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2013 Survey of family medicine residents trained in abortion

February 26, 2014

Every spring since 2007, the Reproductive Health Access Project has surveyed graduating 3rd year family medicine residents who have received abortion training.  The survey helps us connect with and support newly trained family physicians and build our Family Medicine Reproductive Health Network.   Network members receive technical assistance from us to integrate reproductive health into their primary care settings. The Network also serves as safe, welcoming community of pro-choice health care providers who support one another.

PGY3 chartIn the spring of 2013 we sent our annual survey to 211 graduating 3rd year residents at 25 residency programs across the United States and received responses from 112 residents (53%). The survey asked residents what reproductive health skills they were trained in, if they feel competent in those skills, and whether or not they intend to provide the service in their clinical practice. This year 63% of residents surveyed said they plan on providing abortion care and 88% plan to use their skills to manage early pregnancy loss.

We have learned that it often takes more than just clinical training to be able to provide comprehensive reproductive health care.  A total of 85 residents asked RHAP for support in providing abortion, contraception and miscarriage care in their future clinical practices.  Just what kind of support do these want?  Sixty clinicians want additional clinical training (54%), 41 want hands-on support setting up abortion care in their practice (37%), 44 requested to be connecting with a local clinician mentor (39%),  and 39 want to join RHAP’s advocacy efforts (35%).  We are now connecting all these new graduates to our clinical tools and resources and pairing those seeking a mentor with an experienced clinician from our Family Medicine Reproductive Health Network.

RHAP is currently working on next year’s survey of graduating family medicine residents.  Just email us if you want to know more about our survey, the findings and our work to expand reproductive health training in family medicine.

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Texas perspective on the Papaya Workshop

January 28, 2014

Our papaya workshop IMG_4530was on October 28, 2013.  The date was rather fitting, as it was also on this day we learned that District Judge Yeakel found the increased abortion restrictions via the passage of HB2 unconstitutional.  This news infused an extra bit of excitement into the evening’s workshop on manual vacuum aspiration.  Judge Yeakel’s decision felt like a breath of fresh air, a brief period of relief in the midst of an onslaught of attempts to control women’s bodies.  Unfortunately, our joy was short-lived:  the state of Texas filed an appeal, and on October 31st, the 5th Circuit allowed Texas to enforce the law.  When I read about the decision online, I distantly wondered if the judges of the 5th Circuit, in releasing their terrifying decision, were celebrating Halloween.

As a pro-choice Texan, I am constantly fighting the urge to tear my hair out with every anti-choice proposal and decision made by my state.  Now, as a pro-choice medical student in Texas, these frustrations have only escalated.  Not only are anti-choice groups woefully out of touch with the realities of the women who seek an abortion, some are also using bad science and misleading health information to justify their beliefs and actions.  A disturbing trend of frivolous clinic regulations has begun to sweep across states with largely anti-choice governments.  Clinics are suddenly required to worry about standards that include the distance between hand-sanitizer dispensers, the size of their parking lots, and the type of flooring in their janitor’s closets.  Providers must having admitting privileges at a hospital for doing procedures, which, when done correctly, require no hospital admission.  These lawmakers, who are apparently so concerned about women’s health, have suspiciously yet to suggest funding for making such changes.  I am not holding my breath.

Even though we just marked the 41st anniversary of Roe v. Wade, the fight to maintain bodily autonomy and reproductive freedom is far from over.  While a woman is allowed to have an abortion, that decision has been asterisked and footnoted by the numerous anti-choice laws put into place over the last decade, and especially the last few years.  Without access, there is no choice.  With this in mind,  papaya workshops represent more than a learning exercise in state like Texas—they are a staunch rebuttal against the attempts to widen the chasm between choice and access.  They allow similarly-minded and similarly-driven medical students to learn valuable skills and form a community that is aware of the proceedings within the Texas Legislature and aware of how those decisions affect both doctors and patients.  There is very little in my medical school curriculum that discusses intentional abortion, the doctors who provide them, and the care for the women who receive them.  This omission of a legal medical procedure is dangerous, as it contributes to the stigma associated with abortion and the physicians who provide them.  The papaya workshop helps to mitigate some of these gaps in our education and enables medical students to consider the possibility of providing abortions in the future.  But more than that, it aids in the creation of more well-informed, pro-choice medical professionals who can help ensure that women enjoy reproductive choice without barriers to access.

Guest blogger:  Nistha Jajal, medical student at University of Texas Southwestern

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Meet a clinician champion

January 22, 2014

Julie JohnstonAs the national organizer for RHAP, I have the privilege of working with some of the most amazing activist physicians in the country.  I am constantly reminded of the commitment and perseverance it takes to provide abortion care in so many places.  A sterling example of this persistent dedication is Dr. Julie Johnston.

