Abortion is essential health care, and abortion training and education are essential at all levels of medical education. Among the most common procedures performed in obstetrics and gynecology (OB/GYN), abortion is a core competency for OB/GYN residency programs. For nearly 50 years, the procedure was federally protected by the U.S. Supreme Court’s January 22, 1973, Roe v Wade decision. On June 24, 2022, amidst increasing state restrictions limiting abortion access, the Court’s decision on Dobbs v Jackson Women’s Health Organization effectively reversed Roe. As a result, immediate bans on abortion went into effect across the country, removing access to abortion for millions of people and newly limiting training and education in this core competency for many medical residents. As of June 2022, nearly half of U.S. OB/GYN residency programs and more than 40% of residents are located in states that have banned or are likely to ban abortion. In states where abortion is restricted or illegal, states must adapt quickly to ensure their residents meet training requirements. This adaptation may include developing and leveraging relationships with programs in states where access is protected, depending on simulation, and placing greater emphasis on education and training in pregnancy loss management and postabortion care. None of these is a comprehensive solution and even all together, they are insufficient to train residents and medical students. Ultimately, many future physicians will not receive the training they need to provide full reproductive health care to their pregnant patients. Legal and other systems of support are needed to ensure that current and future physicians can provide compassionate, evidence-based reproductive health care, including essential abortion care.
INTRODUCTION: We compared the prevalence of contraceptive use by 12 weeks postpartum among women who participated in group prenatal care (GPC) vs. traditional prenatal care (TPC) and investigated differences in contraceptive method choice by type of prenatal care. METHODS: We performed a retrospective review of patients who received GPC or TPC and followed up within 12 weeks of delivery, between January 1 and December 31, 2017, at our institution, after receiving IRB approval. Postpartum contraceptive methods were analyzed by effectiveness (Tier 1, long-acting reversible contraception and sterilization; Tier 2, hormonal methods; Tier 3, barrier and fertility awareness methods, withdrawal, spermicide; and no method) using Chi-square and multivariate logistic regression. RESULTS: 122 participants in GPC and 121 in TPC were included. The prevalence of any contraceptive use by 12 weeks postpartum was 70.5% and 68.6% for GPC and TPC, respectively (P=.75). After controlling for demographic and clinical factors, there was no difference in Tier 1 versus other contraceptive use (aOR 0.92, 95% CI 0.81-1.07, P=.31). Participants in GPC were significantly more likely to select Tier 2 contraceptive methods (aOR 1.19, 95% CI 1.03-1.36, P=.02), and attendance at each additional GPC visit increased the odds of selecting a Tier 2 method (aOR 1.02, 95% CI 1.00-1.04, P=.03). CONCLUSION: There was no difference in the prevalence of contraceptive use at 12 weeks postpartum among women who received group compared to traditional prenatal care in this study. Participation in GPC was associated with increased use of Tier 2 contraceptive methods in a dose-dependent fashion, regardless of sociodemographics.
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