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ZOE CARRASCO “FELL in love” with reproductive health care while working at a community clinic in East Oakland.
She was in her late 20s at the time. Today at 36 years old, Carrasco is a graduate of the University of California, San Francisco School of Nursing. As a self-described Latina, Carrasco wants to provide comprehensive reproductive care to her Spanish-speaking community, including abortions.
However, Carrasco eventually learned that her schooling would not leave her “clinically competent,” a ranking that allows a practitioner to perform aspiration abortions, requiring an in-clinic, hands-on, physical procedure. To get that, she will have to complete additional training and find work at a clinic that supports recent grads.
“If you really want to do clinical abortion training,” Carrasco said, “you really have to go out of the school system and find it for yourself.”
During her three years in the UCSF nursing-midwifery program, Carrasco attended a 90-minute didactic lecture on medication abortions and a skills lab where she practiced first trimester abortions on papayas. She was fortunate to get 16 hours of observational clinical abortion training at Zuckerberg San Francisco General Hospital over 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.
Carrasco once took it upon herself to further expand her abortion training at a clinic in New Mexico, clocking 35 hours in four days, thereby doubling the clinical experience hours provided by her school program. There, she took advantage of being able to be in the room during each aspect of an aspiration abortion, while her nursing school only allowed observation of the day-before preparation for the procedure.
“If you really want to do clinical abortion training, you really have to go out of the school system and find it for yourself.”Zoe Carrasco
Furthermore, during her time in New Mexico, Carrasco was able to follow a patient through their procedural abortion experience, thus witnessing a patient-practitioner relationship from start to finish. In school, Carrasco received counseling training on how to approach patients with compassion and neutrality, but this was the real thing, she said.
“There’s so much courage that goes behind a decision like this,” Carrasco said. “And everybody from that clinic really honors that.”
In addition, she said that she admired how the clinic emphasized trauma-informed care and preserving the patient’s 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 at the University of California, Berkeley-UCSF joint medical program, just finished her term as co-president of the Medical Students for Choice UC San Francisco chapter.
Teaming up 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 the instruction gaps in abortion and reproductive education within UCSF’s core curriculums, and covers medication abortions, an aspiration abortion skills lab, and reproductive health care access inequalities.
Adamant that abortion training is crucial for nursing students as well as 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 ER room, a patient could come in with an ill-timed medication abortion, a self-managed abortion or just an abortion in their medical history.
“Physicians need to do a little bit more due diligence in terms of empowering their patients to make choices,” Klashman said.
Klashman became passionate about women’s reproductive health justice while studying urinary tract infections due to water exposure. Klashman was both surprised and disappointed to find a lack of focus on women’s UTIs in the UC Berkeley research program, despite a preponderance of such cases among females.
Backing scholars who prioritize reproductive justice
One of the teachers of the Reproductive Health Elective — and the fifth-ever 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 pre-doctoral and post-doctoral scholars at the School of Nursing who prioritize reproductive justice.
“Abortion care is making sure that people’s emotional, informational and spiritual needs get met as they are making a decision about their reproductive health. That screams nursing,” said McLemore. “One of the basic principles of nursing is to help individuals and families manage transitions.”
McLemore has provided abortion care at Zuckerberg San Francisco General Hospital for nearly 20 years, and she said that she always knew professorial life would be an important part of her trajectory.
“As a Black nurse who has had a nursing license since 1993, not only have I never had a Black person take care of me as a member of the health profession, which I’m still really grumpy about,” McLemore SAID, “but I’ve never actively had a Black nursing professor.”
Pushing policy for increased abortion training
Bethany Golden is a registered nurse, certified nurse midwife and pre-doctoral 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 overseas.
Despite being a clinician for almost 20 years now, Golden has never been able to receive aspiration abortion training.
“I asked to learn,” she said. “No one would teach me because there are only so many spots to get that clinical training.”
Endeavoring to address this at the systemic level, Golden said that she became a policy advisor for Training in Early Abortion for Comprehensive Healthcare, an organization that teaches clinics in reproductive and abortion health care in California and beyond, commonly known as TEACH.
Starting in October 2021, through ACTIONS, Golden was also one of the clinicians who worked with the California Future of Abortion Council, which recommends the California Reproductive Health Service 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 care 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 practitioners and a really impactful expansion of our reproductive health care workforce as a result,” said Cottie Petrie-Norris, the author of the bill.
“I would like to be in a practice where I was able to offer that service (aspiration abortions), so I hope to also benefit from the expansion of abortion training.”Bethany Golden
The bill has already secured $20 million in funding in the current state budget that will go toward the scholarships, stipends, and loan repayment, and is soon expected to pass in the state Senate and receive a signature from Gov. Gavin Newsom and be in effect in January.
Golden looks forward to the day when she can be a student again and learn how to provide aspiration abortions.
“I would like to be in a practice where I was able to offer that service, so I hope to also benefit from the expansion of abortion training,” said Golden.
Nursing and medical students, professors, and nurse practitioners are continuing to fight to effect change at personal and policy levels for abortion health care, despite Roe v. Wade and the national right to access abortion being torn down. Carrasco said that the U.S. Supreme Court’s decision last month was a moment to mourn, but also to gather momentum.
“There’s a loss but there is also an eagerness to push forward and be resilient, especially as somebody who is a new provider,” said Carrasco.