7th Edition Prologue

We stand in a maelstrom of forces informing the 7th Edition TEACH Curriculum at this time in history: a full-scale assualt on abortion legality as Roe v. Wade is gutted, social movements for equity long overdue, and global pandemic lessons lived and learned.

In spite of a two decade global trend toward liberalized abortion laws, the U.S. is experiencing a starkly different reality. Nearly 50 years of federal constitutional abortion protections have come to an end, triggering states to ban and criminalize abortion. The Curriculum Working Group has made myriad changes to meet this moment, as the community rapidly rearranges to continue caring for patients, no matter what, in the face of this blow. The evidence is clear that people denied an abortion face worse financial, health and family outcomes for years to come. For those living in states in the South and Midwest, “post-Roe” restrictions were long a reality, with many states including no exceptions for rape, incest, or to save a pregnant person’s life. People will travel farther, spend more, face criminal penalties or forced births. Not surprisingly, these laws most impact those with fewer resources, people of color, people with disabilities, undocumented people, and gender diverse people – further reinforcing systemic oppression.

We approach Self-Managed Abortion (SMA) in more depth in this Edition, and through a person-centered lens, as a valid and necessary option that some, but not all individuals come to by choice. We focus specifically on self-managed medication abortion (SMMA) due to its safety, efficacy, and our knowledge of it in the medical community. Acknowledging the long history of community and indigenous providers of SMA, we expect knowledge on all SMA forms will grow. As abortion care evolves to fit this social and political landscape, we hope to train providers to support patients with all safe abortion management options, uplifting and centering the complex circumstances of patients’ lives.

TEACH, like many organizations, also reflected on its own personal and structural biases and committed to taking steps to dismantle racist power structures during this period. Guided by reproductive justice advocates, TEACH developed an antiracist strategic realignment footprint for moving forward to diversify, better mentor those we train, and better reflect the communities of providers and patients we serve. This commitment guides this and future Editions.

The pandemic also provided many lessons since the last Edition – pivoting practice models to require less in-person contact via telemedicine and remote follow-up. We have added significant material to help providers streamline and eliminate unnecessary steps in diagnosis, care and follow-up.

Lastly, we want to mark the collective nature and evolution of this Curriculum. Starting from an internally developed workbook for our own trainees, it has grown to an online open-access textbook downloaded for use in all 50 U.S. states and over 100 countries. We are pleased it has been instrumental for many trainees in learning to provide services to underserved rural, urban, and global communities. We could not be more thrilled to have two new Co-Editors at the helm who will be taking the Curriculum into the future. Through its development over 2 decades and 7 Editions, the work of so many people – 6 Co-Editors, 50 Co-Authors (Faculty, Fellowship and Program Directors, Fellows, Training Specialists, and Residents), and well over 100 Advisory Members – can still be traced in these pages. With each version, the Curriculum has become more representative and inclusive of our mission and larger community, and for this we are grateful and proud.

This Curriculum provides many ways to support reproductive autonomy. We hope users will better counsel, destigmatize, date, refer, manage, provide, advocate, and/or train future providers and leaders. But no matter the scope, we hope every user walks away with the knowledge and skills to support people in achieving equitable access to sexual and reproductive health care. As our community bands together to find creative means to care for our patients and each other, we hope this Curriculum serves as a resource in those efforts, and as a source of inspiration and motivation. As Roe falls, we will rise.

Suzan Goodman MD, MPH

Montida Fleming, MD

Grace Shih MD, MAS