The Complex Family Planning training program aims to expand training in a field that was already lacking adequate available services, said Dr. Erica Cahill, Stanford University Medicine assistant program director for the fellowship. Complex family planning includes birth control options, unintended and abnormal pregnancies, contraception for people with complex medical issues, difficult IUD/Implant insertion and removal, and abortion care.
"At all levels, we're trying to increase our ability to have more learners from restrictive states," Cahill said.
Depending on the year, up to 12 students will be able to train in a four-week rotation — up from the current six students per rotation. Stanford medical students have priority, and visiting students are admitted if there's no Stanford student interested in an opening, she said. The program is receiving much attention from out-of-state students, but that's been the case for a long time, Cahill said.
Governmental restrictions on abortion aren't the only reasons students are attending, she said.
"We've had students come even from not restrictive states that just have a program that's run by a religious hospital, or something where they're not able to get abortion training ... but I would say more commonly, it is from restrictive states," she said. "We've been increasingly getting, in the past year, more people reaching out to us from programs in Texas, for sure."
Not having enough trained medical personnel in abortion and complex family planning is "a huge threat to the health of pregnant people and women's health, and it has been for a long time," Cahill said.
"Caring for people with complications in early pregnancy is something that happens every day in OB-GYN, and so not having the skills or tools or knowledge is terrible for a provider," she said.
The decision to have a baby — or not — is complicated, weighing on many factors in one's life, she said. There are also many complications out of the control of what the person wants that lead to an abortion being necessary during pregnancy, she said.
"There's a lot of challenges in interpretation of these (abortion) rules about whether or not we can provide standard of care treatment for miscarriage, standard of care treatment for ectopic pregnancy, standard of care treatment for molar pregnancy — like all of these things that are perhaps on a spectrum of care of first-trimester pregnancy care — that all are linked in medicine. You can't piece them out from each other," she said.
Cahill also sees a flip side to the Supreme Court's abortion decision that offers a glimmer of hope.
"At Stanford, our emergency medicine colleagues, our family medicine colleagues, our pediatricians, our anesthesiologists are all thinking more about how they can help support abortion care and pregnancy-related care in different ways.
"And I think we're seeing that across the country, as people are not going to be able to receive standard of care for miscarriage, abortion or pregnancy complications by their OB-GYN," she said. "They're going to get that care in the emergency room. And so our emergency medicine colleagues are adapting quickly ... to still keep people safe when they're seeing complications that would ordinarily be avoided by routine standard of OB-GYN care."
Cahill said it's important to note that abortion is safe and legal in California, and there also are many places where people are accessing nonsurgical medication abortion by pill.