Pregnancy Options Research Articles

87. Evaluation of a Curriculum in Adolescent Pregnancy Options Counseling through an Observed Structured Clinical Exam

87. Evaluation of a Curriculum in Adolescent Pregnancy Options Counseling through an Observed Structured Clinical Exam

Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites.

Cervical pregnancies, interstitial tubal pregnancies, and cesarean scar pregnancies, which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries. The development of high-sensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment. Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported. However, delayed resumption of infertility treatments after methotrexate therapy is indicated, and negative effects on the next pregnancy after uterine artery embolization have been reported. To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site. In this study, we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital, between April 2010 and December 2018, and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes. We evaluated the treatment methods, treatment outcomes, presence of bleeding requiring hemostasis measures and blood transfusion, complications, and treatment periods. Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone. There were 21 total cases comprising 10 cervical pregnancies, 10 interstitial tubal pregnancies, and 1 cesarean scar pregnancy. All patients completed treatment with this method. No massive hemorrhaging or serious adverse reactions were observed during treatment. The mean gestation ages at the time of diagnosis were 5.9 wk (SD, ± 0.9 wk) for cervical and 6.9 wk (SD, ± 2.1 wk) for interstitial tubal pregnancies. The total ethanol doses were 4.8 mL (SD, ± 2.2 mL) for cervical pregnancies and 3.3 mL (SD, ± 2.2 mL) for interstitial pregnancies. The treatment period was 28.5 days (SD, ± 11.7 d) for cervical pregnancies and 30.0 ± 8.1 d for interstitial pregnancies. Positive correlations were observed between the blood β- human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose (r = 0.75; P = 0.00008), as well as between the total ethanol dose and treatment period (r = 0.48; P = 0.026). Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.

Texas Senate Bill 8 and Abortion Experiences in Patients With Fetal Diagnoses: A Qualitative Analysis.

To describe experiences with abortion counseling and access in patients with lethal or life-limiting fetal diagnoses in Texas after enactment of Senate Bill 8 (SB8). In this qualitative study, we interviewed patients who obtained abortions after enactment of SB8, using semi-structured interviews to explore how restrictions affected abortion care. Two researchers coded all transcripts using an inductive technique and analyzed themes in an iterative approach. We interviewed 16 participants who reported gestational durations from 13 to 29 weeks at the time of abortion. Participants described loss of the therapeutic patient-physician relationship and feelings of isolation while pursuing abortion due to the limitations imposed by SB8. For example, participants felt there was a physician "gag rule" regarding abortion ("the unspoken word of termination"), resulting in the need to find information about pregnancy options outside of the medical community and further highlighting the privilege of financial resources necessary to obtain an abortion on their own. Participants also expressed fears regarding confidentiality with their support systems and clinicians ("I would joke around and say, well don't sue me, but halfway mean it") and personal safety when self-referring for abortion ("…am I making the right choice on where I need to go? Is it safe?"). Abortion restrictions and bans such as SB8 erode the patient-physician relationship, evoking fear and safety concerns during a vulnerable time for those undergoing abortion for lethal or life-limiting fetal diagnoses. They force patients to shoulder the significant burden of understanding pregnancy options and navigating the process of abortion alone, which is likely to have greater effects on those with fewer resources.

Understanding the experiences and needs of LGBTIQA+ individuals when accessing abortion care and pregnancy options counselling: a scoping review

BackgroundSafe, accessible, and inclusive abortion care and pregnancy options counselling are essential components of sexual and reproductive health and rights. Research has documented LGBTIQA+ people are as likely, or more...

The key role of hepatology providers in optimizing reproductive care in patients with liver disease: A call to action.

The key role of hepatology providers in optimizing reproductive care in patients with liver disease: A call to action.

Structured Engagement of Community Partners to Revise a Pregnancy Options Counseling Curriculum for Pediatric Residents.

