Kalin Gregory-Davis is a fourth-year medical student at the University of Vermont. She’s known since she started at the Larner College of Medicine — Vermont’s only medical school — that she wants to be an abortion provider.
In fact, part of the reason she decided to attend medical school in Vermont is that the state is unlikely to limit abortion access. That’s unlike Texas, Alabama or Louisiana, where significant restrictions have made it difficult to obtain training in abortion procedures, according to Pamela Merritt, executive director of Medical Students for Choice, an organization that helps medical students get training in how to end a pregnancy.
Through Gregory-Davis’ earlier years of medical school, she was able to learn something about abortion. One class in each of her first two years briefly covered the topic, then in her third year she sought out a clinical rotation in reproductive health at Central Vermont Medical Center in Berlin.
“I didn’t see any abortions at Central Vermont Medical Center, and that was hard for me because I wanted to, as someone who really cares about this,” Gregory-Davis said. So, she reached out to a doctor in Plattsburgh, New York, and spent a day at Planned Parenthood with him. “But that was entirely me-led,” she said.
Gregory-Davis has served as president of the board of Medical Students for Choice at UVM, where she organized film screenings, discussion groups and supplemental learning opportunities for her classmates. However, she said attendance often wasn’t great, which she chalks up to medical students simply being incredibly busy.
She’s now completing a rotation at an abortion clinic in New Mexico, and said she feels grateful she’s been able to get as much hands-on experience as she has. She said UVM always supported her when she looked for outside opportunities to train in abortion care.
Although she knows Larner College of Medicine is ahead of many other medical schools in the country — where sometimes abortion procedures are not taught at all — she wishes abortion had occupied more of the curriculum. Not just to learn the procedures, which are fairly simple, she said, but to navigate the complicated issues swirling around it.
“The impact of laws, disparity between racial groups, different laws and who they impact the most ... these are important conversations for medical students to be having,” Gregory-Davis said.
Year by year
The medical school at UVM has 479 students, about 10% of whom go on to residencies in obstetrics and gynecology, according to Lauren MacAfee, an assistant professor at the Larner College of Medicine, and the primary abortion provider at UVM.
About one-third of Larner graduates are now physicians in Vermont, or completed their residency training in the state.
Based on the most recent numbers available,1,300 abortions were performed in Vermont in 2017. In 2010, the state had 699 publicly funded abortions, all state-funded; no federal money was used.
Vermont uses its own funds to cover all or most "medically necessary" abortions sought by low-income women under Medicaid.
MacAfee has spent the last five years working to incorporate abortion into the medical school curriculum in a more meaningful way.
Before MacAfee started at UVM, the only exposure medical students had to abortion at all was briefly in their third year. Now, abortion is discussed during each year of their training.
During their first year, all students take a class called Professionalism, Reflection and Communication, which deals with doctor-patient relationships. The class examines personal biases in medicine and how a patient’s identity informs care. In one class session, students discuss abortion. MacAfee describes that as an “ethical and political thing,” not specific training in how to perform the procedure.
In their second year, students take a class on reproductive health, which includes a 90-minute session that outlines the basics of medical care involved in abortion.
“I also talk about the role of politics in medicine,” said MacAfee, who leads the session, “and we talk about how you provide this procedure, depending on the state where you live.”
“I do that not to be pro- or anti- or anything … but just to highlight some of the differences (on) what that means for patients. It impacts the patients who come in for this procedure,” she said.
In their third year, all students do an OB-GYN clinical rotation, where they may have the opportunity to see an abortion — depending on where they’re posted, and who happens to need care during the brief time they are there. Because the University of Vermont does not have a particularly high volume of abortion patients, often students won’t see the procedure.
Finally, in their fourth year, MacAfee offers an online course in family planning for students interested in reproductive health. It encompasses “abortion, miscarriage and conception care.” Students can take the course for either two or four weeks and have the chance to home in on specific elements of family planning care.
“You could do a deep dive into emergency contraception, abortion — not only the medical piece, but sociopolitical components related to that,” MacAfee said.
MacAfee emphasized that all abortion training is optional.
“We are fully supportive of opt-out and partial participation. We want to be supportive of students having the medical knowledge that they need, but without compromising any personal beliefs,” said MacAfee, who also emphasized that students’ grades are in no way affected if they decide to opt out of discussions of abortion.
