the wide availability of highly sensitive urine pregnancy tests, early presentation for pregnancy termination occurs with greater frequency and medical abortion presents one therapeutic option. The provider must understand who is a candidate for medical abortion, how to counsel and adequately prepare patients for the medical abortion process, and the contraindications to medical abortion. Additionally, the provider must be facile with methods for accurately dating gestational age, familiar with the medications used and dosing regimens, and able to recognize and treat complications associated with medical abortion. (Note: In this curriculum, medical abortion refers to methods employed in the 1st trimester, primarily through 63 days gestation. We use “induction abortion” for drug-based methods employed during or after the second trimester).

Module 5 – Medical Screening

Screening for underlying medical or gynecological problems, coupled with appropriate management when such problems are detected, can significantly decrease the risk of many abortion complications and avoid exacerbation of the underlying conditions. Pre-procedure detection of reproductive tract anatomic variations and consequent modifications in surgical technique or in some cases use of a medical abortion method may result in a procedure that is safer and better tolerated. To decrease post-abortion infectious morbidity, all patients should receive antibiotics at the time of surgical abortion. Preoperative antibiotic treatment (i.e. therapeutic doses) for selected patients should be considered. Note: Although there are areas of overlap, this module focuses on medical screening for vacuum aspiration and D&E. Information about medical screening prior to a medical abortion is covered in detail in Module 4.

Module 6 – Pain Control

Relief of pain and control of anxiety are important determinants of abortion safety as well as patient satisfaction. Ideally, the woman should be offered her choice of several pain management options. Women undergoing aspiration abortion in the first trimester commonly choose local anesthesia with or without intravenous pain medications. According to a survey of NAF clinics, the most common method of pain management in first-trimester vacuum aspiration was local anesthesia, with or without oral pre-medication (58% of respondents), and the second most common method was local anesthesia combined with IV sedation (32% of respondents). Surgical abortions in the second trimester are commonly provided using more pain medications compared to those done in the first trimester; typically, women undergoing D&E procedures receive intravenous analgesics and anxiolytics. The clinician should be able to provide abortions using gentle operative technique as well as verbal support in order to minimize patient discomfort. In addition, the clinician should understand the pharmacology of any analgesic and anxiolytic used, and should be able to recognize and manage adverse effects of these drugs. This module will review how to provide a paracervical block, an essential skill in first-trimester abortion. Note: This module focuses on pain control for vacuum aspiration and D&E techniques. Specific information about pain relief in medical abortion is included in Module 4.

Module 7 – Vacuum Aspiration and D&E Technique

This section contains specific information on both vacuum aspiration and dilation and evacuation (D&E) procedures. However, it must be pointed out to the trainee that each technique presented is but one way of providing an abortion, and that many other approaches or adaptations are acceptable. Some information presented reflects updates in clinical knowledge and the evidence to support such change in practice as referenced. General reference texts follow specific references at the end of this module.

Module 8 – Management of Abortion Complications

Sound surgical skills are important for preventing abortion compli¬cations, but knowing how to manage complications is also essential. The Accreditation Council for Graduate Medical Education (ACGME) standards for U.S. ob-gyn residency programs require that “experience with management of complications of abortion must be provided to all residents.” Thus, all ob-gyn residents, including those who opt out of abortion training, should participate in management of complications. Note: This module focuses primarily on complications related to vacuum aspiration and D&E techniques. Specific information about management of complications in medical abortion is included in Module 4.

Module 9 – Post-Abortion Care and Follow-up

This section introduces the trainee to the essentials of post-abortion care and follow-up. The service you actually provide will depend on care protocols in your specific site. In many high-volume sites, non-physician staff take the first call (phone coverage) and see patients for routine follow-up visits. Note: Although there are areas of overlap, this module focuses primarily on post-abortion care and follow-up after vacuum aspiration and D&E. Information about post-abortion care and follow-up for medical abortion is covered in detail in Module 4.

Module 10 – Evaluation

Without a format for evaluation, the results of training cannot be effectively realized. In the short term, an evaluation strategy provides the training program with immediate data on the competency of trainees. In the long term, an evaluation mechanism provides feedback on whether the methods are working and whether the most setting-appropriate training is being provided.

Supplemental Module – The Abortion Option: A Values Clarification Guide for Health Professionals

In spite of our efforts at objectivity, we all hold personal values that can influence how we respond to our patients. Sometimes these values are very clear to us and are easily articulated. Others exist at a deeper level, so that we don’t necessarily recognize the influence they have on our behavior and judgments as health care professionals. Further, one’s values may change in response to life experiences and your encounters with patients and colleagues may influence your beliefs without your having much of a chance to reflect on these changes. This resource (PDF file, 2.4 MB; version for black and white printers, 1.3 MB) is intended to help you clarify your personal values about pregnancy options and abortion, and to help you think about those values in the context of professional judgments you may be called upon to make. This guide can be used by individuals or groups, and is appropriate for the wide range of health care professionals who provide care to women experiencing unintended pregnancies.