The engagement of community partners, including patients, is increasingly recognized as important in developing medical education curricula. Structured methodology for partner engagement in curriculum development is lacking in the existing literature. This article describes a structured approach to engaging community partners to provide input on revising a curriculum for pediatric residents about pregnancy options counseling with adolescents. We used the five-step Method for Program Adaptation through Community Engagement: (1) development of a panel of community partners including patients and professionals, (2) and (3) partner evaluation of the existing curriculum and recommendations for revisions, (4) summarization of partner feedback, and (5) development of the revised curriculum. We surveyed partners about their perceived impact on the revision and satisfaction with the process. Seventeen partners participated. Five experienced adolescent pregnancy, while the remaining 12 included healthcare and social service professionals. All partners provided multiple recommendations, generating 124 discrete recommendations. Twenty recommendations were suggested by multiple individuals. The authors reviewed all recommendations by category during consensus meetings and determined which recommendations would be incorporated into the revised curriculum to meet stated learning objectives. We implemented 14 of these 20 recommendations, including adding a values clarification exercise, information about mental health crisis resources, and more detail about adoption. We also incorporated 15 individual recommendations pertaining to curriculum clarity. Recommendations from professionals and patients were similar. Fourteen out of 17 participants completed the survey at the close of the project. All respondents understood their roles, were satisfied with their degree of engagement, and felt that their expectations for participation were met or exceeded. This study describes a methodology for a formal process to engage community partners in curriculum development and revision processes. Such methodology can ensure that medical education curricula are optimally attuned to the needs of key community members and integrate the patient's voice.

Telehealth as a potential tool for outreach among women in Puerto Rico

Access to the full spectrum of healthcare should be available to all individuals. After the revocation of the constitutional right to abortion, women have fewer alternatives to unplanned pregnancy. Telehealth provides an additional option for such pregnancies through its remote provision of services. This could benefit women of all social strata. However, data regarding telehealth among underserved populations are limited. This study aimed to evaluate the use of contraception, awareness of abortion services, and receptiveness to telehealth among women in Puerto Rico, a Spanish-speaking minority population. This was a cross-sectional study of women living in Puerto Rico aged between 21 and 65 years. Data were collected with a self-administered survey via SurveyMonkey from March to December of 2021. Recruitment was done through social media and at the gynecology clinics of the University of Puerto Rico, Medical Sciences Campus and San Juan City Hospital. Analysis was done with Stata, version 14.2.Chi-square and Cochran-Armitage tests were used to evaluate the unadjusted relationship between variables. A P value ≤.05 was considered statistically significant. A total of 286 women were recruited. Of these, 73.3% (189/258) were sexually active, 89.1% (229/257) were heterosexual, and 62.7% (163/260) were not using contraception. In addition, 63.3% (157/248) knew about emergency contraception, yet 42.4% (103/243) were unaware of any sources of access to it; 76.6% (197/257) were unaware of nearby abortion services. A higher education level was associated with knowing about emergency contraception (P<.05) and awareness of sources of access to it (P<.05). However, no significant association was found between a higher education level and awareness of nearby abortion services (P=.799). Regarding telehealth, 65.2% (176/270) were willing to use the service for future gynecologic visits, yet only 18.9% (51/269) were offered telehealth services. No association was found between previous telehealth experiences and willingness to use telehealth for future gynecologic visits (P=.325). The lack of contraceptive use and unawareness of nearby abortion services place women at increased risk of unplanned pregnancy and unsafe practices. The gap between knowledge about and access to emergency contraception also calls for action. Telehealth may be of benefit given that most women showed interest in using it, and could be used for educating and providing women in Puerto Rico with contraception and medical abortions, further increasing their access to reproductive healthcare. Clarifying misconceptions and instructing women about safe practices is essential to our role as physicians. Ensuring women's access to adequate services is also vital for upholding their rights to healthcare.

