We found that among UCLMS final year students, who had seven hours of abortion teaching integrated into their curriculum, a higher number (83%) were pro-choice than previous research which reported percentages as low as 16.3% in 2009 . Gleesen et al.  suggested that attitudes among medical professionals could be becoming more pro-choice and our findings support this. Similarly, a 2019 survey of Glasgow medical students showed that 83% identified as pro-choice following teaching based on the UCLMS materials . Over the last few years, there seems to be an ever-growing attitude shift among healthcare professionals towards accessible and safe abortion care with several professional bodies including the RCOG, the FSRH, the Royal College of General Practitioners, the Royal College of Nursing, the Royal College of Midwives and the British Medical Association all supporting the decriminalisation of abortion.
Overall, most students felt they received the right amount of abortion teaching and fewer wanted more compared to previous studies – 39% versus over 50% of students in Oldroyd’s study who felt they ‘had not received enough’ teaching . A similarly high number of students (96%) rated abortion teaching as important compared to previous studies (95% ) and, for UCLMS students, this was irrespective of whether they identified as pro-choice or pro-life. Students’ positive responses to the UCLMS teaching, their requesting more reminders for clinics and simulated practice of abortion consultations, demonstrates their appetite for thorough, practical teaching which prepares them to be competent, respectful and compassionate practitioners, regardless of their attitudes towards abortion. It is possible that the lack of correlation between students’ attitudes to abortion and their rating of the importance of teaching also reflects the efforts made by teaching faculty to not only ensure teaching is inclusive and respectful of all beliefs, but also to make it engaging, employing multiple changes of stimuli with guest speakers, videos, quizzes, electronic voting, discussion and simulated practice embedded in the more traditional lecture and small group format.
Our study showed similar findings to others with regard to religion – small numbers in each religious group meant we were unable to statistically compare students’ attitudes towards abortion with their beliefs . Another result consistent with other studies was that UCLMS students were less likely to be willing to be involved in providing medical or surgical abortion at later, rather than earlier, gestations .
Students interested in specialties potentially involving abortion care, such as O&G, Sexual Health, Emergency Medicine and General Practice, were more likely to be pro-choice than pro-life. Considering the concern about a future lack of abortion care providers, waning interest in O&G training and the prevalence of abortion itself, this was reassuring. It also supports the argument that the lack of uptake of specialist RCOG and FSRH training in abortion care is not simply a case of pro-life trainees opting out, but encompasses other factors such as the practical aspects of training, abortion-related stigma, workload and other life choices.
Recent research on abortion-related stigma states that ‘work remains to be done to dismantle abortion negativity embedded in the healthcare system’ . The UCLMS teaching aims to counteract this negativity and abortion-related stigma in a number of ways. Firstly, by including teaching about how to counteract stigma in abortion consultations. Secondly, drawing on Allport’s intergroup contact theory approach , by exposing students to doctors with a conscientious commitment to abortion care, as well as doctors with a conscientious objection, and to women who have had abortions. Thirdly, by facilitators striving to create a respectful and safe environment where students are able to express their beliefs, concerns and fears. And lastly, by allocating seven hours of core curriculum time to abortion teaching and including questions on the content of this teaching in all relevant formative and summative assessments, demonstrating to students that abortion is an essential aspect of reproductive healthcare and that UCLMS is committed to preparing them to be competent practitioners in this area.
Following this study, we have reviewed and developed our teaching, adding a simulated practice exercise with a woman requesting an abortion, the anonymous story of a medical student’s abortion and further discussion on how to counteract abortion-related stigma and facilitate trust in an abortion consultation, including identifying and avoiding value-laden language. We have also refined our material on the difference between conscientious objection and obstructing abortion care, as well as emphasising the importance of both knowing how to respectfully opt out of abortion care. To ensure sessions are inclusive and respectful of a spectrum of beliefs about abortion, we have taken steps to secure both pro-choice and pro-life speakers for each session. Finally, we are sending students follow up emails reminding them they can opt into attending abortion assessment clinic placements.
There are limited data about what abortion teaching is included in UK undergraduate healthcare professional curricula despite the prevalence of abortion. We are therefore conducting further research on the extent to which abortion education features in UK medical schools’ curricula, their aims, outcomes and content of abortion education and how it is delivered, as well as the barriers to including comprehensive abortion education in undergraduate curricula.
Furthermore, to support efforts to integrate inclusive and comprehensive abortion teaching into other undergraduate healthcare professional curricula we have established a repository for sharing our teaching resources .
Limitations and future implications
The response rate of 41%, although not as low as some previous surveys of medical students’ opinions on abortion , was the main limitation of the study, as it may indicate a response bias where students who chose to answer the survey had the strongest opinions and so it is difficult to be sure that our sample is valid and reliable. Nevertheless, we maximised this rate with reminder emails and by surveying students months before their final examinations. We tried to avoid bias in the survey questions and encourage honest responses by assuring students there were no ‘right’ or ‘wrong’ answers, using the well-recognised terms of ‘pro-choice’ and ‘pro-life’ and allowing them to opt out of any part of the survey. Our study only represents students’ attitudes at one medical school, however the use of an online questionnaire gives the potential for this study to be reproduced at other medical schools.