Abortion is generally a simple, safe procedure; providing it in a general academic obgyn setting poses unique opportunities and challenges for patients, providers and learners. This chapter reviews options and considerations and provides resources for starting and improving a teaching abortion service, including guidelines, patient education, and important relationships to consider. The family planning teaching services at UCSF and UCSF’s Zuckerberg San Francisco General Hospital are presented as two different service and teaching examples. Abortion services can raise challenges with policies, insurance, scheduling, clinic safety and staff refusals to take care of patients. Patients face their own challenges to seek care, such as stigma, travel, poverty, and intense emotions, and many have experienced domestic violence and sexual assault. Residents and students need to address their personal emotions in addition to learning clinical skills. Providing patient-centered abortion services, particularly for patients who cannot be seen elsewhere, is an issue of equity that makes it highly valuable learning opportunity.

In May 2018, a referendum in the Republic of Ireland resulted in a two-thirds majority supporting more liberal provision of abortion care. Just over seven months later, women could avail of abortion care that was “free, safe and legal”. The development & integration of this service, the education of care providers and the challenge of interpretation of the legal framework in context of care provision has been challenging but achievable. This chapter reviews the current provision of abortion care in the Republic of Ireland. Educational programmes are described and ongoing challenges are discussed. Acknowledgement is given to colleagues internationally who generously gave their time to inform, educate and provide advice.