Abortion Practice After Routine Training: A Prospective Cohort Study

Abstract

PURPOSE: To explore Ryan Program graduates; post-residency practice in abortion care. BACKGROUND: The Ryan Program supports residency programs to integrate abortion into training. In 2012 we commenced a prospective cohort study of graduated residents. METHODS: Residents complete web-based surveys after the family planning rotation and consent to participate in future studies. In 2016, we surveyed ob-gyns 2+ years after residency about their current practice. Post-rotation and post-residency surveys were matched and then de-identified. RESULTS: Sixty percent (394) who consented to participate responded. Nearly all graduates did abortions during residency (median of 31, including medical and procedural techniques). 86% fully participated in training, while 14% opted out for personal or religious reasons. 33% percent overall, and 40% of those who intended to, do abortions in current practice (median of 12 per month). An additional 36% do not do abortions but wish to, and 16% do not nor desire to provide abortion care. Physicians doing abortions are more likely to have fully participated (42% vs. 8%, P=.00) and did more abortions in training than those not doing abortions (median 32 vs. 16, P=.00). Those without an academic affiliation (n=134) are less likely to do abortions (23% vs. 45%, P=.00) and more likely to want to integrate abortion care (56% vs. 44%, P=.02). DISCUSSION: One-third of ob-gyns who trained in Ryan programs include abortion care in their practice. An additional third are unable to despite intending to at the time of their training. Further studies are needed to understand the barriers to integrating abortion care into practice.