Uta Landy


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    How can a Fellowship in Family Planning be established in Europe?

    Uta Landy
    Fellowship in Family Planning and Ryan Residency Training Programme, San Francisco, CA, USA

    Subspecialisation has expanded with the growth of evidence-based practice and complexity in medical care in the US. There are now 127 accredited subspecialties across all medical disciplines with four in Obstetrics and Gynecology: Reproductive Endocrinology and Infertility, Maternal Foetal Medicine, Oncology and, most recent, Female Pelvic and Reconstructive Surgery. The Family Planning Fellowship is exploring potential accreditation and certification.
    Why did we create a subspecialty in family planning? Historically, US medical schools gave clinical care, training, research and advocacy in abortion and contraception little attention. Since the demand for pregnancy termination was mostly met by freestanding clinics, few teaching hospitals offered or taught abortion or complex contraception.
    In response, we launched two national initiatives. The first, the Fellowship in Family Planning, was started at UCSF in 1990 and now counts 31 sites in leading academic ob-gyn departments. It has produced a new generation of leaders in the field who have advanced abortion and contraceptive research, clinical training, and advocacy. Our 300 graduates have helped launch 90 new academic training programmes through a parallel initiative, the Ryan Residency Training Programme.
    While the results of our model may serve as an inspiration to our European colleagues, our approach may not be replicable in the European context.  There are certain steps required to ensure fellowship success. Leaders in the field must be motivated to serve as champions of the effort, and professional organisations, e.g. ESC, must lend their official support. The service delivery system must allow for clinical training and sources of research funding must be identified. Advocacy for reproductive justice should become part of training.  Finally, the structure and settings, clinical care, teaching and research of the family planning fellowship must be substantial enough for academic centres and the service delivery community to recognise it as an essential component of reproductive health.

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    Integrating abortion and contraception training into medical education: the Family Planning Fellowship and Ryan Residency Training Programs in the US

    Uta Landy The Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco, San Francisco, CA, USA - landyu@obgyn.ucsf.edu

    Although abortions were legalized in the United States in 1973, the focus was on service access, not training. As a result, the number of teaching hospitals offering abortion services and conducting research declined steadily. A training mandate was finally passed by the US professional standard setting organizations in 1995 when a lack of trained physicians was noted. The mandate has been affirmed regularly despite the increasing political interference with abortion care and teaching. The Fellowship in Family Planning was founded to ensure future generations of leaders for abortion services, research, teaching and advocacy. During the past 23 years, its graduates have ensured the integration of family planning into the curriculum of medical students and postgraduates, conducted seminal research in abortion and contraception, contributed to the family planning work of national and international governmental and non-governmental organizations and become advocates for evidence-based policies. A parallel organization, the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning, was founded in 1999 to support academic programmes in complying with the new training standards. Since its inception, it has initiated formal programmes in 78 departments of obstetrics and gynaecology to ensure the clinical competence in evidence-based approaches in family planning and abortion for future generations of OBGYNs. Systematic training is an essential aspect of ensuring that future physicians are clinically competent, understand and contribute to research, understand the medical, social and psychological aspects of uterine evacuation and contraception and become advocates for evidence-based policies.