I first met Julie in 2005, when she was a resident. Julie entered residency determined to be able to provide abortion care. As she moved into her 3rd year and attempted to use the elective time she had banked, the administration found out that the residency was no longer carrying an abortion training malpractice policy.  To support her training, the faculty banded together at the last minute and purchased a malpractice policy for her.   This allowed Julie to train in Maine to gain the skills that she wanted.  During her third year of residency, Julie incorporated manual uterine aspiration for miscarriage management as her quality improvement project.

After residency, Julie joined the faculty at her residency with the intent of expanding the reproductive health training options for residents in her program. Quite soon after joining as faculty the policies changed and residents were forbidden to train in abortion care even on their own vacation time.

Julie did not give up. She enlisted support from the Reproductive Health Access Project, the ACLU reproductive freedom team, a lawyer in the Massachusetts attorney general’s office, and the Center for Reproductive Rights to push back against these restrictions.  During this time she provided didactic abortion training for residents in the evening. Over time she created structured training on contraceptive management, options counseling, values clarification, and miscarriage management for everyone in her program.  Eighteen months later the policies were changed to allow residents to obtain abortion training on their personal time.

During her time working in her community Julie has witnessed that many women seeking abortion care struggled with transportation and insurance issues. In 2012, Julie and several other interested physicians began exploring options for setting up an independent practice to meet those needs. Julie is currently working out the logistics to provide comprehensive reproductive health care in a separate practice.

While being a tireless advocate for integrating abortion training, Julie also managed to find the time to start a family, and has two beautiful boys.  Whenever I feel worn down or discouraged about the attacks on abortion access, I think of Julie.  Her quiet determination, great political skills and her unwavering commitment to women’s reproductive health are a constant source of inspiration.  Thank you, Julie, for modeling what an activist physician can do!

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Giving Back on #GivingTuesday

December 2, 2013

GivingTuesdayRHAPgiveaccessLClargeThe Reproductive Health Access Project (RHAP) is proud to be participating in the third annual #GivingTuesday! #GivingTuesday is a campaign to create a national day of giving at the start of the annual holiday season. It celebrates and encourages charitable activities that support nonprofit organizations.

So how can you give this #GivingTuesday?
There is no gift like the gift of access. Access to reproductive health services can mean the difference between getting the health care you need, creating the family you want, and being in control of your body. A donation made to the Reproductive Health Access Project ensures that we can continue to train the next generation of reproductive health and abortion providers, create new patient education materials, and promote the latest  research and best practices at national medical conferences. So this #GivingTuesday, we ask that you #GiveAccess and make a donation to RHAP.

Make a donation to RHAP on December 3rd.
Our goal is to raise at least $1,000 on #GivingTuesday. Make a donation on December 3rd and help us reach our goal!  And, a generous supporters has promised us  $2 for every dollar we get on #GivingTuesday to help us get to our $1,000 goal.

Share our #GivingTuesday images on Facebook and Twitter.
Don’t forget to use the hashtag #GiveAccess and tell us why you care about RHAP!



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A win! ACGME guidelines now include family planning

November 14, 2013

brandingBack in April the Accreditation Council for Graduate Medical Education–the organization that sets the training standards and accredits all residency training programs in the United States–updated the training standards for Family Medicine. Instead of making the training requirements in women’s health stronger, they weakened them!

Training in contraception was no longer required. In fact, family planning wasn’t even mentioned in the proposed guidelines. Training in providing pregnancy options counseling was no longer required. Training in IUD and contraceptive implant insertion (the two most effective contraceptive methods available) were still not required. This was despite strong efforts by many groups to require this training, including the Society of Teachers of Family Medicine Procedures Working Group. (You can see their training recommendations here.) Learning how to do a uterine evacuation, which can be used for miscarriage or abortion care, was still not required. Again, this is going against the recommendations of respected groups and leaders in the field.

homepage-heroOur contention is that if training in basic women’s health isn’t required, then it probably won’t happen–this is especially true for religiously affiliated residency programs. If no one is trained, no one has access, even if it’s legal and covered by insurance. It’s that simple.

During the open comment period, the Reproductive Health Access Project responded by organizing a campaign to let the ACGME know that this is NOT OK. We started an online petition so that people could let the ACGME know how the proposed recommendations would affect their health. We combed through the proposed training recommendations and drafted formal comments that we urged clinicians across the country to submit. We got press coverage on RH Reality Check and NPR. In all, more than 3,600 folks weighed in to the ACGME.

The ACGME heard us! They recently released the new Family Medicine Residency Training Guidelines. These new guidelines, which will go into effect July 2014, now mandate training in contraception care and options counseling.