Use of High-Intensity Focused Ultrasound (HIFU) in Treating Uterine Fibroids: A Case Report

Summary Uterine fibroids are the most common benign uterine tumours in women of reproductive age. They can present with different symptoms, including menorrhagia, cramping lower abdominal pain, bloating, urinary/bowel symptoms, spotting, and infertility. Management could be medical and surgical. Other options include uterine artery embolization and non-invasive treatment with high-intensity focused ultrasound (HIFU). We present a case of a 32-year-old woman with menorrhagia and severe pelvic pain. Ultrasound examination revealed an intramural myoma measuring 93x98x87 mm. The patient signed informed consent for HIFU ablation of the fibroid. Three months after the procedure, an MRI scan showed the fibroid had shrunk to 75% of its original size with dimensions 32x35x29. After six months, she became pregnant and gave birth to a healthy infant at 38-weeks gestation with caesarean section, at which point the fibroid measured 2 cm. HIFU is an alternative to surgical therapies and is highly beneficial in women wishing for future pregnancies. Preserving the option for future pregnancies in patients with uterine fibroids is only one of its benefits and might be the key solution for these women. HIFU treatment of uterine fibroids is an innovative approach. It should be encouraged: it is widely adopted in similar cases where it has positively impacted the treatment of uterine fibroids.

P040“You're on your own”: A qualitative analysis of texas senate bill 8 on abortion care in patients with lethal or life-limiting fetal diagnoses

<h3>Objectives</h3> To describe experiences with abortion counseling and access to care among patients with lethal or life-limiting fetal diagnoses in Texas following enactment of Senate Bill 8 (SB8). <h3>Methods</h3> In this qualitative study, we recruited patients who had an abortion after the enactment of SB8 and used semi-structured interviews to explore how SB8 impacted abortion care. Two researchers coded all transcripts using an inductive technique and analyzed themes in an iterative approach. <h3>Results</h3> We interviewed 14 participants who reported gestational ages at the time of abortion from 13 to 29 weeks. Participants described a loss of the therapeutic physician-patient relationship and feelings of isolation while pursuing abortion due to the limitations imposed by SB8. For example, participants felt there was a physician "gag rule" regarding abortion ("the unspoken word of termination"), resulting in a greater need to initiate their own research and invest personal resources (eg, finances, knowledge) into understanding their pregnancy options and obtaining an abortion. Participants also expressed fears regarding confidentiality with clinicians and their support system ("I would joke around and say, ‘Well, don't sue me,' but halfway mean it.") and need to assess personal safety when self-referring for abortion ("‘You're on your own…go find somebody that can do this…'"). <h3>Conclusions</h3> Bounty hunter abortion restrictions like SB8 erode the physician-patient relationship. These restrictions evoke fear and safety concerns during a vulnerable time for those undergoing abortion for fetal diagnoses. Patients shoulder a significant burden of understanding pregnancy options and navigating the process of abortion alone, which could result in further disparities.

P041The essential role of the primary obstetrician for patients seeking abortion care for fetal diagnoses in hostile settings

<h3>Objectives</h3> To evaluate the role of the primary obstetrician in abortion experiences of patients with lethal or life-limiting fetal diagnoses in hostile settings. <h3>Methods</h3> We conducted a qualitative study of Texas patients with lethal or life-limiting fetal diagnoses using semi-structured interviews. We purposively explored the role of the primary obstetrician through questions related to fetal diagnosis, pregnancy options counseling, abortion decision making, and post-abortion reflections. Two researchers coded all transcripts using an inductive technique and analyzed themes with an iterative approach. <h3>Results</h3> We interviewed 18 participants who reported gestational ages at the time of abortion from 13 to 29 weeks. Participants identified the primary obstetrician as a key relationship during their obstetric and abortion care. This central theme was supported by three sub-themes: 1) participants desired reiteration or confirmation of information they received from a specialist; 2) participants wanted information about what to expect during and after an abortion from a trusted source; and 3) participants noted the benefit of having post-abortion follow-up to assess psychosocial concerns and future family planning needs, especially after obtaining an abortion out of state. <h3>Conclusions</h3> Patients seeking abortion care for fetal diagnoses in a hostile setting view the primary obstetrician as central to their experience. As fetal diagnosis and abortion are often performed by different specialists in separate locations, primary obstetricians have the potential to provide continuity of care before and after an abortion and bridge the gaps in care created by abortion restrictions. Family planning specialists should facilitate this process by forming relationships with and providing resources for referring obstetricians.

