Lack Of Providers, Physician Training Could Limit Access To Abortion Services, Experts Warn

Main Category: Abortion
Also Included In: Primary Care / General Practice;  Medical Students / Training
Article Date: 09 Sep 2009 - 5:00 PDT

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Reproductive health experts are concerned that a shortage of younger physicians willing to perform abortions could limit access to the procedure, which is one of the most common medical procedures in the U.S., the Washington Post reports. The Post reports that about 1.2 million abortions were performed in 2005, and about one-third of U.S. women will have the procedure by age 45. However, the number of abortion providers decreased from 2,908 in 1982 to 1,787 in 2005, according to the Guttmacher Institute. Abortion services are not available in 87% of counties and 31% of metropolitan areas in the U.S.

A January report from an American College of Obstetricians and Gynecologists committee found that only one-third of U.S. medical schools offer formal lectures on abortion. Unlike most clinical experiences, abortion training is optional, rather than a required part of the curriculum, according to the ACOG report. Stigma and violence against abortion providers, especially the May 31 murder of Kansas provider George Tiller, have deterred many medical students from offering abortions once they graduate. According to the Post, a 2008 study found that only half of ob-gyn residents who said that they wanted to provide abortion services in their practices actually did. Lois Backus, executive director of the group Medical Students for Choice, which has chapters on more than 120 medical campuses in the U.S., said that the shortage of physicians who provide abortion services presents "huge public health implications." Susan Hill -- president of the National Women's Health Foundation, which operates abortion clinics in largely rural states -- said the U.S. "need[s] young doctors and we need them badly," adding that the "situation is pretty grave, pretty dire." Hill said, "Our doctors are graying and are not being replaced."

A 2008 report in the journal Contraception found that 66% of physicians who perform abortions in the second trimester are older than age 50. Nebraska-based provider LeRoy Carhart and Colorado-based provider Warren Hern, both of whom fall into that age bracket, are the only two physicians in the U.S. known to perform abortions after 20 weeks' gestation. Tiller also performed late abortions, which represent about 1% of procedures and typically are limited to women with life-threatening conditions or severe fetal abnormalities.

According to the Post, many older doctors who provide abortion services "cite searing memories" of women who underwent dangerous illegal abortions prior to the 1973 Roe v. Wade decision that legalized the procedure. Hill noted that younger doctors "have never known abortion to be illegal or even threatened."

Few physicians offer abortion services in their offices out of fear that they will be targeted by antiabortion-rights advocates. Randall Terry, a prominent antiabortion-rights advocate, said those opposed to abortion rights believe it is not necessary to make the procedure illegal if access to it becomes impossible. He said such advocates, including himself, want medical students to be "tormented," adding that if doctors decide to offer abortion services in their practices, "we will make their lives miserable." Second-year medical student Devin Miller, leader of the Virginia Commonwealth University chapter of Medical Students for Choice, said that she is considering offering abortion services but that it is "very hard to be confronted with the constant negative energy and constant fighting" that surround abortion.

A few medical schools do offer abortion training, the Post reports. For example, George Washington University Medical School offers student four hours of instruction on family planning and related topics, as well as an hour-long lecture on abortion. Megan Evans, a third-year medical student at the school and president-elect of GWU's chapter of Medical Students for Choice, said of the amount of training, "Compared with other schools, that's a lot. I think some of us feel there should be more" (Boodman, Washington Post, 9/1).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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