Our campaign also asked that the new guidelines include uterine aspiration and IUD and implant insertion/removal in the list of required training procedures. They didn’t say no to that. Instead the ACGME  completely removed the list of required procedures and now simply state that family physicians need to be trained in appropriate diagnostic and therapeutic procedures.

This is a win for all of us. All family physicians trained in the U.S. must receive education on contraceptive care and options counseling for unintended pregnancy, no matter where they are trained, even in a religiously affiliated institution.

Now we want to thank the ACGME for doing the right thing. We’ve drafted a sign on letter and ask you to take a minute to add your name to it. There is space for you to add your own comments too. Organizations can sign on here.  We’ll be collecting signatures until November 19th.

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A screening of “After Tiller”

October 3, 2013

Last week I saw the film After Tiller, a documentary that explores third-trimester abortion care in the United States by focusing on the only four doctors publicly known to offer this procedure. The screening was hosted by the Reproductive Health Access Project and the film was followed by a Q&A session with the filmmakers, Martha Shane and Lana Wilson.

I don’t want to give too much away–but I will say that the doctors in this film are truly inspiring and thoughtful in their care towards their patients and their work. I really, really recommend this film to everyone, no matter your background knowledge on abortion or where you fall on the pro-choice-anti-choice spectrum.

The film looks specifically at the four physicians’ experiences and perspectives, a view often overlooked in political debate on abortion. As Lana and Martha said in the Q&A, they went into this project with no expert knowledge on abortion in the United States, neither political or medical. What they found was a fascinating, emotionally charged story.   And what they produced is a small, yet powerful glimpse at the only truly direct participants of abortion care – the patients and the providers.

As an aspiring physician and abortion provider, this film served as an encouraging reminder that abortion is about so much more than the tug-of-war between lawmakers and activists–though activism is very important! At the most basic level, abortion is about compassion. After Tiller reveals how simple or extraordinarily complex an abortion can be to those most affected by it.

While I am definitely not a professional film reviewer, all I can say is go see it! And make sure to tell your friends to see it too! You can find out when After Tiller is coming to a city near you–and if it’s not screening in your area, you can request a screening.

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Ultrasounds can expand access to reproductive health care

September 16, 2013

FacebookAvatar200pxIf you’ve been hearing a lot about ultrasound machines lately, it’s most likely because anti-abortion state legislatures across the country are proposing and passing laws that mandate the provision of ultrasounds on anyone seeking abortion care.  These laws regulate who, when and how ultrasounds are performed for abortion care.  Many of these laws require clinicians to provide scripted, biased counseling.  Some impose unnecessary waiting periods between the ultrasound and the procedure.  Others even require that the patient view the ultrasound images.   Despite legislators’ claims that these laws are intended to improve patient safety, they are not even remotely based in science, and they aren’t good medicine.  Their sole purpose is to stigmatize women and create barriers to abortion care.

When used appropriately, ultrasounds do help clinicians provide high-quality reproductive health care.  Many clinicians who provide abortion and prenatal care rely on ultrasounds to date a pregnancy.  Ultrasounds are critical in early detection of ectopic pregnancies, helping clinicians expedite treatment and patients avoid surgery.  They allow clinicians to diagnose early pregnancy loss and provide miscarriage care.  Having access to an ultrasound machine helps primary care clinicians provide comprehensive reproductive health care.

This year, RHAP has been interviewing family physicians to understand how they provide miscarriage care to their patients.   All of the clinicians we’ve interviewed as part of our study agree that miscarriage care should be a core part of their clinical practice.  But many aren’t providing all miscarriage treatment options to their patients because they do not have access to sonography.

We found that this lack of ultrasound technology disproportionately affects rural communities.  If there is no local access to ultrasound, people often have to travel far just to get a sonogram, only to have to turn around and drive miles back to get treatment from their local doctor.  Here is how one of the clinicians we interviewed put it:

Without an ultrasound machine in the office, if we have to send them all the way to the  hospital to get the ultrasound, then why make them travel all the way back?  We might as well have them do the procedure in the hospital instead of having them come back to the clinic.

No local access to ultrasound = no local access to comprehensive reproductive health care.

The issue is that ultrasound technology can be expensive, too expensive for many clinicians and community health centers to afford.  Luckily, technological advancements are starting to make these machines smaller, portable and more affordable.

This week the Reproductive Health Access Project is launching a two-week campaign to provide rural community health centers with small, portable, affordable ultrasound machines.  Our goal is to raise at least $5,000 so that we can provide a rural health center with an ultrasound machine.  We figure if 1,000 of our friends and supporters each donate $5, we can reach our goal.  We’ll be reaching out on Facebook and Twitter.  Join us there and help us expand reproductive health care in rural communities.

