The Impact of COVID-19 on Abortion Education

By Dr. Sarah Prager

2020 was a year like no other, and that holds true from the perspective of an American abortion provider as well.  I am an academic OBGYN, working at a university where I am the Chief of the Complex Family Planning (CFP) service as well as the director of the CFP Fellowship.  Additionally, I spend 10-20% of my time at a free-standing reproductive health clinic where I do high volume abortions and train fellows, OBGYN and Family Medicine residents and medical and nursing students.

One way in which this year has been different is that we have not been able to have residents or students training with us since March.  When COVID first hit, we also limited the clinicians to just attendings, although the fellows started back in June with their training.  As someone who is as much an educator as a clinician, this inability to safely include residents and students in our clinic has been a source of real sadness for me.  Of course, the lost training opportunity for the residents and students could have more far-reaching implications than mere sadness.

To recognize some of these implications, one must understand that in the US, as everywhere in the world, abortion remains stigmatized, marginalized and “otherized”, even in places where it is more widely accepted and acceptable, as it is in Washington State.  We have state laws supporting the right to access abortion beyond those rights afforded by Roe vs. Wade, the Supreme Court decision which established abortion as legal in the US in 1973.  And yet, even here, it feels the right to abortion must be re-litigated every time there is a question or a complication.  A patient seen for abortion at a free-standing clinic recently had a complication and was very appropriately transferred to my hospital for management, where I was the receiving doctor to manage her complication.  During her care, I fielded questions from an emergency department nurse, an anesthesiologist, a consulting physician, an operating room scrub nurse, and a circulating nurse about whether this was an illegal abortion clinic, whether the doctors were terrible, and whether this was a “botched” abortion.  The patient suffered a known complication from abortion (perforation), was appropriately referred for higher level care and management, received the proper treatment and will recover completely.  I was taken aback that in this scenario, at my own institution, I still had to explain that this patient had her initial procedure at a safe and legal clinic where I, in fact, also practice, and where I train our own students, residents and fellows.  I worry that missing the opportunity to have residents and students working with us during this year of isolation will eliminate our opportunity to normalize abortion for these trainees, not to mention eliminating their best opportunity to learn how to safely perform abortions which, along with cesarean deliveries, I consider the most important and life-saving procedure in obstetrics and gynecology.

Interestingly, the social distancing required by COVID has also inspired necessary and long-overdue forward movement on implementation of no-touch medication abortion protocols.  We have benefitted from these innovations at the sites where I practice, and I know these new protocols have been implemented in clinics in the United Kingdom and many other countries around the world, allowing people to access medication abortion without needing to step foot in a clinic facility.  At the same time, some places in the US used COVID-19 as a motivation to ban access to abortion, claiming it is done to protect people from the virus (and ignoring the devastating effects of not being able to access abortion when needed).  These bans ultimately were shut down in various US courts, but with the confirmation of Amy Comey Barrett to the US Supreme Court after the devastating loss of Justice Ruth Bader Ginsburg, the balance of conservative to liberal judges is now six to three, and there is little hope of that body continuing to support abortion as a federal right available to all Americans.  For this reason, as much as any other, the importance of my role as an abortion educator is brought home to me.  I do not expect everyone I lecture or train to become an abortion provider.  I do not even expect everyone to support abortion.  But I do hope that by teaching and talking with compassion about abortion, those who have them and those who provide them, more doctors, present and future, will consider that whatever their individual beliefs, abortion is a critical aspect of healthcare and needs to be accessible.

As with so many other issues in this strange year dominated by the pandemic, the importance of abortion has been underscored and this may continue to have long-lasting consequences.  However, with the beginnings of vaccine provision, I hope I will soon be back to training the full complement of learners.  Here is hoping for 2021.

 

Dr. Sarah Prager is an obstetrician gynecologist who specializes in Complex Family Planning.  She dedicates her life to reproductive health and justice in the US and globally, and is a proud abortion provider and educator.

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