When it comes to abortion, do medical schools need to smarten up?

Why do Canada’s medical schools avoid the subject of abortion?

Thirty-one per cent of Canadian women under 45 have had an abortion — yet many schools simply won’t teach it.

(Erik Putz)

(Erik Putz)

Nina Nguyen, a third-year medical student at Quebec’s Université de Sherbrooke, has spent precisely 35 minutes learning about abortion in school — and all from a single case study she read in an ethics class. “It was about a 32-year-old woman who comes in to your office. She’s six weeks’ pregnant, she’s really nervous, and she wants an abortion because she’s in an abusive relationship,” Nguyen says. Students were asked a series of questions: What concerns you about the patient? What are the ethical values and principles in conflict? And what’s your personal stand on abortion? “That’s it,” she says. “Some groups only talked for 20 minutes.” Her class did, however, devote six hours of their obstetrics-gynecology unit to male anatomy and erectile dysfunction, working diligently through the physiology, statistics and potential treatments for the condition.

During Anjali Kulkarni’s second year of medical school at the University of Toronto (U of T), she also met once with a small group of classmates to discuss the ethics surrounding abortion. “We’d had a talk from a lawyer who gave a good history of abortion law in Canada,” she says, but the hypothetical cases they were then asked to review all concerned pregnant women suffering from rare diseases or issues of fetal anomalies. “There was nothing in it that was ‘A woman is pregnant and doesn’t want to be; what do you do?’ ” she says, nor was there any medical information.

Related reading: A new kind of mid-life crisis: Unwanted pregnancies

Since 1988, when the Supreme Court struck down Canada’s abortion law — calling it a violation of a woman’s right to “life, liberty and security of the person” — abortion has, on paper at least, been governed by the same regulations as any other medical procedure in this country. Yet more than 25 years later, medical schools still tiptoe around the subject in the classroom. Despite the Supreme Court’s ruling, abortion remains a polarizing issue in the medical community; providers fear for their safety, and students struggle to find out where faculty members stand. Too often, it’s easier to simply avoid the subject altogether. Because there is no standardized curriculum for any medical discipline, by the mid-2000s, only half of Canada’s 17 medical schools offered some discussion about first-trimester surgical-abortion techniques. A recent study published in the journal Contraception found that in a third of schools, abortion isn’t raised in mandatory lectures at all.

That’s a patchwork approach to educating medical students about an enormously common procedure: Thirty-one percent of Canadian women under the age of 45 have terminated a pregnancy. In 2011 alone, the most recent year for which data is available, 92,524 abortions were reported. It’s safe to expect, then, that every physician in every discipline will encounter a patient who has had or is seeking an abortion. Women’s health specialists shouldn’t be the only ones getting training — all physicians ought to have a basic understanding of the procedure and its implications. This wouldn’t mean they’d have to perform one, since the Canadian Medical Association allows for conscientious objection. But the choice to terminate an unwanted pregnancy belongs to a woman alone. Once she makes that choice, she is entitled to a safe, timely and confidential abortion. That’s not a question of values: In Canada, it is a matter of law.

Related reading: Colby Cosh: ‘The law should stay the hell away from abortion’ 

Still, the distribution of providers across this country is abysmal, especially outside our largest urban centres, where free-standing clinics — which perform some 57 percent of abortions — are predominantly located. Roughly one in six hospitals offers abortion services, nearly all of them concentrated within 150 km of the U.S. border. In July, New Brunswick’s sole private clinic closed, leaving two hospitals, and no more than four gynecologists, to provide all the province’s abortions. (Last Friday, however, it was announced that a new medical centre offering abortions would open in the old Fredericton clinic, after a crowdfunding campaign raised more than $125,000.) Women in the Yukon, Northwest Territories and Nunavut can have the procedure in just three hospitals. While Quebec has 46 abortion facilities, the Prairies combined have eight. Prince Edward Island has no provider at all. As a result, Canadian women in rural or remote areas often must travel great distances, out of pocket, to access an essential element of their reproductive care.

In many cases, medical schools have done little to help normalize what is, in this country, a very normal procedure. “Schools are not keen to court anything they perceive as controversial,” says Dr. Mei-Ling Wiedmeyer, a Vancouver-based family physician who graduated from Montreal’s McGill University in 2008 and completed a women’s health fellowship at U of T. “Medical schools as institutions are not typically brave. And it shouldn’t require any bravery, because abortion is a legal medical procedure that is clearly within their purview.”

