Like most people who decide to train to be OB-GYNs, Dr. Nicole Fanarjian loves delivering babies. But she doesn’t get a chance to do it.
Fanarjian has given up obstetric care, instead electing to spend her time providing abortions to the women in the Southeast who need those services. Although she would prefer to be involved in every aspect of women’s decisions about childbearing, political barriers to abortion rights have forced her to make a difficult choice.
In an op-ed published on xoJane, Fanarjian illuminates a little-known consequence of the ongoing crusade against abortion rights: The doctors who care for women have been cut off from providing the full spectrum of reproductive health services to their patients, even though many of them wish they didn’t have to choose.
“Despite years of training and a passion for obstetrics, I decided to stop delivering babies so that I could provide abortions. I could no longer turn my back on the patients who need abortion care,” Fanarjian writes. “I still consider giving up obstetrics to be my biggest sacrifice to do this work. I was good at it and derived immense satisfaction from it. The process of delivering a baby was a rush.”
But, in the region of the Southeast where she and her husband live, she ultimately couldn’t find a job that allowed her to integrate abortion care into her OB-GYN practice. That’s largely because, thanks to decades of stigmatization surrounding abortion, the procedure has been isolated from the rest of medical practice.
It’s not easy to become an abortion provider in the first place. Fanarjian recounts struggling to learn more about abortion in medical school, as well as facing barriers to abortion training while she was completing her residency.
In the program where Fanarjian was trained, she was told that the hospital was wary to partner with local abortion clinics because those partnerships often incite protests from anti-abortion groups, and officials didn’t want that kind of unwanted publicity. It’s not uncommon for hospitals to try to avoid the war over reproductive rights. Some other OB-GYNs have also admitted that the institutions where they work required them to sign contracts promising they wouldn’t provide abortions.
“It shocked me that a few protesters — or really, cowardice — could lead the hospital administration to decide that it was okay for residents to not be taught a relatively simple procedure that so many of their future patients would need,” Fanarjian writes in her op-ed.
Fanarjian’s experiences are backed up by research. Plenty of medical schools are failing to include any instruction about abortion in programs that are supposed to train the future doctors who will care for women’s reproductive systems. In the late 1990s, only 12 percent of OB-GYN programs were teaching their students about how to provide an abortion. By 2009, one third of medical schools still didn’t talk about elective abortion at all during students’ first two pre-clinical years.
That lack of training has contributed to a generation of medical professionals who are largely unprepared to tackle this field of reproductive health. According to one recent study, a staggering 97 percent of OB-GYNs have worked with patients who want to get an abortion — but only about 14 percent of those doctors actually knew how to perform one. There’s a concerning shortage of qualified abortion doctors.
“Unfortunately, Nicole’s story is not unique,” Dr. Kathleen Morrell, the reproductive health advocacy fellow at Physicians for Reproductive Health, a group that encourages comprehensive reproductive health education in medical residency programs, told ThinkProgress. “Doctors have to make a decision sometimes. I find it really disheartening that we live in a place where such a common surgical procedure is treated so separate from everything else that we do.”
Over the past several years, medical professionals have started to fight back, quietly laying the groundwork to shift the status quo. The national Ryan Program, which was founded in 1999 and now has dozens of locations at medical schools across the country, helps OB-GYN departments integrate abortion into the rest of their family planning training. Local chapters of Medical Students For Choice support the individuals who want to become abortion providers. And OB-GYNs have started pressuring hospitals to stop shying away from abortion, arguing that it’s hospital officials’ responsibility to “reverse a decades-long trend that has isolated abortion providers from the mainstream medical community.”
“Ideally, women should be able to get every aspect of their reproductive health care taken care of by their provider,” Morrell said. “We’re trying to get people to understand that this is just another thing you need to be trained in as an OB-GYN. Many of your patients are going to need it, so you should be trained on how to give it.”
But for providers like Fanarjian, the changes aren’t coming soon enough. The political climate in states hostile to abortion rights doesn’t allow it. “I am continuing to try to figure out a way to integrate obstetrics into my practice again,” she concludes. “But unless and until more health care providers decide to integrate abortion care into their practices, I will continue to fill this gap.”