A Medical Community in Moral Conflict

"[These findings are] a bit depressing."
"We have 66 residents a year in family medicine and a number of them come to me saying, 'I really want to become [an abortion] provider. Help me find somewhere to do the training'. And they can't get anywhere to do it."
"[Medical education now avoids abortion techniques, conservative/religious faculty members in fear of pressure] from a very small but vocal group of students that believes abortion is killing and we shouldn't be teaching it, we shouldn't be condoning it and we shouldn't be doing it."
"The [medical] schools have perhaps capitulated, or seen that it is better to just be a bit quiet about this."
Dr. Susan Phillips, professor, family medicine and public health sciences, Queen's University, Kingston, Ontario

"The majority of family medicine residents do not feel competent to provide abortion services."
"[Medical schools] should focus on normalizing [abortion training, while respecting the right to opt out]."
Survey study, journal BMC Medical Education

"We believe that if you make abortion something that is part of the scope of family medicine training, while respecting people's rights ... you remove a lot of the stigma and you make people more likely to get exposed."
"These are essential -- not 'niche' -- competencies. We need to have the current generation of family physicians graduating and being, at a minimum, able to counsel and speak with women on this topic."
Dr. Daniel Myran, family physician, Study lead author

Eighty per cent of respondents in Canada received less than one hour of formal education on abortion. Getty Images/iStockphoto

There are no legal restrictions on abortion in Canada. There are also no legal guidelines enacted into law with respect to abortion, although abortion is freely available throughout most of Canada with few exceptions. Most Canadians are in agreement that abortion availability represents a woman's right to choose whether she is prepared to carry a pregnancy to full term for any reason whatever. And among those in support of medical abortions many believe there should be a cut-off date commensurate with that time when a fetus passes the stage of viability.

An estimated one in three women in Canada will have an abortion at some point in her life. Family physicians perform the majority of pregnancy cessation procedures and only medical doctors are licensed to provide abortions (76 percent of the 86,824 reported abortions in 2014-15 were performed by family doctors). A new study has come to the conclusion that there is a shrinking pool of abortion providers willing to undertake the procedure. Leading to the obvious realization that there is a need for graduating physicians to replace them, with proper training.

Approximately one in three Canadian women will have an abortion in her lifetime.   Fotolia

The study reached out in a survey of family medicine residents throughout Canada. The researchers in studying the responses from family physicians ascertained that 88 percent of respondents were exposed to less than a single hour of formal education on abortion specifically during their medical training. This, while 79 percent had never during their medical training had the opportunity to observe or assist in an abortion procedure. Professor Phillips outlines a number of issues at play in this stepping back of acknowledging the need to ensure that graduating physicians are competent in abortion procedures.

She places responsibility for this serious deficit on what she points out is a new era of "accommodation -- putting accommodation of the individual learner or teacher ahead of publicly held values and standards". The Supreme Court of Canada in 1988 struck down what it ruled to be overly restrictive laws when it decriminalized abortion. Despite which, all these years later, barriers remain firmly in place, inclusive of a reaction by doctors in rural areas and some provinces due to "ongoing stigma toward abortion provisions", as the study authors point out.

Eight medical schools outside the Maritimes and Quebec aided in distributing an anonymous online survey produced by the researchers, reaching a wide audience of medical practitioners. Of the tens of thousands of doctors receiving the online survey, a total of 436 family medicine residents responded, 21 percent of whom reported having been exposed to one or more abortions during residency, while 57 percent claimed to have had no formal education on abortion whatever. Of the residents surveyed, 61 percent were in support of more abortion training to be available to residents.

The newly introduced drug Mifegymiso, an abortion pill, was made legal for prescription use in Canada last year, after the survey was conducted. The new drug can be prescribed up to nine weeks, "And it doesn't detract from the clear need for an approach to offering abortion training as a core aspect of family medicine", remarked Dr. Wendy Norman, a leading researcher in reproductive health at the University of British Columbia.

Abortion does not appear on the list of 99 priority topics to be taught established by the College of Family Physicians of Canada, the body responsible for setting training standards. The results of the survey, however, has led the College to re-examine its lack of recognition of abortion procedures as a must-have skill and is now prepared to look at "how to enhance abortion education in family medicine education programs in Canada."