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How providing abortion care makes me a better doctor

July 22, 2014

woman doctor woman patient 3Linda Prine, RHAP’s medical director, moderates the Access List, a clinical listserv with more than 1,000 subscribers all dedicated to providing abortion care within family medicine and primary care settings. This regular column features Linda’s postings to the Access List. At our recent Reproductive Health Access Project gathering at Society of Teachers of Family Medicine annual meeting, we discussed some of the ways in which providing abortion care makes us better doctors. I pulled together everyone’s comments and am sharing below. Providing abortion care makes me a better doctor because:

•  It teaches me the real meaning of being patient centered.

•  It taught me how to reserve judgment and understand that I can’t walk in anyone else’s shoes.

•  It makes me brave because I don’t really think I’m a brave person. But when I do this work that I intensely believe in, in a state that would like to criminalize it, I know that I am being brave and that makes me a stronger person.

•  It makes my procedure skills better for IUDs and endometrial biopsies and really all procedures.

•  It taught me how to really, really listen to my patients. It lets me make abortion a normal part of the life cycle. Since I take care of women I’ve known since they were infants, and they know me and trust me and I can make the abortion a normal part of medical care for them and let them know I think it’s a good decision for them and be a supportive person who they know cares about them as I provide this care.

•  It has helped me discuss so many difficult areas with patients: morality, spirituality, and ethics.

•  It gives me a chance to let women know that I respect their dreams for their future and that I will help them get there by providing the abortion they need so that they can have that life back that includes pursuing those dreams.

•  It has been a way for me to improve my counseling skills, my listening skills, my empathy with patients, so many things I need for being a good doctor. I have gotten better at due to providing abortions in my own office and all that it takes.

•  It’s all transferable to other areas of medical care: including understanding systems issues and politics of medicine and really everything!

•  It has helped me become a better teacher of residents because I have to be mindful of the patient and the resident and be sure that both of them are doing ok all the time.

•  It helped me be there to support women through a particularly difficult moment – it sometimes occurs to me that my patient will remember this day for the rest of her life.

•  It helped me to recognize that abortion can be something super important or something routine and normal, depending on the particular patient’s situation.

•  It is the thing that gets me “jazzed” which helps keep me interested in other aspects of family medicine. It taps into all aspects of myself within my work. Thinking, feeling, troubleshooting, coordination, love and family and friends and all that is truly important in life.

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After Hobby Lobby: taking action to ensure contraception is basic health care for everyone

July 2, 2014

contraception-scotusThe development of safe, effective contraception is widely considered to be one of the greatest public health achievements of the last century. Contraception reduces unintended pregnancy, improves birth outcomes, reduces maternal death and has been correlated with improved health and economic benefits for families and communities. Worldwide, contraception is considered basic health care and access to health care that includes contraception is a core human right.

The Reproductive Health Access Project is dedicated to ensuring that contraception, abortion and miscarriage care are integral components of our nation’s primary care system. We know from our work across the country that there are many factors that influence how readily you can access reproductive health care. Our medical director, Linda Prine, and research associate, Gabrielle deFiebre, recently published an article in the Journal of Health Care for the Poor and Underserved entitled Disparities in Contraceptive Care that breaks it all down. Age, race, income, and geographic location are key factors associated with access to contraception in the U.S.

Now, because of the Supreme Court’s Hobby Lobby decision , the religious affiliation of your employer has been added to the list of barriers to contraceptive access. Religious institutions have always posed barriers to women’s health. Our blog post by a family nurse practitioner working in the rural south highlights the convoluted hoops she has to jump through in order to provide her patients with contraception.

What can we do we now? We need to take action now to urge President Obama and Congress to come up with a plan to ensure that those affected by yesterday’s Supreme Court decision have access to basic health care – including contraception. Please join us in telling Congress and the President that contraception is basic health care. Access to contraception is non-negotiable. Tell your friends, family, and colleagues to take action too. Together we can ensure that everyone can access the reproductive health care they need.