When formal instruction falls short, it’s left to small groups of self-motivated students to educate themselves. An organization called Medical Students for Choice, which was founded in the U.S. in 1993 and now has chapters in 10 of Canada’s 17 schools, has been instrumental in pushing for curriculum reform, clinical electives and apprenticeships. Individual young men and women are also finding ways to arm themselves with knowledge, coordinating lunchtime lectures with abortion providers and arranging volunteer work in family-planning centres. “There are a lot of myths and misinformation about abortion and its complications out there,” says Kulkarni. “We need the raw data.”

Read the rest of the feature on Chatelaine.


Why do Canada’s medical schools avoid the subject of abortion?

  1. The heavy hand of religion overriding science again, that’s why….

    Do it properly

    • http://www.morgentaler.ca/contact_stjohns.html

      You think the “heavy hand of religion is overriding science” at the Morgentaler Clinic? Maybe they don’t get a lot of training about abortion in med school but I bet they get some opportunities to meet it head on during their practicums (residencies).

  2. “Once she makes that choice, she is entitled to a safe, timely and confidential abortion. That’s not a question of values: In Canada, it is a matter of law.”

    Not exactly. We don’t have a law on abortion, remember? “Since 1988, when the Supreme Court struck down Canada’s abortion law…”

    Apparently, the med schools are as afraid of the issue as the politicians are.

  3. Why do Canada’s medical schools avoid the subject of abortion?
    Because physicians know what it really is, or rather who that really is. Medical students are knowledgeable of fetal development – a 100 level anatomy course is enough to show you that the pre-born are indeed human. Abortions aren’t happening to zygotes, or ‘clumps of cells’.Abortion procedures happen in the embryonic and fetal stages of development. Most abortions in Canada occur after 8 weeks of pregnancy.

    Between four and six weeks after a woman’s last menstrual period, and only 2-4 weeks after conception, the external appearance of the developing human is a flexed, C-shaped body, with arm and leg buds present, and the head at right angle to the body. The measurement from head to bottom is 0.4 to 0.5 cm. The stomach, liver, esophagus, and intestinal beginnings are able to be recognized. The heart is developing, double chambers are visible, it begins to beat, and the aortic arch and major veins are completed. Primary lung buds appear, and the beginnings of eye, the ear, and even the urinary system are present. In these early weeks of pregnancy the mother will often find out that she is pregnant, as she will miss her monthly period, and at 2 weeks past conception a home pregnancy test will turn positive.

    By the time a month has passed (at 8-10 weeks of pregnancy, or 6-8 weeks after conception) the developing baby’s body is fairly well formed, the fingers are well formed, the head is elevating, and the eyes, ears, nose, and mouth are recognizable. Baby measures about 2.5 to 3 cm from head to bottom, and weighs about 2 grams. Different bones are becoming distinguishable and even at this early stage the fetus becomes capable of some movement, as by the 7th week muscles are contracting spontaneously. The main blood vessels of the heart are assuming their final plan, and there is more differentiation in the parts of the brain. Also at this time testes, if baby is a boy, and ovaries, if baby is a girl, are distinguishable internally and the external genitalia are beginning to differentiate.

    By 12 weeks of pregnancy (10 weeks after conception), the baby has the recognizable shape of a newborn, with its head erect but disproportionately large, and his/her skin pink and delicate. (End of summary – Source: Maternal Child Nursing Care – a textbook used in the nursing program at the UofA)
    Medical science certainly shows us that the pre-born are human. Sadly this is a truth some will simply not accept. According to the University of Ottawa, approximately 100,000 abortions occur in Canada each year. Let’s stop lying to women about fetal development – let’s empower them by providing support for those facing unplanned pregnancies, streamlining adoption services, and supporting foster children and parents.

    • Thanks for the riveting review of the biology lesson that anyone who ever had a sex-ed class is familiar with . Frankly, if the fetus/child/zygote cannot survive outside of the mother, than that being/biological mass/thing is under her control. If she does not want something growing inside her, be it because of contraception failure, rape, fetal health conditions or personal choice, it is her decision and the Canadian government lets it be her own decision because it is her own body. A women’s body is no one’s concern but her own and her doctor’s. You are free to disagree with abortion and not choose it for yourself – I am obviously pro choice but at this point in my life I would continue with an unplanned pregnancy – but it is not your right or the right of the government to force all women to give up the option of choice.

      Getting back to the article subject, perhaps all of these later-term abortions you are referencing are necessary because a Canadian women living outside of a major city must travel at her own expense and take time off of work to travel to one of the few qualified doctors available to perform this essential medical service.