Supplemental Module – NAF’s Clinical Policy Guidelines

NAF’s Clinical Policy Guidelines (CPGs), the only evidence-based guidelines for abortion practice in North America, provide a basis for ongoing quality assurance in abortion care. The guidelines are developed based on rigorous review of the relevant medical literature and known patient outcomes.

Principles of Abortion Care: A Curriculum for Physician Assistants and Advanced Practice Nurses, Edited by Michael S. Policar, MD, MPH, Amy E. Pollack, MD, MPH, Cate Nicholas, MS, PA, and Sudan Dudley, PhD

This 1999 curriculum includes 11 modules on all aspects abortion care in outline form that is appropriate for didactic and/or clinical training. More

Medical Abortion Curriculum Resources

NAF has developed a complete series of medical abortion curriculum resources, including educational slide modules, self-study guides, online programs, and other professional educational materials. More

Several other curriculum resources have been developed to facilitate abortion training for a variety of audiences. Below are brief descriptions and contact information for some of those curriculum resources.

Medical Abortion Curriculum Resources – National Abortion Federation

NAF has developed a complete series of medical abortion curriculum resources, including educational slide modules, a self-study guide, an online CME program, and other professional educational materials. More

Principles of Abortion Care: A Curriculum for Physician Assistants and Advanced Practice Nurses – National Abortion Federation

This 1999 curriculum includes 11 modules on all aspects abortion care in outline form that is appropriate for didactic and/or clinical training. More

Early Abortion Training Workbook – Advancing New Standards in Reproductive Health, UCSF Center for Reproductive Health Research & Policy

This workbook was developed as part of an ongoing effort to assist primary care providers in delivering more comprehensive health care. The workbook is designed to be used in tandem with the NAF textbook, Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care, and to integrate reading, guided exercises and activities, and hands-on practice with early abortion procedures. At the conclusion of the program, the trainee will be able to:

  • list key elements of informed consent, counseling, and major psychosocial issues of importance for women who seek abortions;
  • provide first trimester vacuum aspiration abortions using local anesthesia without supervision;
  • carry out the steps involved in early medical abortion service provision; and
  • describe the management of emergency situations and complications related to first trimester abortion care.

Download a free copy of the Early Abortion Training Workbook

Reproductive Choice and Abortion Curriculum Resource Guide for Nurse Educators – Abortion Access Project

This guide outlines fundamental content on reproductive choice and abortion for nursing programs at the Associates, Bachelors, and Masters degree levels. It also lists resources such as videos and literature, and includes case studies that may be used to implement the recommended curricula. It also reviews and lists resources that may be useful in implementing the recommended curricula content. The Guide is part of a CD-ROM that includes a full lecture on Caring for the Woman with an Unintended Pregnancy, or it can be ordered alone. Get more information and request a copy

The Curricula Organizer for Reproductive Health Education (CORE)

CORE is a collection of peer-reviewed, evidence-based teaching materials. It is an open access tool that anyone can use at any time free of charge to build scientific presentations on the full spectrum of reproductive health topics. In additional to individual slides and full presentations,  CORE offers activities, case studies, videos, images, and handouts to enhance reproductive health instruction. CORE is a collaborative effort of many organizations working to improve the quality and quantity of reproductive health information included in health professions education and is managed by the Association of Reproductive Health Professionals (ARHP). Visit CORE atwww.arhp.org/CORE.

Surgical Abortion Education Curriculum – Planned Parenthood of New York City

This curriculum includes five training modules that are designed to train physician assistants and non-ob-gyn residents and physicians in first trimester abortion. Each course module is divided into interactive didactic material, short case studies for discussion in question-and-answer format, and direct clinical experience. Minimum numbers of observations and procedures for proficiency are noted. Goals and objectives and preparatory readings are provided for each case, including creative pedagogical techniques to promote trainee participation and group learning. The curriculum also covers pregnancy diagnosis, sizing via physical exam and ultrasound, and local pain management. Routine post-procedure care, management of common complications, and counseling follow-up care are discussed and illustrated with case studies. Sample evaluation instruments are included. For more information contact Planned Parenthood of New York City at(212) 274-7255.

