Abortion: Quality Care and Public Health Implications

Abortion is a common experience for reproductive-aged women around the world.  In the US, half of all pregnancies are unintended and half of these end in abortion. (Finer 2013) Around the world, 43.8 million abortions were done in 2008 representing one fifth of all pregnancies. (Sedgh 2012)  Abortion is safe and has lower morbidity and mortality than childbirth when carried out by trained practitioners in sanitary conditions (Raymond 2012), but nearly half of the abortions done in the world are unsafe, according to the WHO definition.

Despite its universality, abortion remains controversial and inaccessible for many women. Both the clinical and public health contexts of abortion are often excluded from curricula in medicine, nursing, and other health professions. Restrictions at the hospital or clinic level, and conscientious objection at the provider level compounded with legal restrictions further reduce women’s access to services. 

In this six-week course, over twenty faculty from various institutions and multiple disciplines will place abortion within the context of public health and fill in the gaps left by its exclusion from mainstream curricula in health professions. Each week’s lectures will incorporate the stories of women who seek abortion in order to better portray abortion significance and rationale.  Other topics will include a brief history of abortion, the clinical aspects of medication and procedural abortions in and after the first trimester, an overview of patient-centered abortion-care, the basics of abortion counseling, the professional obligations of health care practitioners to ensure that women have access to safe abortion care, and the maze of restrictions that make safe abortion care inaccessible to many women. 

In addition to video lectures, there will be weekly quizzes, peer assessments, and optional additional content and reading for learners who want to explore the topic further.  

WEEK 1: Abortion in the U.S. And Around the World

• Introduction to the public-health framework of this course
  
• Who has abortions, why, and how do they access care
  
• History of abortion and abortion stigma
  

WEEK 2: Abortion, Professionalism, and Patient-Centered Counseling

• Principles of pregnancy options counseling, abortion counseling, and informed consent
  
• Abortion in the United States after legalization
  
• Professional responsibilities around abortion care
  
• Values clarification about abortion care
  
• Conscientious provision and refusal in abortion care
  

WEEK 3: Abortion in the First Trimester

• Clinical aspects of medication abortion, aspiration abortion, post-abortion contraception, and pain management for abortion
• Legislative and policy obstacles to abortion access
  

WEEK 4: Abortion after the First Trimester: Obstacles to Accessing Safe Abortion in the U.S. And Worldwide

• Who has abortions after the first trimester and how do they access care
  
• Clinical aspects of abortion after the first trimester
  
• Role of patient preference in appropriate care
  
• Guidelines for safe abortion care and the principles of high-quality abortion care across settings
• Complications and myths about abortion
  

WEEK 5: Overcoming Obstacles to Abortion Access

• Sociology of abortion especially related to health and health-care disparities
  
• Impact of obstacles on clinical care
  
• Importance of abortion training for health professionals
  

WEEK 6: Early Pregnancy Loss and Course Conclusions

• Patient-centered care for early pregnancy loss
  
• Counseling and decision making for early pregnancy loss
  
• Relationship between early pregnancy loss care and abortion care
  
• Course conclusions