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Deep in the heart of Texas

August 7, 2013

stand-with-texas-women-logo-orange-800x800This post was written by RHAP’s field organizer in Texas, Jenny Horton. She was at the state capital during the July special legislative sessions to vote on a bill that contained sweeping restrictions on abortion access in Texas.  Senator Wendy Davis’s filibuster to prevent passing the bill mobilized reproductive health/rights/justice advocates in the state and across the country.  Jenny was one of the many who signed up to provide public testimony against the bills and rallied with reproductive health supporters and advocates from all over the state. This piece is a reflection on her time at the capital and the subsequent passing of HB2.

Deep in the heart of Texas, we stood with Wendy. We were ready to go to the Capitol at a moment’s notice! We signed up to testify and waited all night—some of us signed up to testify and were never allowed to speak at all. We saw memes on Facebook and Twitter from pro-life conservatives accusing us of chanting “Hail Satan” in the Capitol, accusing us of being murderers, accusing us of not being “Real Texans.” We gave up our tampons. Medical professionals listened to politicians, politicians with no clinical education, tell them about women’s health. Young men whose grandmothers died in botched back alley abortions weren’t allowed to speak. It made us so angry that we talked to all of our friends and families, until thousands of committed pro-choice progressives were standing with Wendy, marching for our cause, and rallying for what’s right in the oppressive Texas heat.

It’s hard to explain the South to someone that hasn’t lived here. Living in the South is the art of holding complexity—understanding the issues that face us politically but remaining completely enamored with the people that call this place home. It’s difficult for women and men in Texas to mobilize in such a fierce and coordinated away against these attacks on women’s health and to see the legislation pass anyway. It’s hard to hold that complexity when it seems like several people in the state hate you because you know, without a doubt, that women must have access to abortion care.

In spite of these incredible challenges, we continue the fight.  We are fighting against mandatory adoption counseling, fetal heartbeat bills, and lack of access for the women living in the Rio Grande valley.  We are fighting for our home.

It’s truly a labor of love.

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Meet our summer interns!

July 31, 2013

sarah_gordonName: Sarah Gordon

Hails from: New Jersey

Why are you passionate about reproductive health? During my junior year of high school, I volunteered for a sexual health program called the Teen Prevention Education Program (Teen Pep). I really enjoyed learning about sexual health and working with other students to conduct workshops for younger peers to teach them about sexual health. During my senior year, I lived in Argentina as an exchange student. Since abortions are illegal in Argentina, I have become interested in reproductive health issues and how they affect women and adolescents in different countries.

Life after RHAP?  I am a rising sophomore at Columbia University, where I intend to study psychology and Chinese. I hope to do volunteer work throughout NYC during the next few years, particularly in the field of public health.

Any fun summer plans in the city? Eating a lot of good food and seeing friends who live in the area!


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Abortion is not a ‘bad thing’

June 24, 2013

When I give a bonded handspresentation about the abortion services we provide in our family medicine clinic,  people often ask, “Do you have a counselor to meet with your patients to help them?” I’m a bit put off by this question. I want to say, “It’s my patients with a new diagnosis of diabetes or high blood pressure or cancer who need a counselor – they are the ones having their lives changed forever with a diagnosis and disease that won’t go away, whereas my abortion patients are addressing their issue!” But, of course, I can’t say that.   I am perturbed by the implication that women having abortions are somehow being traumatized.  To the extent that they are traumatized, it is the fault of our culture that demonizes women for obtaining an abortion.  The abortion experience itself can be positive.

Affirmation from physicians, telling women that we understand and support their decision, goes a long way towards destigmatizing abortion. Normalizing it – telling them how common abortion really is – helps.    Also, we can encourage women to bring a support person and then make every effort to give respect and praise to that support person, and to the way in which he/she being there strengthens the woman and that relationship.

Last week, for example, I had a 16-year-old couple come in who were really scared, but clearly sure of what they needed.  They relaxed quite a bit after we started talking and they realized that I was very willing to help them and that I was not going to shame them or be mean to them.  She wanted a medication abortion and I asked her boyfriend if he would be able to be with her the day she had chosen to have the cramping and bleeding, and he said, “of course!”  I said how great it was that they had such a strong relationship to help each other through this difficult time and they started holding hands.  It was truly a sweet moment.  I gave them both my phone number (as we always do) and said to call with any questions/concerns.  They left smiling and clearly feeling very relieved.  When she came back the next week for her follow up appointment, he came with her and held her hand during her IUD insertion, and we were able to reinforce how wonderful his support was and tie it all to their goals to finish their educations and be responsible about when to be parents.


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