Training Program for Abortion and Related Services – by Cate Nicholas, Vermont Women’s Health Services

This training program includes ten units of study that detail measurable objectives for gaining skills to provide abortions up to 15 weeks. Early evacuation, vacuum aspiration, manual evacuation techniques, and cervical preparation are all thoroughly described. Pregnancy detection via ultrasound, sizing, and providing and interpreting urine pregnancy test results is reviewed in detail, as are contraindications for an outpatient procedure. Trainee and program evaluation tools, including clinical logs and check lists, are provided. Each unit includes a required reading list, along with behavioral objectives and learning activities. Adaptation of the training plan allows for physicians, residents or physician assistants to train under the program. More information

These textbooks, publications, and additional resources are not stand-alone curricula but serve to expand and enhance abortion training experiences. Ideally the context in which to address abortion education is in the broader scope of comprehensive reproductive health education and services. The resources listed here are specifically geared towards abortion training. Some of our collaborating organizations also produce resources focused on other reproductive health issues.

NAF Resources

Many of the National Abortion Federation’s resources were developed with both current and future providers in mind. Among NAF’s resources are the Clinical Training Curriculum in Abortion Practice, 2nd Edition; the NAF Textbook, Managment of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care; and the Medical Abortion Curriculum ResourcesOrder now

Publications and Literature

Abortion Practice, by Warren Hern, M.D., M.P.H., Ph.D – This practical resource covers abortion counseling, patient management, staffing and staff attitudes, operative procedures and techniques, prevention and management of complications, legal and administrative aspects of abortion practice, and community relations. There is also a step-by-step explanation of operative outpatient abortion techniques through the second trimester, specific data on preoperative and postoperative diagnosis of fetal age, information on prevention of long-term adverse sequelae of abortion, and sample forms detailing data needed for patient records and care.

Surgical Abortion, by Eugene Glick, M.D., M.P.H. – This instructive text on first- and second-trimester surgical abortion contains concise and practical information including charting and counseling, anesthesia, and surgical technique from a noted expert in abortion. It is a valuable resource for skilled abortion providers and trainees alike. Order

Online Resources

Ipas

Ipas has worked for three decades to increase women’s ability to exercise their sexual and reproductive rights and to reduce deaths and injuries of women from unsafe abortion. Ipas’ global and country programs include training, research, advocacy, distribution of equipment and supplies for reproductive health care, and information dissemination. Visit the Ipas website for an extensive listing of resources, publications, and training materials about manual vacuum aspiration (MVA).

Resource Guide for International Preservice Medical Education

This Resource Guide, originally produced by the Reproductive Health Initiative and now held by the Association of Reproductive Health Professionals, is a catalog of 164 reproductive health training materials that can be adapted for use within preservice training. The Resource Guide is useful in developing reproductive health curricula for preservice medical education; supplementing existing reproductive health content; evaluating reproductive health content covered at medical education institutions; and identifying appropriate resources for inservice training.

 

NAF Textbook

Naf_textbookManagement of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care

Maureen Paul, MD, MPH; E. Steve Lichtenberg, MD, MPH; Lynn Borgatta, MD, MPH; David A. Grimes, MD; and Phillip G. Stubblefield, MD; Mitchell D. Creinin, MD

Access to high-quality abortion care is essential to women’s health, as evidenced by the dramatic decrease in pregnancy-related morbidity and mortality since the legalization of abortion in the United States and by high rates of maternal death and complications in those countries where abortion is still provided under unsafe conditions.

The past two decades have brought important advances in abortion care as well as increasing cross-disciplinary use of abortion technologies in women’s health care. Abortion is an important option for pregnant women who have serious medical conditions or fetal abnormalities, and fetal reduction techniques are now well-integrated into infertility treatment to reduce the risks of multiple pregnancies resulting from assisted reproductive technologies.

Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care serves as the standard, evidence-based reference text in abortion care. This state-of-the-art textbook provides a comprehensive overview of the public health implications of unsafe abortion and reviews the best surgical and medical practices for pregnancy termination, as well as managing ectopic and other abnormal pregnancies.

Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care is the leading source for a comprehensive understanding of issues related to unintended and abnormal pregnancy. This textbook:

  • was authored by internationally known leaders in women’s health care;
  • addresses unintended pregnancy and abortion from historical, legal, public health, clinical, and quality care perspectives;
  • includes chapters on pregnancy loss, ectopic pregnancy, gestational trophoblastic disease, and multifetal pregnancy reduction;
  • covers treatment of pregnancies in the first and second trimester by both medical and surgical techniques; and
  • provides resources for clinical, scientific, and social support for the abortion provider and patient.

Read an Excerpt

Table of Contents 
Chapter 1: Abortion and medicine: A sociopolitical history
Index

Ordering the textbook

Hardback
ISBN: 978-1-4051-7696-5
400 pages
April 2009, Wiley-Blackwell

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ISBN: 978-1-4443-1293-5
400 pages
April 2009, Wiley-Blackwell

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