For the first time ever, an American university is offering a dedicated online course on abortion.
Starting on October 13th, the University of California, San Francisco (UCSF) will offer a six-week class called “Abortion: Quality Care and Public Health Implications” through the online course platform Coursera. Operating primarily in a public health framework, the course will address patient-centered abortion care both during and after the first trimester before proceeding to examine obstacles to safe abortions and abortion access worldwide.
Given the current proliferation of massive open online courses (MOOCs), this course would hardly be noteworthy if not for the fact that abortion education in U.S. medical schools and public health programs in the United States is still in lackluster shape. While the Guttmacher Institute estimates that 30 percent of American women will have an abortion by the age of 45, a 2005 review of U.S. medical school curricula on abortion revealed that less than a third of schools include a single lecture focused on abortion during the clinical years. A 2009 survey also found that a full third of North American medical schools do not include abortion education in preclinical courses either.
And the discipline of public health, as a committee from the American College of Obstetricians and Gynecologists observes, has traditionally focused on “reducing the frequency of unintended pregnancy” in their approach to abortion, a stance that matches American sex education’s focus on abstinence over safe sex practices in both its idealism and its implicit moralism. Public health’s approach to abortion has shifted over the years with many prominent figures in the discipline now emphasizing legal access to safe abortions worldwide, but public health curricula at many U.S. schools still tend to relegate abortion to a single unit or lecture within a course.
Residency training in obstetrics and gynecology fares slightly better with the Accreditation Council for Graduate Medical Education mandating that “access to experience with induced abortion must be part of residency education.” Even so, these requirements leave plenty of loopholes: residents with “religious or moral objections” are permitted to opt out and institutions themselves may opt out as well, referring residents interested in abortion care to an outside institution instead. As a result, nearly a quarter of U.S. ob-gyn clerkships do not include abortion training.
By creating an entire online course that exclusively addresses abortion, Dr. Jody Steinauer, an Associate Professor in Obstetrics, Gynecology and Reproductive Sciences at UCSF, is hoping to give the subject the sort of in-depth treatment it may not otherwise receive in a traditional classroom, even in ob-gyn training. Steinauer has a long history of advocating for change in abortion education from within medical institutions themselves. As a student, she founded Medical Students for Choice, a non-profit organization that advocates for the inclusion of abortion in medical school curricula. She currently serves as the Director of Innovating Education in Reproductive Health, which provides abortion and family planning resources for clinicians.
In a phone interview, Dr. Steinauer said she believes that there are “two reasons” for the resistance she has encountered in her efforts to promote abortion education. First, she notes that “stigma about abortion prevents abortion from being discussed” despite the fact it is a common medical procedure. In an effect that some scholars have described as “the prevalence paradox,” the silence that results from this stigma leads people to “believe that [abortion] is not common,” thereby providing a false justification for its omission from courses and trainings. In other words, people tend to assume that abortions are infrequent simply because they are rarely discussed, in what amounts to a self-perpetuating cycle of silence and unchecked assumptions. Second, Steinauer says that the subject of abortion “sometimes makes people feel emotional” to such an extent that it “probably feels safer for professors and education leaders to not talk about it.”
Steinauer’s own approach to abortion education stresses two inevitabilities that she believes must be loudly acknowledged and accepted before meaningful education can take place: “Unintended pregnancies happen and women will access abortion.” In light of these facts, she defines her pedagogical priorities through a series of questions: “How can we, as a community that cares about women, help to decrease morbidity and mortality from unsafe abortions? How can we make abortions safer? How can we make them more accessible?” But she also emphasizes that her course will factor in the time that it might take people to consider these questions in light of the heightened emotions that crop up around discussions of abortion. The course will encourage students, she says, to “really reflect on your feelings about abortion... and then, take time to think about how you can best serve your community.” One assignment will ask students to “write about their feelings about abortion and how they should manage them.”
Steinauer’s decision to take her style of abortion education to the Internet, in particular, is especially intriguing in light of the polemical attitudes that surround the MOOC format in higher education. Academic commentators on The Chronicle of Higher Education and other academic publications frequently exhibit an agonistic relationship with MOOCs, worrying over their effectiveness, their place in the modern university, and their effects on accreditation systems.
But a stigmatized subject like abortion that barely receives adequate coverage at elite institutions could stand to benefit from an online format, providing educators like Steinauer with the flexibility, freedom, and time that teaching a controversial but important subject like abortion requires. Where medical, nursing, and public health curricula include a token lecture on abortion, Steinauer will be able to use the MOOC form to include a number of lectures on the topic from faculty across multiple disciplines. And when other institutions opt for silence in the face of abortion stigma, an extended and digitally-mediated conversation about abortion may be able to push past the institutional hesitation that too often lead to its total omission from classroom syllabi.
Steinauer stresses that teaching the course online will allow her to reach not only U.S. students who might not have access to abortion education at their home institutions due to cultural stigma, but a “global audience of learners” as well. MOOCs do indeed have an asymmetrically international reach and Steinauer is encouraged by the fact that “only about half” of those who tend to enroll in UCSF’s online health-related courses are from the U.S. Considering the fact that around 13 percent of all maternal deaths worldwide are due to unsafe abortion, Steinauer believes that a global reach for abortion education is crucial.
When asked how she feels about paving the way for abortion education on the Internet, Steinauer was quick to relay her enthusiasm. “I think that if we can inspire even a small portion of the people who take the course to take steps in their communities to increase access to safe abortion and decrease stigma about abortion, then we have been totally successful,” she said. And when prompted to discuss the pushback she might experience as a public educator in this contested space, Steinauer noted that UCSF is “100 percent supportive of the course and feels that it’s critical learning content for all medical students and nursing students.” She estimated that over 3,000 people have already enrolled for the course.
While nearly a third of women will have an abortion by age 45, abortion care remains locked behind often insurmountable barriers to access, including prohibitive state laws, waiting periods, and insurance requirements. At the root of these barriers to access is a U.S. educational system that ignores the frequency of abortion, producing health care providers who have no formal training in abortion care. By frequency alone, this would be about as unacceptable as a general practitioner not being able to treat a urinary tract infection, a condition that affects one in five women. If stigma continues to stymie efforts to require abortion training for healthcare professionals, Dr. Steinauer might be right to move some of her educational efforts online. The Internet could be exactly what abortion education needs to move forward in the 21st century.