Abortion opponents are launching a full-scale attack on clinics across the country. Mounting piles of state-level restrictions are forcing a record number of abortion clinics to close their doors — and the fight continues to become increasingly localized, as anti-choice activists use every tool at their disposal to target specific clinics for closure.
But there’s a growing threat to abortion access that won’t be solved even if every clinic in the country is able to keep operating. We’re not training enough medical professionals to perform abortions in the first place — and an aging population of current providers means that the shortage is threatening to get worse.
“There are still a lot of institutional barriers to getting the training, even basic training, on abortion at the medical school level,” Sarp Aksel, the president of the board of Medical Students For Choice, explained in a recent interview with the Thomas Reuters Foundation. Aksel’s organization, which has chapters in over 15 different countries, works to increase the number of health care professionals who are trained in abortion care.
Aksel says that even though abortion training is often available at the residency level, that’s not early enough in medical training. He thinks students need to be exposed to it in medical school so that future doctors can decide whether they want to include abortion services in their practices.
A 2009 study conducted by Medical Students for Choice found that a third of medical schools don’t talk about elective abortion at all during the first two pre-clinical years. In contrast, the study found that 84 percent of medical schools cover Viagra.
Making the issue worse, Aksel says, is the pervasive stigma surrounding abortion in medical school. Students are allowed to reject abortion training if they have moral or religious objections to it. Even when they don’t object to it, many students don’t want to stir up controversy by expressing an interest in the area. “I think when students who are interested in abortion care and learning about it are shunned in their medical schools. That’s a big problem,” Aksel told the Thomas Reuters Foundation.
And even if medical students do speak up about their desire to learn about abortion, they don’t always have the means to do so. When abortion clinics are forced to close, or when hospitals are pressured to end their agreements with them because it becomes too politically contentious, doctors in training lose the opportunity to study abortion care there. Many medical schools don’t want to wade intro controversy, and would rather not fight to maintain abortion training programs. It’s often easier, and cheaper, to just scale back.
Of course, aside from the difficulties in getting abortion training, many future doctors are dissuaded from entering the field because they’d rather not risk their careers and their lives.
While that might sound like a dramatic over-exaggeration, it’s not. Doctors are less likely to want to practice in states that have piles of abortion restrictions that make their jobs more difficult, and even threaten to level criminal charges against them for providing their patients with medical care. Doctors are also probably invested in their own personal safety, and persistent levels of anti-abortion harassment — including ongoing violent threats — have proven that it’s still not necessarily a safe field. Slain Dr. Tiller’s former clinic almost wasn’t able to re-open to the public because its new owner couldn’t find a medical professional who was willing to practice in that notorious Kansas town.
And what’s the end result of all of these dynamics? Not nearly enough doctors. The National Abortion Federation estimates that the number of abortion providers has dropped by 37 percent since 1982. A staggering 97 percent of family practice residents don’t have any experience with first-trimester abortion care whatsoever. According to one recent study, 97 percent of OB-GYNs have had patients who want to get an abortion, but only about 14 percent of those doctors actually knew how to perform them.
Since 57 percent of all of the existing abortion providers are over the age of 50, these issues will only keep getting worse unless a new generation of doctors are educated in a different environment.
There are some potential workarounds to this issue currently being pursued. A group of OB-GYNs recently made the case that more hospitals need to be providing abortion care, so the practice doesn’t end up being segregated in stand-alone clinics that are ripe for anti-choice attacks. California lawmakers just approved a bill that would allow other types of medical professionals, like nurses and trained physicians assistants, to perform first-trimester abortions.
But ultimately, preserving reproductive health care starts in medical school. (This issue isn’t limited to abortion; it’s a potential threat to birth control as well.) As one of Medical Students for Choice’s slogans notes, “we need to be educated to keep choice alive.”