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Religious restrictions vs. quality care: my struggle in a Catholic healthcare system

July 1, 2014

I’m a pro-choice nurse practitioner anBirthControl-Catholocism_jpg_800x1000_q1001d I am the only medical provider in the only clinic serving a community in the rural South. My clinic is run by a Catholic hospital. I want to share my story for a couple of reasons. One, I hope that other folks out there in similar situations (I know you’re out there!) will read this, feel a little less alone, and will keep on fighting the good fight. And two, I want to create a window into my world for those who are practicing in more liberal environments.

When I moved to the South from New York City and started looking for jobs it became clear early on that I had to choose between being a comprehensive family practice provider or an abortion provider. I think that I knew that I had been practicing in a ‘bubble’ for the past few years, but I really didn’t realize what an unrealistic view I had of how primary care actually occurs in most of the country. I had an “in” for a job at an abortion clinic but I didn’t want to leave primary care. I felt a real responsibility to work in primary care, as if it would be a waste of my skills to leave it behind. I decided to take my current position because it offered some unique opportunities for me as a nurse practitioner with regard to the level of control I have over the practice as the only provider on site. The clinic was not even open yet when I was hired, so I got to pick the supplies and medications we keep in stock (with limits of course: no Depo, no IUDs, no EC, etc), I got to hire my nurse, I even was involved in picking the art we have hanging on the walls.

One of the first questions that I asked during my interview for this job was about providing basic women’s health care that included contraception. Basic, right? Contraception is legal and, especially in resource poor rural areas, control over fertility can make the difference in a family’s economic future. I was told by my administrative manager that “what happens in the exam room is none of my business, I’m sure that lots of other providers are prescribing whatever they want.” I thought this was a really weird answer at the time, but I now realize that it perfectly sums up the de facto “don’t ask, don’t tell” policy here. I reached out to my colleagues for clarification, and nobody would (or maybe could?) give me a straight answer about what was allowed or forbidden. One of my colleagues who has been prescribing birth control told me that when she provides contraception, she always gives the patient a medical diagnosis (like “Acne” or “Dysmenorrhea”) rather than use the standard v25.9 Contraceptive Management diagnosis code. So now I do that too. When a patient comes to me asking for birth control I lead them through a series of questions trying to find a reason other than fertility control to provide contraceptives, hoping that they will mention cramps or irregular periods.

birth control choicesEvery patient who needs birth control is a puzzle to be figured out. A time consuming, complicated puzzle. For example, if a patient wants the Depo shot, I have to call their insurance company and try to convince them to cover the Depo at the pharmacy instead of at my office because I’m not allowed to stock it. This also puts added responsibility on the patients to pick the Depo up at the pharmacy and bring it back to the clinic so I can administer it. I have been building a list of providers located within an hour of my practice who insert IUDs and contraceptive implants. These processes create a real mix of emotions in me. It is immensely satisfying to solve each of these contraceptive puzzles–I did a little dance after giving that first hard-earned Depo shot! I’m proud to spend this time to provide women the care that they need, but it does put a strain on me, my patients, and my practice.

The relationship between religion and medical practice has created a strange environment within which I provide medical care. Talk of religion happens early and often. Every staff meeting starts with religious reflections and my clinic has been blessed by a nun. I had to sign an employment contract that said I would uphold Catholic ethics. I believe it excludes good practitioners who happen not to be Catholic by limiting the scope of their practice—you have to decide to provide birth control and risk being fired every time you do, or simply not work there. Considering how large this Catholic healthcare system is in the region where I live and work, this is definitely problematic.

