UVM’s Larner College of Medicine offers limited abortion training. Some students want more.

Kalin Gregory-Davis, a fourth-year medical student at the University of Vermont. Photo courtesy of Kalin Gregory-Davis

Kalin Gregory-Davis is a fourth-year medical student at the University of Vermont. She’s known since she started at Larner College of Medicine – the only medical school in Vermont – that she wants to be an abortion counselor.

Part of the reason she decided to attend medical school in Vermont is that the state is unlikely to restrict access to abortion. That’s in contrast to Texas, Alabama or Louisiana, where significant restrictions have made it difficult to receive training in abortion procedures, according to Pamela Merritt, executive director of Medical Students for Choice, an organization that helps medical students receive training in termination of a pregnancy.

Through Gregory-Davis’s earlier years of medical school, she was able to learn a thing or two about abortion. A class in each of her first two years covered the topic briefly, and in her third year, she sought a clinical rotation in reproductive health at Central Vermont Medical Center in Berlin.

“I haven’t seen abortions at Central Vermont Medical Center, and that was hard for me because I wanted to, as someone who really cares about this,” said Gregory-Davis. So she contacted a doctor in Plattsburgh, New York, and spent a day with him at Planned Parenthood. “But that was completely led by me,” she said.

Gregory-Davis chaired the board of Medical Students for Choice at UVM, where she organized film screenings, discussion groups and additional learning opportunities for her classmates. However, she said the turnout was often not great, which she attributes to medical students who are just incredibly busy.

She is now completing a rotation at an abortion clinic in New Mexico, and said she is grateful she was able to gain as much hands-on experience as she has. She said UVM always supported her when she looked out for opportunities to train in abortion care.

While she knows that Larner College of Medicine has an edge over many other medical schools in the country — where abortion procedures are sometimes not taught at all — she wishes abortion took up more of the curriculum. Not just to learn the procedures, which are pretty simple, she said, but to navigate the complicated issues that revolve around them.

“The impact of laws, inequality between racial groups, different laws and who they affect the most … these are important conversations for medical students to have,” Gregory-Davis said.

Year after year

According to Lauren MacAfee, an assistant professor at Larner College of Medicine, and the primary abortion provider at UVM, UVM’s medical school has 479 students, about 10% of whom go on to residency in obstetrics and gynecology.

About a third of Larner graduates are now doctors in Vermont, or have completed their residency training in the state.

Based on the most recent available figures, 1,300 abortions were performed in Vermont in 2017. In 2010, the state had 699 state-funded abortions, all state-funded; no federal money was used.

Vermont uses its own funds to cover all or most “medically necessary” abortions requested by low-income women under Medicaid.

MacAfee has spent the past five years working to include abortion in the medical school curriculum in a more meaningful way.

Before MacAfee started at UVM, the only exposure medical students got to abortion was briefly in their third year. Now abortion is discussed during every year of their education.

During their first year, all students take a course called Professionalism, Reflection and Communication, which is about doctor-patient relationships. The class explores personal biases in medicine and how a patient’s identity determines care. In a classroom session, the students discuss abortion. MacAfee describes that as an “ethical and political matter,” no specific training on how to conduct the procedure.

In their second year, students take a class on reproductive health, including a 90-minute session outlining the basics of medical care in abortion.

“I also talk about the role of politics in medicine,” said MacAfee, who leads the session, “and we talk about how you offer this procedure depending on the state where you live.”

“I’m not doing that to be pro- or anti- or whatever… but to highlight some of the differences (on) what that means for patients. It has implications for the patients who come for this procedure,” she said.

In their third year, all students do an OB-GYN clinical rotation, where they have the opportunity to see an abortion – depending on where they are placed and who needs care during the short amount of time they are there. Because the University of Vermont does not have a particularly high number of abortion patients, students often will not see the procedure.

Finally, in their fourth year, MacAfee is offering an online family planning course for students interested in reproductive health. It includes “abortion, miscarriage, and conception care.” Students can take the course for two or four weeks and have the opportunity to delve into specific elements of family planning.

“You could take a deep dive into emergency contraception, abortion — not just the medical part, but socio-political components associated with it,” MacAfee said.

MacAfee stressed that all abortion training is optional.

