Doctors lack access to abortion medical training in Texas

Every year, more than 100 new obstetrician-gynecologists graduate from a Texas residency program and enter the medical workforce. Theoretically, all have had the opportunity during their four years of residency to learn about what's called "induced abortion" — named that to distinguish it from a miscarriage. However, the closure of abortion clinics in Texas — more than 20 since 2013 — has made that training increasingly difficult.

The Residency Environment

Texas has 18 residency programs in the field of obstetrics and gynecology, but only one allowed me to observe how abortion is taught. Medical residents can opt out of abortion training for religious or moral reasons, but Jane, a resident in the program, felt a professional obligation to learn the procedure. "This is part of OB-GYN — it's not an optional part, per se," Jane said. "Women can choose if they want an abortion or not, but you as their doctor need to be able to provide them with all the choices available."

Clinical Skills and Education

Jane spent about a month at this family planning clinic during the third year of her residency. Being able to perform the abortion is just one set of skills she learned. She also learned to counsel patients about abortion, contraception and sexually transmitted diseases, and learned techniques for pain management and dilation of the cervix. The rotation taught her things that will be useful in other practice areas, Jane said. For instance, OB-GYNs use ultrasounds for many different reasons. "Before in residency, we were doing ultrasounds maybe once during a clinic afternoon, or a few ultrasounds in the OB triage area," Jane said. "But here we do 30 ultrasounds in a morning, so it's a lot of good learning about how to do ultrasounds."

Regarding the training statistics and landscape in Texas, the following table summarizes the current situation:

Institutional and Political Pressures

It may be good learning, but in Texas this training happens quietly, almost in secret. "Doctors working in these institutions are walking a very delicate line," said Carole Joffe, a medical sociologist at the University of California, San Francisco. Academic medical centers in Texas receive tens of millions of dollars a year in state funding. Many of those centers sponsor residencies, which are the training programs that come after medical school. These programs last four or more years and allow doctors to focus on a specialty. "But they are fearful of the other sectors of the university coming down on them and saying, 'You're threatening our funding,' " Joffe noted.

Challenges for Future Providers

It's understandable why an OB-GYN resident in Texas might think twice about providing abortions. Doctors who provide the service must think about security issues for themselves and their staff. They also have to deal with the scrutiny of state inspectors as well as anti-abortion protesters. Surveys and other research show that doctors who do abortions may have fewer job opportunities. Because of the political pressures facing abortion providers, many must operate under strict privacy; for example, NPR agreed not to reveal the doctors' full names or the clinic's location.