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Zoe Russell practices giving an abortion, with the manual vacuum aspiration (MVA) technique, on a papaya.
Zoe Russell practices giving an abortion, with the manual vacuum aspiration (MVA) technique, on a papaya. Photograph: Mark Makela/The Guardian

Cheyenne Mangold’s hands shook ever so slightly as she reached with a long metal instrument to catch hold of what looked like the cervix. The medical student was attempting, for the very first time, the rudiments of performing an abortion.

As she inexpertly brought the pincers together on the soft flesh, you might have expected a little yelp of pain from the patient.

There was silence. Not because the “patient” was brave, but because it was a papaya.

And it so happens that the papaya, with its little fruity neck and a central cavity full of seeds and pulp, is a serviceable approximation of a woman’s cervix and womb for the purposes of basic initiation for a medic in training.

Papayas sit alongside instruments.
Papayas sit alongside instruments. Photograph: Mark Makela/The Guardian

Mangold was in a roomful of 60 rookies from across the country. They juggled fruit and tools as they began their journey, come what may, to become the next generation of abortion providers – an increasingly scarce species in some parts of the US.

Mangold had traveled to Philadelphia from Lubbock, where she’s a third year student at Texas Tech University Health Sciences Center and aspires to become an obstetrician/gynecologist (OB-GYN).

“It’s already a five-hour drive to the nearest abortion clinic from Lubbock,” she said.

“The community is very anti-choice. When it comes to abortion, there’s no education at my school. You have to seek it out and that’s a travesty,” she said.

Mangold belongs to Medical Students For Choice (MSFC), a US not-for-profit organization with members at medical schools in several countries who aren’t getting family planning and abortion education because of conservative mores or laws.

Medical students don’t specialize until later in their careers and could learn about it then, but the MSFC executive director, Lois Backus, said many schools left abortion out of the curriculum entirely “but erectile dysfunction medication is in there every time”.

Medical school student Leah Trippell reacts while practicing giving abortions.
Leah Trippell, a medical student, reacts while practicing performing an abortion. Photograph: Mark Makela/The Guardian

“I can visualize it even though it’s just a fruit,” she said. “I’m hoping to become a pediatrician but I want to be able to provide this service if a teen needed it and can’t get it anywhere else.”

How would she feel about performing an illegal abortion?

“If necessary I would risk going to prison or losing my license. No one should have to do a self-induced abortion,” she said.

Marta Rowh had flown in from Bend, Oregon, to help teach two “papaya workshops” as part of an MSFC conference that had drawn 450 med students from the US and Canada. She’s the only abortion provider for two-thirds of her state. Before demonstrating the standard manual technique used in the first 10 weeks of pregnancy, she arrayed some mostly disposable tools.

“These are designed to be used in a hut in rural Zambia with no electricity if necessary,” she said. There was a plastic speculum to hold open the vagina, a metal tenaculum, or pincers, to grip the cervix, steadying the opening to the uterus, a plastic rod for dilation, and a large, plastic syringe-type device used for the common practice of manual vacuum aspiration (MVA). She squeezed two buttons on the device to seal it, then pulled back the plunger, making a vacuum in the cylinder, then attached a tube from a sterile packet.

The students were transfixed. Apart from an encounter with a cadaver, their medical training had been all lecture halls so far.

Rowh put the tube inside the papaya and moved it carefully around to simulate dislodging fetal tissue and the related products of pregnancy from the walls of the womb.

The tools ‘would be something you could have in your closet in a small bag that you could pull out and go’, said an instructor.
The tools ‘would be something you could have in your closet in a small bag that you could pull out and go’, said an instructor. Photograph: Mark Makela/The Guardian

“In a post-Roe v Wade world, some of these tools would be harder to get hold of. They would be something you could have in your closet in a small bag that you could pull out and go,” said Rowh.

MSFC members in some African countries where abortion is illegal call them “stealth kits” and mainly use them in clinics that fly under the government’s radar.

Mariel Cohn, a Philadelphia nursing student, had never used a speculum before and declared the sensation of operating on a papaya “freaky” but added: “I’ve already started a little kit of various medical supplies I might need in the future.”

Shariq Khan, 24, one of a handful of men in the room, is a first-year medical student at Washington University in St Louis, Missouri.

“Ooh, it’s tricky, doing something different with each hand and trying to look inside the papaya, and feeling for the depth,” he said.

Instructor Emily Young, an abortion provider from Charlottesville, Virginia, warned the students not to poke too harshly and risk perforating the uterus.

Khan wants to offer family planning “especially in underserved areas”. But he added: “I don’t know if I would still provide abortion if it was illegal, which is maybe in our very near future.”

The papaya is a serviceable approximation of a woman’s cervix and womb.
The papaya is a serviceable approximation of a woman’s cervix and womb. Photograph: Mark Makela/The Guardian

Would she risk performing a “back alley” abortion?

“I like to think I would. I want to provide a full spectrum of reproductive health for my future patients. But how would I screen people so the right ones get to me? I’d be worried about ‘plants’,” she said.

Hours earlier, the US Senate had passed a tax bill with a provision allowing fetuses to get tax breaks on college savings accounts, seen as a further undermining of abortion rights.

Backus fears the supreme court could overturn the Roe v Wade decision, which legalized abortion in the US in 1973. Even without that move, hardline conservatives in many states have been so effectively using legislation to restrict abortion in the last decade that “it’s very likely they’ll weaken Roe until it’s close to meaningless anyway”, she said.

But actually overturning Roe could result in the closure of clinics and an end to legal channels for obtaining pills used for early-stage “medical” abortions.

Young reckons there are “too many smart lawyers defending reproductive justice” for Roe to go.

Rowh fears individual states may get the power to decide.

Audrey Jaeger, a student attending the workshop from Rocky Vista University of Colorado, said: “You’re not going to get rid of abortion, it’s been around for ever. Things just go backwards to times when everyone knew someone who almost died because they had a dangerous abortion.”

Priya Suri is outraged that Republican lawmakers in Wisconsin, where she’s a medical student, are debating legislation prohibiting university faculty from teaching abortion to trainee doctors, despite a shortage of OB-GYNs.

“I’m so upset. I chose the program because I would learn about abortion; now that’s in jeopardy. In a post-Roe world, I’d be more on the advocacy side – but I could provide the care myself,” she said.

medical students
‘These are life savers,’ an instructor said of the students. Photograph: Mark Makela/The Guardian

Chiavarini flies regularly from home in Portland, Oregon, to perform abortions in Oklahoma and at the Kansas clinic where George Tiller worked before his 2009 murder.

Chiavarini said: “When I do abortions there are patients who need hand-holding and they’re crying. Other patients, we’re blasting Aretha Franklin and joking around; that’s something people are afraid to talk about. Sometimes people feel like they are ending their baby’s life, and that’s what I’m doing because that’s what they need to do, and I’m going to call it their baby. I use the term the patient uses. Sometimes I refer to what I’m removing from a woman’s uterus as the pregnancy, the embryo or the fetus – I never just say tissue.”

The students chattered away as exhausted papayas piled up in the garbage.

“There’s no point in adopting fake reverence,” said Chiavarini.

“In medicine there’s a tendency to dark humor. It’s intense, so you have to joke about it sometimes.”

What she’s serious about is the continued need for tools and training. She waved a hand at the tubes and vacuum devices scattered about, and the students scooting out for coffee.

“These are life savers,” she said.