PARTIAL PARTICIPATION or OPT-OUT CURRICULUM

This curriculum is designed to help trainees achieve their individualized learning objectives in reproductive health care. Not everyone will be able to train or go on to provide abortion care, nor does everyone live in a state or country where they can legally provide abortion care. However, it is important that all primary care clinicians become familiar with the services their patients seek. Benefits commonly reported by partial participants who opt out of abortion training include improved counseling skills, gynecologic procedural and ultrasound exposure, and reflection on individual values (Steinauer 2014).

Professional organizations such as the AAFP, ACOG, ACNM, and NONPF recommend that trainees receive exposure to many core skills covered in this curriculum, including:

• Evaluation of pregnancy dating and risk, and provision of pregnancy options counseling
• Management of uncomplicated early pregnancy loss
• Contraceptive counseling and provision, including IUD and implant placement and removal
• Uterine aspiration (considered advanced training by professional organizations of Family Medicine, Ob/Gyn, Nurse-Midwives, WH Nurse Practitioners).

After orientation and values exploration, trainees benefit from discussing options with their faculty to arrive at a balanced appraisal of appropriate training content. The alternative or opt-out curriculum recommendation below is for partial participants to cover the foundation of values exploration, options counseling, contraception, follow-up care, complication management, and early pregnancy loss, with additional material as desired.

For trainees in states with abortion restrictions and bans, inability to receive abortion training may be an unavoidable reality. As of December 2022, 14% of U.S. obstetrics and gynecology residency programs previously offering in-state abortion training lost access following Dobbs (Vinekar 2023). Nearly half of programs in states where abortion remains legal still lack routine abortion training, limiting opportunities even where laws allow it (Beshar 2024). These restrictions affect abortion provision, clinical care, public health, and professional training in ways we are only beginning to understand.

At the same time, history shows that limitations on care can lead to innovation (DoCampo 2025), such as the transition to medication abortion during the pandemic. This moment calls on us to think critically about how we practice, ensuring that we continue to provide person-centered, values-driven care even within restrictive environments. Trainees can play a vital role in supporting people, sharing knowledge, advocating for reproductive health, and finding creative ways to navigate the systems available. The need for skilled, compassionate clinicians has never been greater, and the impact of this work extends far beyond procedural training. Together, we can build a resilient, adaptable care network committed to individual autonomy and reproductive freedom, no matter where we practice.