8407 Interstitial Ectopic Pregnancy: A Case Series with Practical Tips for Surgical Management

<h3>Study Objective</h3> To review current treatment options for interstitial ectopic pregnancy (IP), with a focus on surgical treatments. To review outcomes of three surgically managed cases of IP. To demonstrate practical tips for success in laparoscopic management of IP. <h3>Design</h3> A case series presenting three cases of surgically managed IP with guided explanation of surgical intervention using video. <h3>Setting</h3> Academic affiliated community hospital. <h3>Patients or Participants</h3> The 3 cases of IP evaluated and treated over the past year were included in the study. <h3>Interventions</h3> Two patients underwent laparoscopic cornual resection of IP and one patient underwent emergent abdominal repair of ruptured IP. <h3>Measurements and Main Results</h3> Estimated blood loss (EBL) for laparoscopic management of 6-week IP with preoperative uterine artery embolization (UAE) was 20ml; length of post operative length of stay (LOS) was 1 day. EBL for 13-week IP without embolization was 50 ml, post op LOS was 0 days. EBL for ruptured IP repaired via open approach was 1000ml including hemoperitoneum, post operative LOS was 2 days. Beta hCG was trended once per week post operatively for all patients. Both patients undergoing laparoscopic resection had negative HCG by week 4. The patient with ruptured IP had negative hCG by week 8; however, she did not complete testing between week 5-7; at 4 weeks her hCG was 17. <h3>Conclusion</h3> IP is sometimes a difficult diagnosis to make; a high index of suspicion is necessary. Laparoscopic surgery for IP is achievable using similar techniques as laparoscopic myomectomy for limiting perioperative blood loss and repair of the myometrial defect; Ultrasonic scalpel, vasopressin, delayed absorbable barbed suture. IP can often be treated laparoscopically, however laparotomy may be necessary in unstable patients with advanced gestation. Further investigation is necessary to determine the best practice for surgical management of IP.

Exploring barriers to abortion access: Medical students’ intentions, attitudes and exposure to abortion

ObjectiveTo describe medical student attitudes and exposure to abortion and pregnancy options counseling and influences of that experience on the provision of these services in their future practice. Study DesignA survey was conducted of 3rd and 4th year medical students in 2019 at an US medical school in the Northeast. ResultsOne hundred and sixty-two students participated in the survey (response rate = 46 %, 162/353). Only 27 % reported receiving at least one educational lecture on abortion during medical school. Fifty-eight percent reported clinical exposure to surgical abortion. About 2/3 reported being somewhat likely to provide abortions in the future, despite most identifying as “pro-choice.” There was significant association between clinical exposure to surgical abortion and desire to include abortion in future practice (P = 0.03). The most common objections to performing future abortions were personal values, religious objection, and lack of training/experience. Most respondents did not feel comfortable providing counseling for abortion or adoption. Combined, only 14.4 % reported that they would be at least somewhat likely to apply to obstetrics-gynecology or family medicine residency programs, including programs with opportunities for such training. ConclusionsEarlier work has shown that medical student intentions to provide abortions prior to residency are better predictors of future abortion provision than during residency. Thus, medical school is a critical time for exposure to abortion and pregnancy options counseling. Such exposure and medical student attitudes are areas of research that should be further studied to contribute to the expansion and normalization of these services.

Measures to Mitigate Sodium Valproate Use in Pregnant Women With Epilepsy.