“We fully support opt-out and partial participation. We want to ensure that students have the medical knowledge they need, but without compromising their personal beliefs,” said MacAfee, who also emphasized that students’ grades will not be affected in any way if they decide to opt out. for discussions about abortion.

One in four women

In 2019, the U.S. Department of Health and Human Services accused the UVM Medical Center of forcing a nurse to assist in an abortion procedure, despite the nurse’s religious objections.

The Justice Department eventually filed a lawsuit in federal court in the final days of the Trump administration, but under Biden it reversed course and finally dropped the lawsuit last summer.

That ordeal caused the university to worry about ensuring that students can always opt out of abortion training at any level. Opting out due to religious objections had always been an option, but some believe the procedure is so common that medical students should at least undergo abortion training.

No numbers were available on how many Larner students opted out of abortion training.

In the United States, one in four women will have an abortion by age 45, making it one of the most common medical procedures in the country.

“I think it should be something that everyone should learn to become a doctor,” Gregory-Davis said.

Allison Bates, director of drug abortion, sedation, and ultrasound at Planned Parenthood of Northern New England, supports students who forgo hands-on abortion training, but believes all students should be required to at least take one of the most common medical procedures in the world.

“They should have the framework and the opportunity to talk about it as an essential part of reproductive health care,” she said.

State Sen. Ruth Hardy, D-Addison, who worked at Planned Parenthood before she became a senator, supports the opt-out choice but hopes medical schools will emphasize the importance of training on the procedure to students.

“There are cases where a woman dies if she doesn’t get an abortion, so if you’re an emergency room doctor and you don’t know how to do that, I think you’re limited in your skills,” Hardy said. “I hope (medical schools) to explain the reality to medical students that they’re in a situation where it’s necessary and maybe they should know how to do it.”

But others disagree.

“Maybe you went to medical school to save lives, not get involved in things you think are against your conscience, so (the medical industry) will lose some excellent employees if they start making this training mandatory, said Mary H. Beerworth, executive director of Vermont Right to Life.

A national shortage of education

UVM is considered one of the most abortion-friendly medical schools in the country, even though that training is quite limited.

Lack of education in abortion care is a major problem nationwide, and the fact that UVM students get the chance to even talk about the procedure is exceptional.

Several factors can make it very difficult to get training in this simple and common procedure.

First, in states like Texas that have severe restrictions on abortion, it’s hard for students to get a chance to witness an abortion because they’re becoming rarer.

Another problem: medical schools with religious affiliations. Abortion violates Catholic medical principles and schools affiliated with the Catholic Church cannot teach it.

Now, some state lawmakers are working to ban state-funded universities from joining organizations that provide abortions. This often happens under the radar, as was suggested in Missouri. There, House Bill 302 is still pending before the House Ways and Means Committee, billed as a proposal to change “provisions relating to taxes.” But part of the bill would tax the endowment of any university affiliated with or referred students to train with an abortion provider.

“That’s a clear example of what’s surreptitiously happening in state lawmakers across the country,” said Merritt of Medical Students for Choice. Such bills, even if not passed, pose a sufficient threat to schools to deter them from providing adequate abortion training, she said.

“In states with legislatures hostile to abortion, the science, the ever-present reality that if you partner with an abortion provider for education and training, you might be punished — that’s a deliberate threat being made there and it’s very hard for universities not to respond to it,” Merritt said.

And without training in abortion, some states struggle to find enough providers.

“Without a pipeline of suppliers, abortion is a right in name only,” Merritt said.

In 2020, the Guttmacher Institute characterized Vermont as a state that is “supportive” with regard to abortion rights. As Bill 5 makes its way through the legislature this session, heading to voters in November, the state could become the first to make the right to “reproductive liberty” part of the state constitution.

The Vermont legislature has never given any serious thought to proposals that would restrict access to abortion in the state.

“I always use Vermont as a pinnacle of a state where we don’t restrict access to abortion the way other states do, and by coding it by us, it provides support not only to health care providers but also to patients,” he said. MacAfee.

Still, MacAfee said, UVM currently has no plans to expand its abortion training program.

Gregory-Davis would like to see more emphasis on the complicated socio-political climate surrounding abortion, but feels pretty good about what UVM is now offering students, especially when compared to other states.

“In Vermont I was very lucky and I felt supported. In general, people said, ‘Yeah, we need to learn more about that,’ Gregory-Davis said.

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