The double-edged sword of abortion regulations: Decreasing training opportunities while increasing knowledge requirements

ABSTRACT

Purpose

The authors explore how abortion regulations in Ohio, an abortion-restrictive state in the USA, impact obstetrician-gynecologists’ (OB/GYNs) training in reproductive healthcare and describe what OB/GYNs believe to be the broader impact of Ohio’s regulations on skill-building, skills maintenance, and professional retention of reproductive healthcare providers in the state. Authors discuss how their findings foreshadow abortion training limitations in Ohio and other abortion-restrictive states now that abortion regulations have returned to the states.

Methods

The authors conducted four semi-structured focus groups and five in-depth interviews between April 2019 and March 2020. Participants included OB/GYNs practicing obstetrics and gynecology in Ohio between 2010 and 2020. Thematic analysis was conducted using Atlas.ti.

Results

Twenty attending physicians and 15 fellows and residents participated in the study. Participants discussed the impact of Ohio’s written transfer agreement, gestational-limit, and abortion method and facility bans on training and skill-building opportunities. Participants felt that Ohio’s strict abortion regulations 1) limit opportunities to observe and perform abortion procedures during training; 2) require learning the ever-changing legality of abortion provision; 3) limit the number of abortions OB/GYNs can provide, leading to the atrophy of their skills over time; and 4) may prevent prospective medical students and residents from choosing to study in Ohio and may lead to physician attrition from the state.

Conclusion

Prior to the reversal of federal protections for abortion in 2022, OB/GYNs in Ohio and other abortion-hostile states experienced barriers to training in abortion care. In returning abortion regulation to the states, access to training is likely to be increasingly restricted. This research demonstrates how abortion-restrictions hamper physicians’ skills needed to care for patients, particularly in emergent situations. This puts patients at risk and places physicians in precarious ethical positions. Expanding protections and reducing restrictions on abortion will ensure OB/GYNs and trainees have the skills necessary to care for patients presenting for reproductive healthcare.

KEYWORDS:

• Abortion
• abortion restrictions
• medical education
• residency
• medical school
• fellowship
• training
• qualitative research

Acknowledgments

The authors wish to thank the study participants who graciously shared their time, experiences, and expertise.

Ethical approval

The University of Cincinnati Institutional Review Board approved this study protocol (Study #2019-0095).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

In order to protect the privacy and confidentiality of study participants, data collected in this study are not publicly available.

Additional information

Funding

This research was supported by an anonymous foundation. The funders played no role in the design or conduct of this study or in the preparation and review of this manuscript. The content is the responsibility of the authors and does not necessarily reflect the views of the funders.