I’ll admit, when I took this job I envisioned myself blowing in here and bringing in fresh ideas and making huge changes. I know now that this expectation was unrealistic. Not just because of the barriers created by my employer, but also because of the values and comfort level of many of my patients. Many of my patients have never been provided with contraception or pregnancy options, and will sometimes respond to their presentation with offense, but more often with the resignation of a decision already made by the environment in which they grew up. When I mention abortion as an option for an unplanned pregnancy, I might get a resounding “NO!” or I might get a resigned, soft “no…” that has become all too familiar. But whereas at my previous practice, I was often able to get to the bottom of that soft little “no…” I am still struggling to get there with many of my current patients. I think it’s a combination of geographical barriers (the closest abortion provider is an hour away), financial barriers (Medicaid doesn’t pay for abortions), structural barriers (at my last office I might be able to provide them with an abortion that same day!), and, finally, cultural barriers (often the patients say they don’t know anyone who has had an abortion). I’m still working on it. Another puzzle.

L.M. is a nurse practitioner working in an environment under onerous religious restrictions. L.M. must remain anonymous as any connection between their personal values and their work environment would lead to loss of employment.

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The 2014 Civil Liberities and Public Policy Conference

June 18, 2014

This post was written by Ayesha Rehman, a junior at Macaulay Honors College at CUNY and the Reproductive Health Access Project’s research intern.  Every year RHAP sponsors our interns to attend the Civil Liberties and Public Policy conference at Hampshire College.  This year we asked Ayesha to document her experience at the conference and share her thoughts on our blog.  

Day 1, April 11, 2013

CLPP_Ayesha_2014

Ayesha between workshops at the 2014 CLPP Conference

After a long bus ride, my friend and I finally arrived at Hampshire College for the 2014 CLPP Conference. The first workshop that we attended was called Deconstructing the Good Mother Myth. The panel consisted of 5 people – Avital Norman Nathman, Deborah Jiang Stien, Sarah Buttenwieser, Natasha Vianna, and Tope Fadiran Charlton. Each panelist had a unique story, but the two that made me think the most were Natasha and Deborah’s narratives. Before attending the workshop, I admit that I always perceived teen pregnancy as a negative thing. I had the belief that teen moms are often not able to care for their children because they are still high school students who can only manage to get minimum-wage jobs. While the reality might be grim for many teenage moms, it is not always the case. Natasha, a mother who became pregnant when she was 17, shared how she grew to be more resilient by having the chance to be a mother. She had to transfer from her unsupportive Catholic school to a public school- where there was a day care. She said it was the attitude of the surrounding people that was hard to deal with. Natasha completed high school and went on to get a college education, but again the uncooperative approach of people around her made life difficult. Society often promotes the notion of delayed parenthood as the right choice, but at the end of the day, it falls on each person to decide when to become a responsible and caring parent. The other speaker who touched me was Deborah, an adoptee born in prison. She shared how women who are incarcerated are denied basic human rights when it comes to fulfilling their right to be a mother. From being shackled during labor to not having legal custody of their children, women in prisons are treated as if they don’t deserve to be mothers. I became so interested in this topic that  I went to another workshop called Invisible: Women in America’s Prisons and Jails on Saturday that delved into it more deeply. More on this in Day 2.

