Doctors are concerned about a post Roe v. Wade world

“Decimating abortion training in half the country will have far-reaching impacts.”

One woman was far along in pregnancy and heavily bleeding. Another patient came in experiencing a miscarriage. A third had given birth two months ago, but was facing ongoing complications and bleeding.

For Dr. Bria Peacock, a resident in the obstetrician-gynecologist program at Zuckerberg San Francisco Hospital, this was a typical Monday. Health emergencies happen all the time. Peacock gets a ping on her pager and hustles to respond to a number of reproductive health concerns that patients come to her with. Many require her to rely on training she received in abortion care.

But reproductive health care is under threat now that the majority of the U.S. Supreme Court appears in favor of overturning Roe v. Wade, the landmark 1973 ruling that affirmed a person’s right to terminate a pregnancy. Access to abortion care would become a state-by-state issue if the decision is overturned, and more than half of U.S. states already have outlined plans to restrict abortion access.

Moreover, nearly half (45%) of obstetrician-gynecologist residency programs are in states where abortion is likely to be banned or further restricted, according to a recent study from UCSF and UCLA.

Although the Accreditation Council for Graduate Medical Education has said abortion training will remain a requirement for residency training programs even if Roe v. Wade is overturned, students and professors alike are fearful of the world in which they could soon be operating.

The issue goes beyond abortion services. Patients come to Peacock with varied needs and situations. This week, someone with a desired pregnancy came in experiencing a miscarriage and dangerously heavy bleeding. Peacock knew what to do thanks to her very specialized medical training and performed a manual uterine aspiration to remove the pregnancy loss, which stopped the bleeding.

It’s a common and relatively safe procedure, but Peacock and other health professionals worry these skills might be even harder to acquire if abortion is indeed outlawed in states across the country.

“She wanted to remove the products of conception, and that stopped her bleeding,” said Peacock, who graduated from medical school in May 2021. “I knew exactly what to do and ask for consent and talk the patient through it because I learned about this in our classes on abortion, and it translated to helping me know what to do when someone was bleeding during a miscarriage.”

Peacock grew up in Atlanta, Georgia. Her interest in reproductive health and rights stems from observing family and community members experience teen pregnancies with few alternative options available to them, making her passionate about a person’s right to have an abortion. As she went further along in her medical training and practice, she said she came to realize how the type of health care she aspired to provide extends far beyond abortion debates among politicians.

“This goes farther than this Roe. v. Wade conversation,” said Peacock. “These types of laws are so very dangerous just to the day-to-day things we do to save lives and take care of our patients. Our lawmakers don’t understand that. It comes with medical training. We want to do the best for our patients always. It’s heartbreaking that this is where we are at.”

“Decimating abortion training in half the country will have far-reaching impacts,” said Jody Steinauer, senior author of the study and who directs the Bixby Center for Global Reproductive Health at UCSF. “It could affect the care of future patients of clinicians who trained in these states wherever they go on to practice. We need to develop new and innovative ways to train OB-GYNs and other clinicians to provide this essential care.”

Students have long advocated for increased access to training in abortion and reproductive care as part of the core curriculum for medical programs. But the latest development at the Supreme Court has many students and residents on edge.

“We are given just a one-hour lecture on surgical abortion methods and a one-hour lecture on medication abortions, plus one or two lectures on contraception. But one in four women get an abortion, so that’s really not proportional to the number of people we’ll see who require this,” said Neha Pondicherry, an incoming third year medical student at UCSF School of Medicine.

“Even in California where abortion is legal, there are limited providers who are willing to do that service. One of my biggest fears is the more we restrict abortions the more stigma there is, and the fewer providers there will be who are willing to do this,” Pondicherry said.

Meredith Klashman, who is in her second year at the UCSF-UC Berkeley Joint Medical Program, has teamed up with Pondicherry to advocate for more abortion training for medical students and adjacent fields. That has included planning a reproductive health elective with nursing students where they hosted workshops on topics such as how to perform an abortion, insert an IUD and how to dose different medication-assisted abortions.

“That’s all a function we serve outside of the core curriculum,” said Klashman.

UCSF medical students Meredith Klashman, left, and Neha Pondicherry at Zuckerberg San Francisco General Hospital as seen on Wednesday. The two students have teamed up to advocate for more abortion training for medical students and adjacent fields. (Craig Lee/The Examiner)

UCSF medical students Meredith Klashman, left, and Neha Pondicherry at Zuckerberg San Francisco General Hospital as seen on Wednesday. The two students have teamed up to advocate for more abortion training for medical students and adjacent fields. (Craig Lee/The Examiner)

But one challenge she has noticed is that the elective course is self-selecting for individuals who want to work in reproductive health. In a post-Roe v. Wade landscape, Klashman and her peers at the global student association Medical Students for Choice are calling for more opportunities for those unfamiliar or uncomfortable even with abortion care to get exposure and talk through misconceptions and patient care.

Klashman said she was drawn to abortion care after her personal experience with reproductive health and illness. She had two tumors removed from her ovaries and said part of what’s motivated her to get more involved has been realizing the medical field still has a long way to go in giving patients full choice with their reproductive health.

“We feel strongly, especially in a post-Roe world, that more than just gynecologists need to know how to perform an abortion or what this looks like,” said Klashman. “I’m thinking a lot about how the patient population we serve is going to really expand and how the health care infrastructure can meet that need.”

Back at S.F. General, Peacock is preparing for a future where she plans to return to Georgia — one of around 26 states that are poised to roll back abortion access — to provide abortion care and other sexual and reproductive health services for marginalized communities that don’t have easy means of traveling to so-called “abortion friendly” states like California.

“There is always the fear of repercussions as we provide these life-changing procedures. You have to just move forward in spite of that,” Peacock said. “It’s actually very sad. Especially where I’m thinking about going back to in Georgia, it might be much more hostile than being here in California.

I think about how the patients are also receiving that pushback in such vulnerable moments and what they are feeling as they walk into a clinic being ridiculed… But we push past it knowing what we are doing is very important.”

sjohnson@sfexaminer.com

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Doctors are concerned about a post Roe v. Wade world

“Decimating abortion training in half the country will have far-reaching impacts.”