Site Presented By
Sunday, Nov 8, 2009
Few doctors learn how to perform abortions, and women pay for their lack of training. New York City is taking steps to reverse the trend.
Jul 25, 2002 | Back in the '80s, before I was ready to settle down with husband or child, I got pregnant. I went to my OB-GYN to talk about abortion.
I'd known and trusted this doctor for years. He'd always listened attentively and answered my questions with kindness and respect. That's what I expected now. Instead, he looked stricken. "Abortion?" he asked, almost choking on the word. "But you'd make such a great pregnant lady!"
Considering the hassle and outrageous harassment that women often confront when they seek abortions, a dumb, hurtful comment from a doctor should seem like no big deal. But that moment sticks in my mind more vividly than the memory of the vacuum aspiration that eventually ended the pregnancy. The message was unmistakable: Yes, abortion is legal; yes, it is one of the most common surgeries performed on women. But it is a procedure beyond the bounds, interest and dignity of the medical establishment.
Two decades later, medical schools and doctor training programs are finally taking important steps to bring abortion into the mainstream of medicine -- where it belongs. After years of simply ignoring the procedure and conveniently sidestepping controversy, a growing number of training programs are now requiring obstetrician-gynecologists to learn how to do abortions. This slow, steady, quiet shift got a dramatic boost this spring, when New York became the first city to mandate abortion training for OB-GYN residents at its public hospitals.
The move to incorporate abortion into standard medical education is one of the most significant developments in decades in the debate over a woman's right to choose. By teaching medical students about abortions, and by requiring newly minted M.D.'s to get hands-on experience, educators are giving the procedure the same legitimacy as any other medical treatment -- for the first time since Roe vs. Wade.
"If abortion is part of a clerkship, it's not going to be seen as a dirty procedure that has no educational value for students," said Mindy Sobota, a fourth-year student at the New York University School of Medicine.
Abortion-rights groups such as Medical Students for Choice and the National Abortion and Reproductive Rights Action League have pressed educators for years to add abortion to the medical-school curriculum. The effort has gained urgency as abortion providers -- actively stalked and threatened with death -- have packed up and abortion clinics have shut. Eighty-six percent of U.S. counties, and one-third of U.S. cities -- Sioux City, Iowa; Grand Forks, N.D.; Erie, Penn.; and Joplin, Mo., among them -- had no identifiable abortion provider in 1996, according to the most recent survey by the Alan Guttmacher Institute in New York.
While it is possible to blame antiabortion violence for the diminishing access to abortion, the medical establishment bears some responsibility. When medical schools and training programs fail to teach medical students how to do abortions, very few doctors perform them.
Though it was never part of most OB-GYN curricula, abortion training began to surge after 1973, when women suddenly flocked to hospitals for a newly legal procedure that almost no M.D. had been taught to perform. But by the late 1970s -- despite the demand -- only about one-quarter of OB-GYN residency programs routinely included abortion training. The number of programs to carry the training diminished further when abortions were less frequently performed in hospitals, the doctor's traditional training ground.
By the mid-1990s, a mere 7 percent of abortions were performed in hospitals, down from 81 percent in 1973. Women were going to clinics, like those operated by Planned Parenthood, for the procedure. The shift made sense medically and economically -- at least in the years before 1982, when clinics largely operated in peace. Early abortions are technically simple and patients tend to be healthy. Hospital operating rooms are set up and staffed for complicated surgery on the desperately ill. Outpatient abortions proved to be safer, quicker and cheaper -- so successful, in fact, that they precipitated the wholesale shift of elective surgery to outpatient centers.
But the rise of abortion clinics had an unintended consequence: It eroded abortion education. As abortions slipped off the hospital operating-room schedule, they also were dropped as a training requirement for young physicians. "They get trained to do things that happen in hospitals," said Felicia Stewart, co-director of the Center for Reproductive Health Research and Policy at the University of California, San Francisco. "It's not easy to get trained to do things that don't happen in hospitals."