Day 2, April 12, 2013

20140412_091528

Banner in the main hall during the morning plenary

Saturday’s opening plenary consisted of brief presentations by organizations that are working for reproductive justice throughout the country. From the upbeat performance of Joe Scott’s song Golden by Monica Simpson of SisterSong to poems read by activists, the day started with vibrant energy. The first workshop I went to was called Self Cervical Exam: Abortion, Menstrual Stories, Birth Control, and Self Examination As Tools for Self-Determination. I was curious to find out about the self-exam. But I came to the conclusion that learning such a skill is not of much use to me. I do not think that knowing what color the lining of one’s cervix is helpful in telling anything. I believe it is best to consult a clinician when it comes to taking care of one’s reproductive health. The second workshop was on the violation of female prisoners’ reproductive rights. The panelists talked about the conditions of jails in Massachusetts, but I assume the circumstances are not much different in other parts of the United States. Visitors have no rights as they are sniffed by dogs and made to wait long hours. These actions are taken to dissuade people from visiting, so that inhumane treatments like female inmates being stripped in presence of four or five male guards may go unnoticed and ignored. An incarcerated mother who gave birth to her son while shackled spoke of the unnecessary and cruel practice of restraint during labor. She explained how officers at the facility did not believe her when she said she was going into labor and so she was not taken to the hospital on time. From her story, I saw how organizing a campaign with media coverage can move anti-shackling bills forward and shed light on the barbaric treatment that is  practiced in prisons. If an anti-shackling bill passes in Massachusetts, it will be the 19th state where imprisoned women can safely give birth just like any other mother. The last workshop for the day was Organizing for Reproductive Justice in Religious Communities. The main theme that I took away was that if you want to bring reproductive justice into the conversation among religious people, you have to start small. You can begin by talking to a close friend or family member and instead of pinpointing who is opposing your ideas, try and find allies. This makes it easier to move your goal forward. This strategy is very relevant to activists who want to discuss abortion rights because 87% of U.S. population has some sort of religious beliefs. Another important thing that the panelists discussed was recognizing our own limits. For instance, if you feel that abortion is permissible but later-term abortion doesn’t align with your own beliefs, then advocating for all abortions might be problematic. All in all, I learned there is no one-way to reconcile religious beliefs with reproductive justice. But we can find answers by beginning to talk to people with the same position.

Day 3, April 13, 2013

The workshop I went to on Sunday explored environmental and climate justice. I was interested in how the panelists – Asa Needle and Jacqui Patterson – were going to relate environmental issues to reproductive justice. Sure enough, the advocacy agenda of Injustice Anywhere is a Threat to Justice Everywhere became clear when they discussed how landfills are almost always located in communities of color and low-income populations. Harmful chemicals and carcinogens that seep into the water supply can mean disaster for everyone, from children to pregnant women. The panelists mentioned how one African American community was not informed about landfill pollution that was happening in their vicinity and as a result, people in that community consumed contaminated water for a year! This is also true for other facilities that are known to emit toxic residue. For instance, besides having a sewage treatment plant and health-hazardous-particulates-puffing bus depots, there are plans of building research labs with security clearance for highly dangerous substances such as anthrax in Harlem, which has the densest African population in the world after Africa. Factors like these play major roles in the overall health of the people in these communities. From harmful mutations in babies to higher asthma prevalence, the health of some social classes is being knowingly compromised. This has to be stopped. One way to do so is by informing more people and starting a conversation about the problem. I am glad I was able to attend the 2014 CLPP conference and go beyond just the facts, like how the U.S. constitutes 4% of the world’s population but emits 25% of carbon gases. There is so much more to the discrepancy than the numbers show and I was able to learn and talk about important issues at the conference.

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Two new members of the RHAP team!

May 8, 2014

Nora

Nora Langknecht

Every year the Reproductive Health Access Project has the sincere pleasure of hosting young advocates of reproductive health and justice at our New York City offices. These students are the key to the future of reproductive health and we are very proud to assist them in developing the tools they need for a future in social justice.

Eleanore “Nora” Langknecht is a senior at Eugene Lang College at The New School University. She will graduate this May with a BA in Social Inquiry. In addition to working with RHAP this spring, Nora is writing and researching a senior thesis about the history of comprehensive curricula and the advocacy for sexuality education demonstrated by non-profits and government groups. Fostering a lifelong interest in comprehensive sexuality education, as well as access to proper care and information, she is thrilled to be joining RHAP as a development and fundraising intern.

Hailey

Hailey Broughton-Jones

Hailey Broughton-Jones is a proud Brooklynite and a high school senior at the Institute for Collaborative Education. She is excited to be attending Wesleyan University in the fall. Her passion for reproductive health began in the 10th grade after she and a few fellow classmates created a mock grass-roots organization called Teens for Choice.  Hailey’s commitment to reproductive justice is rooted in her deep belief that sex equality cannot be obtained until individuals have complete control over their reproductive health.

In addition, Hailey also co-founded Project Skittles, her high school’s gay straight alliance.  Outside of work Hailey is a major foodie, loves Zumba, biking, and spoken word. This semester she looks forward to working with the RHAP team and soaking up as much knowledge as possible before summer!

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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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