House Bill 465 is a new anti-abortion bill proposed earlier this month in the North Carolina House. It is a broad, sweeping bill that aims to increase waiting periods for women seeking abortion and to limit the type of health care professionals who can perform the procedure. Perhaps the most dangerous piece of the bill involves a clause that would ban abortions from being performed at UNC and ECU hospitals. If this bill becomes law, it would gravely threaten not only access to reproductive services for the women of North Carolina, but the education and training of medical students and residents across our state.
The UNC School of Medicine has a critically important mission of serving underserved populations. The hospital was founded with the goal of improving the health of ALL North Carolinians. This mission – serving the people of North Carolina – permeates the curriculum of the medical school and residency programs.
The Family Planning division at UNC has fully embraced the school’s mission of serving the underserved. Patients turn to UNC for the expertise of physicians with sub-specialty training in performing abortion procedures that are too complex for local clinics. Often these patients found out late in a desired pregnancy about a fetal anomaly or genetic condition that is incompatible with life. By the time these women reach UNC, they have often had to deal with not only a devastating diagnosis, but also a barrage of judgment and shame. However when they reach UNC, they are met by compassionate physicians who provide unbiased and empathetic care. It is the opportunity to work with these providers and patients, and witness the desperate need for trained professionals proficient in abortion procedures, that motivates medical students and residents to consider a career in which the provision of abortion is a key element. Without this exposure in our hospitals, the pipeline of potential providers will be drastically reduced.
Having this direct patient experience is paramount in creating the next generation of abortion providers. Trainees in the field know in the abstract about the shortage of abortion providers: 89% of US counties don’t have an abortion provider. Ninety-seven percent of OB/GYNs encounter patients seeking abortion care in their practice, while only 14% actually perform them. Fifty-seven percent of OB/GYN abortion providers are between the ages of 46-65 and nearing retirement. However, it is one thing to know these facts on paper, and quite another to meet the patients that these provider shortages affect. Having firsthand exposure to the range of abortion procedures, and realizing how relatively simple these procedures are, turns the abstract idea of being a provider into a concrete reality for students and residents.
Competitive applicants to OB/GYN training programs actively seek out opportunities for abortion training in their future residency programs. Faculty members at leading institutions have reported an uptick in interest from applicants on the specifics of guaranteeing abortion training in their curricula. For OB/GYN residency programs to be competitive, comprehensive reproductive services training is a necessary component. The Ryan and RHEDI programs are organizations that certify that residencies have comprehensive contraception and abortion training for OB/GYN and Family Medicine programs, respectively. Having this certification is considered a point of pride for the programs that qualify. The UNC OB/GYN residency program’s Ryan certification places it on par with other elite institutions of medicine in this country.
If House Bill 465 passes and becomes law, the countless North Carolina women who come to UNC will be left without any abortion access. It would also severely handicap the family planning division at UNC – a jewel of the department with a strong history of groundbreaking research that has led to improvements in patient safety. House Bill 465 would also directly harm the education of our medical students and residents. Exposing trainees to this patient experience and training residents in how to perform these procedures is absolutely vital to ensuring the continued supply of physicians who can provide comprehensive care to the women in North Carolina who so desperately need it. This bill is dangerous to the education of North Carolina doctors and to the women that our state hospitals serve so tirelessly.
Michelle Brown is a fourth year medical student at the UNC School of Medicine and past president of the UNC chapter of Medical Students for Choice.