Are clinicians getting abortion education?
Nurse practitioners, physician assistants, and certified nurse-midwives provide many health services in family planning, yet many of their training programs do not provide didactic or clinical education about abortion services, results from a recently published survey show.1
"Regardless of an individual's interest in and intention to provide abortion services as part of her or his practice, all advance practice clinicians [APCs] need to be knowledgeable about the full range of reproductive health options, including family planning and abortion," states Angel Foster, DPhil, an associate at Cambridge, MA-based Ibis Reproductive Health, a women's reproductive health research organization, and lead author of the paper. "As integral components of women's health care, abortion, pregnancy options counseling, and family planning merit incorporation into routine didactic and clinical APC education."
Nearly half of all pregnancies in the United States are unintended, and about half of such pregnancies are electively terminated.2 Despite these numbers, the ranks of abortion providers have declined by 37% since 1982, and many American women live in a county without an abortion provider.3 The drop in provider numbers is attributed in part to the lack of routine education and training opportunities for health service professionals.
Scan survey results
The study, jointly conducted by Ibis Reproductive Health, the National Abortion Federation (NAF) in Washington, DC, and the Abortion Access Project in Cambridge, MA, surveyed program directors at 486 accredited APC programs in the United States. A total of 202 responses were gathered for the analysis.
About half of the programs (53%) said they offered didactic instruction in at least one abortion procedure (surgical abortion, manual vacuum aspiration, or medication abortion), and 43 programs (21%) reported they provided clinical instruction in at least one abortion procedure. However, less than half (44%) of the programs offered multifaceted didactic instruction in abortion care — defined as the inclusion of pregnancy options counseling, postabortion care, and one or more abortion procedures — and just 17% of programs said they provided their students multifaceted clinical exposure to abortion care.
Other reproductive health issues received broader coverage, survey results reveal.1 Didactic instruction on family planning and contraception were included in 96% of the programs, with 89% of the programs saying they provided clinical coverage on these subjects. Emergency contraception (EC) instruction also is included; 88% of respondents say EC is covered in didactic education, with 67% of responses indicating inclusion in clinical education.
Survey results show that certified nurse-midwifery (CNM) programs are more likely than nurse practitioner (NP) or physician assistant (PA) programs to include didactic instruction on abortion and to incorporate EC and family planning issues in their clinical training. However, PA programs provide the highest rate of clinical training in surgical, manual vacuum aspiration, and medication abortion, according to survey results.1
Why isn't abortion education included in clinician training? Nearly half of the programs that did not offer didactic training on abortion procedures, options counseling, or postabortion care indicated that abortion was not a curricular priority.1 Other reasons cited for non-inclusion were lack of availability of clinical sites; belief that abortion is outside the scope of practice; lack of qualified faculty; and belief that state law prohibits APCs from providing abortions.1 About 20% of NP respondents and 33% of PA respondents indicated that abortion training was not included in the curriculum because it is politically charged.1
Put resources in play
Advance practice clinicians regularly care for women with unintended pregnancies who are seeking abortion care, observes Vicki Saporta, NAF president and chief executive officer. These providers need to know how to do appropriate options counseling, she notes. Many advance practice clinicians are engaged in actual abortion service delivery and perform medical abortions at many of NAF's member clinics, with some performing surgical abortions as allowed by individual state scopes of practice, Saporta states.
NAF's Clinicians for Choice organization allows advance practice clinicians to advocate within their professional associations and schools to include abortion content in professional schools and national conferences, says Saporta. To help further abortion education, NAF has developed curricula in CD-ROM and online format on medical and surgical abortion. Such materials include continuing education on medication abortion using mifepristone (Mifeprex, Danco Laboratories, New York City), as well as a clinical reference on abortion education.
"We have these materials available and have developed them so that these professional schools can incorporate them into their own curricula," says Saporta. "In [2007], we are going to be increasing our outreach to professional schools that are teaching certified nurse midwives, nurse practitioners, and physician assistants to let them know that we have these kinds of materials available."
Ibis Reproductive Health and the Office of Population Research at Princeton (NJ) University have jointly developed a multilingual web site dedicated to information about medication abortion, www.medicationabortion.com. The site, available in English, French, Spanish and Arabic, carries medically accurate information on three methods of early pregnancy termination: mifepristone/misoprostol, methotrexate/misoprostol, and misoprostol alone. In a one-year study period, the site received more than 78,000 visits.4
References
- Foster A, Polis C, Allee M, et al. Abortion education in nurse practitioner, physician assistant, and certified nurse-midwifery programs: A national survey. Contraception 2006; 73:408-414.
- Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect 1998; 30:24 -29, 46.
- Henshaw SK, Finer LB. The accessibility of abortion services in the United States, 2001. Perspect Sex Reprod Health 2003; 35:16-24.
- Foster AM, Wynn L, Rouhana A, et al. Providing medication abortion information to diverse communities: use patterns of a multilingual web site. Contraception 2006; 74:64-271.
Resource
Visit the National Abortion Federation's web site, www.prochoice.org, to review its educational content. Click on "Professional Education" and click on "Early Options Online CME/CE." Also, click "Educational Resources," then "NAF Textbook" to review selected chapters from A Clinician's Guide to Medical and Surgical Abortion, a clinical reference on abortion practice.
Nurse practitioners, physician assistants, and certified nurse-midwives provide many health services in family planning, yet many of their training programs do not provide didactic or clinical education about abortion services, results from a recently published survey show.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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