The July 18, 2010 issue of The New York Times Magazine has an informative article titled “The New Abortion Providers,” which puts the spotlight on upcoming doctors and the need to include abortion-care training in medical school curricula.
As the article points out, in 1973 more than 80 percent of the nation’s abortion facilities were located within hospitals; by 1996 more than 90 percent of abortions were taking place in clinics. The move from hospitals to free-standing clinics made the abortion provider more vulnerable. This weakness was exploited by groups such as Operation Rescue, whose tactics include the harassment of doctors, as well as terrorists who single out abortion providers for assassination.
While the first post-Roe generation of abortion providers was motivated by their exposure to infections and deaths following self-induced or illegal abortions, today’s crop of medical students does not generally have firsthand experience with such horrors. In the years following the Roe v. Wade decision, the number of abortion providers has been on the decline; this move away from mainstream medicine has led to the disappearance of abortion training in residency programs. Currently more than half of U.S. abortion providers are over the age of 50, which is indicative of the need for more trained medical students.
Enter Medical Students for Choice. Founded by a medical student in the 1990s, the group agitates for increased focus in medical schools on abortion as a part of basic gynecological care. Today the group is 10,000 members strong, and thanks to their activism over the years, today more than half of OB-GYN residency programs in the United States include abortion training in regular rotations, with many more programs offering such training on an elective basis.
Another force for change is the Family Planning Fellowship, a two-year program in which doctors can focus on abortion, contraception, and other family-planning work. Such training is now available at 21 universities, from top schools like Johns Hopkins to those with more conservative reputations such as the University of Utah. Fellows might also work abroad, where they could, for instance, find themselves teaching local health-care providers how to insert IUDs. This kind of preventive care can drastically reduce the number of deaths from illegal or self-induced abortions in countries where safe abortions are not available.
The new generation of abortion providers could include abortion as an integrated part of health care. The hospital, less vulnerable to protests and harassment than free-standing clinics, could be returned to its former place as the predominant site for legal abortions. This would make it difficult for abortion opponents to pick out abortion providers and their patients from the rest of the employees and clientele, which in turn could offer encouragement for would-be abortion providers who are concerned about their safety in the wake of the murder of Dr. George Tiller.
So far, however, this is not a reality. Despite an increase in training, abortion providers are still decreasing in number. As The New York Times Magazine points out,
As yet, all the success in training new doctors hasn’t translated into an increase in access. Abortion remains the most common surgical procedure for American women; one-third of them will have one by the age of 45. […] In metropolitan areas, women who want to go to their own doctor for an abortion can ask whether a practice offers abortion when they choose an OB-GYN or family physician. But in 87 percent of the counties in the U.S., where a third of women live, there is no known abortion provider.
Many doctors who have been trained in the procedure may be barred from performing it under pressure from senior members of group practices to which they belong, and many show their pro-choice support simply by referring patients to Planned Parenthood. Medical-malpractice insurance covering abortion can also be cost-prohibitive for many doctors.
Abortion training is integral in ensuring physicians providing reproductive health care are equipped to meet all of their patients’ needs, including the need for abortion. The number of U.S. abortion providers is declining, however, which leaves women with fewer options and decreased access to the medical care they need. If more medical students were able to take their training in abortion into their practices, abortion could be centered in hospitals rather than in clinics, making anti-choice protesting and harassment more difficult. It would be interesting to see what kind of implications that could have for the ongoing national dialogue about the politics of abortion.