Sodium valproate is a sodium saltof valproic acid. It is often used in the medical treatment of several conditions like epilepsy, bipolar disorder, mania, and migraines. This review debates whether the usage of valproic acid is appropriate in pregnancy. It also lists the various neonatal deformities and other teratogenic effects the said drug presents due to prenatal exposure to the drug and the implications of continuing drug therapy in certain situations. We should often weigh the outcomes and implement it only in conditions where its use is inevitable. It also includes the importance of awareness among middle-aged women with mental illness regarding the teratogenic effects of sodium valproate use and the relevance of discussion by physicians with patients regarding the usage of this drug despite being aware of the complications. It also explores other treatment options and modalities that can be used in the place of valproic acid for epilepsy and bipolar disorder in pregnant women and women of the reproductive age group, and how we can mitigate the usage of this drug by implementing various measures by referring to various guidelines present in different areas of the world. In summary, this article explores the numerous teratogenic effects sodium valproate presents in pregnancy, alternative medications, and treatment options instead of valproate. It also enumerates conditions where valproate use is necessary and how we can reduce and prevent the usage of valproate in pregnancy by opting for pregnancy prevention programs during valproate use and various other guidelines.

Racial disparities in pregnancy options counseling and referral in the US South.

The objective of this study is to examine racial variation in receipt of counseling and referral for pregnancy options (abortion, adoption, and parenting) following pregnancy confirmation. Equitable offering of such information is a professional and ethical obligation and an opportunity to prevent racial disparities in maternal and child health. Primary data from patients at southern United States publicly funded family planning clinics, October 2018-June 2019. Patients at 14 clinics completed a survey about their experiences with pregnancy options counseling and referral following a positive pregnancy test. The primary predictor variable was patients' self-reported racial identity. Outcomes included discussion of pregnancy options, referral for those options, and for support services. Data from eligible patients with non-missing information for key variables (n=313) were analyzed using descriptive statistics, χ2 tests, and multivariable logistic regression. Patients were largely Black (58%), uninsured (64%), and 18-29 years of age (80%). Intention to continue pregnancy and receipt of prenatal care referral did not differ significantly among Black as compared to non-Black patients. However, Black patients had a higher likelihood of wanting an abortion or adoption referral and not receiving one (abortion: marginal effect [ME]=7.68%, p=0.037; adjusted ME [aME]=9.02%, p=0.015; adoption: ME=7.06%, p=0.031; aME=8.42%, p=0.011). Black patients intending to end their pregnancies had a lower probability of receiving an abortion referral than non-Black patients (ME=-22.37%, p=0.004; aME=-19.69%, p=0.023). In the fully adjusted model, Black patients also had a higher probability of wanting access to care resources (including transportation, childcare, and financial support) and not receiving them (aME=5.38%, p=0.019). Clinical interactions surrounding pregnancy confirmation provide critical opportunities to discuss options, coordinate care, and mitigate risk, yet are susceptible to systemic bias. These findings add to limited evidence around pregnancy counseling and referral disparities. Ongoing assessment of pregnancy counseling and referral disparities can provide insight into organizational strengths or the potential to increase structural equity.

Abortion Knowledge Among Advanced Practice Clinicians inColorado.

Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians. We conducted a stratified random survey of advanced practice clinicians, oversampling women's health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores. A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, "I don't know" was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, "I don't know" was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women's health. Providing options counseling was positively associated with abortion knowledge (law, β=0.44; 95% confidence interval [CI], 0.10-0.78; care, β=0.52; 95% CI, 0.08-0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β=-0.03; 95% CI, -0.65 to 0.59), but lower abortion care knowledge (β=-1.85; 95% CI, -2.34 to -1.36). Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.

Options Counseling for the Pregnant Adolescent Patient.

Although teenage pregnancy rates have decreased over the past 30 years, many adolescents become pregnant every year. It is important for pediatricians to have the ability and the resources to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental counseling that includes the full range of pregnancy options. Counseling includes an unbiased discussion of the adolescent's options to continue or terminate the pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. It is important for pediatricians to be familiar with laws and policies impacting access to abortion care, especially for minor adolescents, as well as laws that seek to limit health care professionals' provision of unbiased pregnancy options counseling and referrals, either for abortion care or continuation of pregnancy in accordance with the adolescent's choice. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling that includes the full range of pregnancy options. Pediatricians should be aware of and oppose policies that restrict their ability to provide pregnant adolescents with unbiased counseling that includes the full range of pregnancy options. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.