      • Can the same be said of my toddler then? She can’t survive without me either, so is her life ‘under my control’? What changed from 5 weeks past conception when I first saw her via ultrasound, to now at 3 years? Back then you would have me believe my right to my own body was more important than her right to grow up. But I’m certain you wouldn’t say the same now. Can you objectively tell me what exact age or characteristic should be met in order for a person to be recognized as human and worthy of their rights as such?

  4. Toss the religious crap, and do the procedure properly.

  5. Obviously all good thinking people believe women have the right to have unprotected sex, conceive a child, and then have an abortion to erase those consequences. A women shouldnt be forced to become a parent against her will.

    Also obviously, all good thinking people believe that men and women should have equal rights.

    It follows that men should also be able to have unprotected sex, conceive a child and not be burdened by parenthood should the mother choose to carry the child to term.

    Since Im told constantly, feminism is about equality (according to the dictionary), Im sure feminists will support men’s right to opt out of fatherhood and not have to pay child support for an unwanted child. The current situation, where a woman becomes entitled to a man’s labour for 18 years by the exercise of her choice is very much unequal.

    • Men have always opted out of fatherhood. Many of them never grow up and take responsibility for their actions.

      • But courts can condemn men to 18 years of child support just for having sex. This is a legal question, not a historical or moral question.

        If sex is not consent to parenthood for women, equality requires that sex is not consent to parenthood for men either.

        If a women cant be forced to be pregnant for 9 months, a man should not be forced to pay child support for 18 years.

        It’s also a question of bodily autonomy. Paying child support for 18 years requires labour, and labour implies using your body to perform a task. If a women’s body is hers to control, then a man’s body should be his to control, including how the fruits of his labour is spent.

        Her choice, her responsibility.

        • You were there for the fun, but you don’t want to be there for raising your own child?

          Are you responsible for anything in your life?

          • This is not about me. I have 2 kids and a 3d on the way. I love them more than anything else in the world.

            This is about the law and about equality. If you support a women’s right to an abortion, why dont you support a man’s right to not pay child support?

            Do you shame women who have abortion with such vile pro-life nonsense such as “You were there for the fun, but you don’t want to be there for raising your own child?”, or do you just say that to men?

        • Then don’t sound like a teenage idiot!

          Abortion is a medical procedure….and doesn’t require ‘support’ anymore than a heart bypass does.

          Don’t confuse your religion with science.

          • Abortion is a medical procedure….and doesn’t require ‘support’ anymore than a heart bypass does.

            Of course it does. That’s why this article is all about drumming up support for it. If people dont support it, it doesnt happen, whether it’s a medical procedure or not.

            Im in favour of abortion, I just want the equivalent right for men. I have no religion and I am pro-choice, for women, and for men also.

            It’s you who is shaming people with pro-life language like “You were there for the fun, but you don’t want to be there for raising your own child?”. What’s up with that? Are you not pro-choice? Are you pro-choice for women only?

        • I hate to disagree but I believe men are also responsible to assist in the post-secondary education of the child. Therefore, it is more than 18 years of financial responsibility you are looking at. Now, if you don’t have the resources, you cannot be made to pay. Also, if the mother has far more resources than the father, likely you won’t. be made to pay very much.

        • The majority of Canadians not only back ‘choice’, it’s protected by the constitution.

          Get over it.

  6. Parts of this article are definitely misleading. When it points out how few hospitals offer abortion services, it doesn’t explain that the hospitals divide up specialties so that all of the heart surgeries are done at one hospital in a major center and all of the urinary surgeries are done at another hospital. All of the neurological surgeries are done at one hospital and all abortions are done at one hospital. It doesn’t mean the services are lacking, it means they have designated one site to deliver the service. It has NOTHING to do with religion as it is a “no questions asked” service. One can refer oneself.

    • The article pointed out they don’t teach the procedure properly….or say much about it.

      THAT is religion entering into it.

      • If they’re not teaching the procedure because most doctors do not agree with abortion, perhaps it’s their morality entering into it.
        Each person holds to a religion of their own – be that secular humanism, Christianity, atheism, Buddhism, etc., so lumping this as a problem of ‘religion’ isn’t very helpful.
        Clearly the pre-born are human beings and their lives should be respected as such.

        • Do stop with the nonsense.

          • Well, tell me why the pre-born aren’t human then, why they shouldn’t be protected?

          • Stop trying to force your beliefs on others.

          • Emilyone, What really is your pro-abortion position based on? Are you able to defend your position – responding to the obvious facts of the personhood and humanity of the pre-born? The “my right, my body” argument rings hollow in light of the humanity of the pre-born (What about their body and their rights?)