One in four women
In 2019, the U.S. Department of Health and Human Services accused the UVM Medical Center of forcing a nurse to assist in an abortion procedure despite the nurse’s religious objections.
The Justice Department eventually filed a lawsuit in federal court in the final days of the Trump administration, but under Biden reversed course and ultimately dropped the lawsuit this past summer.
That ordeal left the university concerned about ensuring that students can always opt out of abortion training at any level. Opting out over religious objections had always been an option, but some believe the procedure is common enough that medical students should be required to at least have some abortion training.
No numbers were available on how many Larner students have opted out of abortion training.
In the United States, one in four women will have an abortion by age 45, making it one of the most common medical procedures in the country.
“I think it should be something everyone needs to learn about to be a doctor,” Gregory-Davis said.
Allison Bates, director of medication abortion, sedation and ultrasound at Planned Parenthood of Northern New England, supports students who opt out of hands-on abortion training, but believes all students should be required at least to discuss one of the most common medical procedures in the world.
“They should have the framework and the ability to talk about it as an essential element of reproductive health care,” she said.
State Sen. Ruth Hardy, D-Addison, who worked at Planned Parenthood before she became a senator, supports the opt-out choice but hopes medical schools emphasize to students the importance of training on the procedure.
“There are cases where a woman will die if they don’t receive an abortion, so if you’re an emergency room doctor and you don’t know how to do that, I think you’re limited in your skillset,” Hardy said. “I hope (medical schools) explain the reality to medical students that they may be in a situation where it's necessary and they may need to know how to do it.”
But others disagree.
“Maybe you went into medical school to save lives, not to be involved in things you feel like are against your conscience, so (the medical field) will lose some excellent employees if they start mandating this training,” said Mary H. Beerworth, executive director of Vermont Right to Life.
A national shortage of training
UVM is considered one of the most abortion-friendly medical schools in the country, even though that training is quite limited.
Lack of training in abortion care is a major issue nationally, and the fact that UVM students have a chance to even discuss the procedure is exceptional.
Several factors can make it very difficult to obtain training in this simple and common procedure.
First, in states like Texas that have serious restrictions on abortion, it’s difficult for students to get a chance to witness an abortion, because they’re becoming more and more rare.
Another issue: medical schools with religious affiliations. Abortion violates Catholic medical principles, and schools affiliated with the Catholic church can’t teach it.
Now, some state legislatures are working to bar publicly funded universities from affiliating with organizations that provide abortions. Often that happens under the radar, as was proposed in Missouri. There, House Bill 302 is still pending in the House Ways and Means Committee, billed as a proposal to modify “provisions relating to taxation.” But one section of the bill would tax the endowment of any university that associated with or referred students to train with an abortion provider.
“That is an overt example of what happens covertly in state legislatures all over the country," said Merritt, of Medical Students for Choice. Bills like that, even if they aren’t adopted, are enough of a threat that schools are scared away from offering adequate abortion training, she said.
“In states with legislatures that are hostile to abortion, the knowledge, the ever-present reality that if you partner with an abortion provider for education and training, you might be punished — that is an intentional threat being put out there and it’s very hard for universities not to respond to it,” Merritt said.
And without training in abortion, some states struggle to find enough providers.
“Without a provider pipeline, abortion is a right in name only,” Merritt said.
In 2020, the Guttmacher Institute characterized Vermont as a state that “leans supportive” in regard to abortion rights. With Proposal 5 making its way through the Legislature this session, on its way to voters next November, the state could become the first to make the right to “reproductive liberty” part of the state constitution.
The Vermont Legislature has never seriously considered any proposals that would limit abortion access in the state.
“I always use Vermont as a highlight of a state where we don’t restrict access to abortion in the ways that other states do, and by us codifying it, it really lends support not only to providers but to patients,” MacAfee said.
Even so, MacAfee said, UVM has no current plans to expand its abortion training program.
Gregory-Davis would like to see more emphasis on the complicated sociopolitical climate surrounding abortion, but feels pretty good about what UVM offers students now — especially compared to other states.
“In Vermont, I’ve been very fortunate and felt supported. People in general have been like, ‘Yeah, we should learn about that,’ ” Gregory-Davis said.
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