By Ally Dickson. Bay City News.
Zoe Carrasco “fell in love” with reproductive health care while working at a community clinic in East Oakland.
She was in her early 20s at the time. Today, at 36, Carrasco has graduated from the University of California, San Francisco School of Nursing. A self-described Latina, Carrasco wants to bring comprehensive reproductive care to her Spanish-speaking community, including abortion in California.
However, Carrasco eventually learned that her education would not make her “clinically competent,” a classification that allows a practitioner to perform aspiration abortions, which requires a hands-on physical procedure in the clinic. To get that, she will have to complete additional training and find work at a clinic that supports recent graduates.
"If you really want to get trained in clinical abortion," Carrasco said, "you really have to go outside the school system and find it for yourself."
During her three years in UCSF's nursing and midwifery program, Carrasco attended a 90-minute didactic lecture on medication abortions and a skills lab where she performed first-trimester abortions using papayas.
She was fortunate enough to get 16 hours of observational clinical abortion training at Zuckerberg San Francisco General Hospital during the summer of 2021. Her classmates typically received only four to eight hours. She was able to pick up extra hours by filling in for classmates who couldn’t cover shifts.
On one occasion, Carrasco took it upon herself to further expand her abortion training at a clinic in New Mexico, logging 35 hours in four days, thereby doubling the hours of clinical experience provided by her school program. There, she took advantage of being able to be in the room during every aspect of an aspiration abortion, whereas her nursing school only allowed observation the day before in preparation for the procedure.
Additionally, during her time in New Mexico, Carrasco was able to follow a patient through her experience with the abortion procedure, thus witnessing a doctor-patient relationship from start to finish. In school, Carrasco received counseling training on how to approach patients with compassion and neutrality, but this was real, she said.
“There’s so much courage behind a decision like this,” Carrasco said. “And everyone at that clinic really honors that.”
She also said she admired how the clinic emphasized trauma-informed care and preserving patient autonomy.
Advocating for abortion education
Meredith Klashman wants to fight for her patients inside and outside the hospital. Klashman, a rising third-year medical student in the joint medical program at the University of California, Berkeley and UCSF, just finished her term as co-president of the UC San Francisco chapter of Medical Students for Choice.
Working with the group Nurses for Sexual and Reproductive Health, Klashman’s organization created the Reproductive Health Elective, which is open to all UCSF programs. The elective aims to fill gaps in abortion and reproductive education instruction within UCSF’s core curricula, and covers medication abortions, an aspiration abortion skills lab, and disparities in access to reproductive health care.
Adamant that abortion training is crucial for nursing and medical students, the student organization advocates for more clinical experience in abortion clinics. Abortion training is extremely important when working in an emergency room, for example, Klashman says.
In an emergency room, a patient might come in with a mistimed medical abortion, a self-managed abortion, or just an abortion on their medical record.
“Doctors need to do a little more due diligence in terms of empowering their patients to make decisions,” Klashman said.
Klashman became passionate about women's reproductive health justice while studying urinary tract infections due to water exposure. Klashman was surprised and disappointed to discover that UC Berkeley's research program did not focus on women's UTIs, despite the preponderance of such cases among women.
Supporting scholars who prioritize reproductive justice
One of the faculty members of the Reproductive Health Elective, and the fifth Black tenured professor at the UCSF School of Nursing, Monica McLemore co-directs the Abortion Care Training Incubator for Outstanding Nurse Scholars (ACTIONS) program. In this capacity, McLemore supports predoctoral and postdoctoral fellows at the School of Nursing who prioritize reproductive justice.
“Abortion care is about making sure that people’s emotional, informational and spiritual needs are met as they make a decision about their reproductive health. That screams nursing,” McLemore said. “One of the core principles of nursing is helping individuals and families manage transitions.”
McLemore has provided abortion services at Zuckerberg San Francisco General Hospital for nearly 20 years, and said she always knew teaching would be an important part of her career.
“As a Black nurse who has had a nursing license since 1993, not only have I never had a Black person looking out for me as a member of the healthcare profession, which I’m still very bitter about,” McLemore noted, “but I have never actively had a Black nursing faculty member.”
Promote a policy to increase training on abortion
Bethany Golden is a Registered Nurse, Certified Nurse Midwife, and Predoctoral Fellow at UC San Francisco through ACTIONS, attended Yale School of Nursing, and has worked in private practice, community health, hospitals including NYU Langone Health and Northwestern Memorial Hospital, at Planned Parenthood in California, and even abroad.
Despite being a doctor for nearly 20 years, Golden has never been able to receive training in aspiration abortion.
“I asked to learn,” she said. “No one would teach me because there are few places to get that clinical training.”
Striving to address this on a systemic level, Golden said she became a policy advisor for Training in Early Abortion for Comprehensive Healthcare, an organization that teaches reproductive health care and abortion clinics in California and beyond, commonly known as TEACH.
As of October 2021, through ACTIONS, Golden was also one of the physicians working with the California Abortion Future Council, which recommends the California Reproductive Health Services Corps created under Assembly Bill 1918.
AB 1918 aims to recruit, train, and retain a diverse workforce by establishing scholarships, stipends, and loan repayment for reproductive health professionals. Those who qualify must commit to completing abortion training and commit to working for three years in California, prioritizing underserved areas.
"My hope would be that what we're seeing is lifelong professionals and, as a result, a really impactful expansion of our reproductive health care workforce," said Cottie Petrie-Norris, the bill's author.
The bill has already secured $20 million in funding in the current state budget to go toward scholarships, stipends and loan repayment, and is expected to soon pass the state Senate and receive Gov. Gavin Newsom’s signature and take effect in January.
Golden looks forward to the day when she can return to her student career and learn how to perform aspiration abortions.
"I'd like to be in a practice where I could offer that service, so I'm hoping to benefit from the expansion of abortion training as well," Golden said.
Nursing and medical students, professors and nurse practitioners continue to fight for personal and policy changes to abortion care, even though Roe v. Wade and the national right to access abortion have been struck down. Carrasco said the U.S. Supreme Court's decision last month was a moment of mourning, but also of gaining momentum.
“There is loss, but there is also a desire to move forward and be resilient, especially as someone who is a new supplier,” Carrasco said.
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