The Adolescent's Right to Confidential Care When Considering Abortion.

The American Academy of Pediatrics reaffirms its position that the rights of adolescents under 18 years of age to confidential care when considering legal medical and surgical abortion therapies should be protected. Most adolescents voluntarily involve parents and other trusted adults in decisions regarding pregnancy termination and should be encouraged to do so when safe and appropriate. The legal climate surrounding abortion law is rapidly becoming more restrictive and threatens to adversely impact adolescents. Mandatory parental involvement, the judicial bypass procedure, and general restrictive abortion policies pose risks to adolescents' health by causing delays in accessing medical care, increasing volatility within a family, and limiting their pregnancy options. These harms underscore the importance of adolescents' access to confidential abortion care. This statement presents a summary of pertinent current information related to the impact of legislation requiring mandatory parental involvement in an adolescent's decision to obtain abortion services.

Health Care and Adoption Service Experiences of People Who Placed Children for Adoption During Adolescence: A Qualitative Study

Study ObjectiveTo understand the perspectives of people who placed children for adoption during adolescence DesignWe conducted qualitative interviews with adults who placed children for adoption during adolescence. We recruited participants through social media and two adoption-related organizations. We audio-recorded and transcribed interviews. Using thematic analysis, 2 investigators coded the transcripts and identified themes. SettingTelephone interviews ParticipantsAdults ages 18-35 years old who placed children for adoption before they were 20 years old InterventionsSemi-structured telephone interviews Main Outcome MeasuresQualitative data ResultsWe conducted interviews with 18 individuals (median age of 32 years; range 21-35 years). The median age at pregnancy was 18 years (range 13-19 years). Seventeen participants identified as female and one as nonbinary. Themes included the following: (1) Negative experiences with counseling included limited empowerment to make choices about pregnancy or adoption options; (2) negative experiences with counseling included limited information about practical or financial support for pregnant adolescents; (3) negative experiences with the health care system included insensitivity or lack of awareness of the adoption plan at delivery; (4) positive experiences with counseling included comprehensive unbiased options counseling and adoption counseling emphasizing birth parent choice in openness and family placement; (5) positive experiences included longitudinal emotional support during pregnancy, particularly in ways that normalized adoption placement; and (6) participants desired therapy and/or psychological support following adoption placement. ConclusionsIndividuals who chose adoption after adolescent pregnancy described positive and negative encounters with health care and adoption professionals that could serve as targets to improve the overall care experience for this population.

The impact of policy changes from the perspective of providers of family planning care in the US: results from a qualitative study

In recent years, there have been several state and federal policies that have disrupted access to publicly supported family planning care in the United States, including the 2019 rule that altered the federal Title X family planning program. In late 2020, we conducted in-depth interviews with health care providers from 55 facilities providing family planning care in Arizona, Iowa, and Wisconsin with the aim of learning how sites were affected by policy changes. We identified perceived effects on clinic finances, patient confidentiality, contraceptive counselling and service provision, and options counselling resulting from state and federal policy changes. Some clinics lost funding and had to pass some of the cost of services on to patients, raising new confidentiality concerns and creating new burdens on staff to carry out financial counselling with patients. Other sites had to grapple with restrictions on the pregnancy options counselling that they could provide, concentrate counselling on fertility awareness-based methods, and increase efforts to include parents/guardians in the care of adolescent patients. State and federal policies impact how publicly supported family planning care is provided, and compromise efforts to provide patient-centred care.

Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school

ObjectiveEvaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. Study designA survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. ResultsThere were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84–88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. ConclusionWe identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. ImplicationsDespite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.