Fourteen percent

It’s not just new laws and restrictions, it’s not just protesters outside clinics, it’s not just Catholic hospitals gobbling up secular hospitals – it’s also training, and how difficult it is to get it. The Daily Beast reports on the scarcity of medical training in abortion.

…abortion training is still largely isolated in freestanding clinics and the relatively few OB-GYN residency programs that provide comprehensive training. Although the Accreditation Council for Graduate Medical Education—the governing body which sets nationwide rules for medical residencies—put abortion training on the curriculum for all OB-GYN programs in 1996, Congress took the unprecedented step of nullifying that decision soon afterward. To this day, any program that does not abide by the ACGME guidelines won’t lose its federal funding, and only 40 percent of OB-GYN programs in the country offer comprehensive abortion training.

“It’s this cuckoo level of micromanaging,” Carole Joffe, a sociologist and author of two books on the history of abortion rights, said of Congress’s decision. “In theory, it’s not illegal for them to do that, it’s just unprecedented.”

Congress micromanaging medical education to make sure abortion training is not required – wonderful, isn’t it? Nothing is too much when it’s a question of making sure women don’t have rights.

“We had one OB-GYN resident come work with us, and her hospital was affiliated with a Catholic hospital and she was getting no training in abortion whatsoever,” Debra Stulberg, a family practitioner and researcher at the University of Chicago, told The Daily Beast. “Often, having the elective time and being able to find an experience where you can get training is not the same.”

Even when motivated medical students and residents can find abortion training, they’re not always able to make use of those skills later on. Some private practices and hospitals have been known to make physicians sign contracts saying they won’t provide abortions—even at an outside clinic—while on staff.

“The real problem facing abortion provision—besides the stuff you know about Texas and admitting privileges—is at a much quieter level,” Joffe told the Beast.“It’s becoming hard for those who are trained to find places at which they can practice. From a hospital administration point of view, do you want picketers? Do you want hassles? No.”

They don’t need to overturn Roe v Wade. They can just make it too scary to provide abortions, and the result is the same.

Stulberg has observed the same thing. In 2011, she published a paper in which she found that, while 97 percent of OB-GYNs encountered patients seeking abortions, only 14 percent provided them.

“The tactic on the religious right to stigmatize abortion has translated beyond just making it hard for women to seek abortion,” she said. “Hospitals, medical schools, others who you would think might be neutral or even take a pro-reproductive-health stance, often are just afraid—afraid of protests, afraid of attention. They would rather just fly beneath the radar.”

Only 14% of OB-GYNs provide abortion.



  1. says

    So same question I had before. How do we wrap up all of these anti-abortion laws into a smaller set of challenges based on the fact that they create a de facto hindrance to the right to an abortion? If the right is dying from a thousand hurdles either enough resources need to be marshaled to counter them all, or a new approach is needed on the same level as previous efforts at creating civil rights law.

  2. iknklast says

    I wonder what the percentage is of OB/GYNs who won’t provide referral to an abortion provider?

  3. Pierce R. Butler says

    All this will create a burgeoning market for (mostly bogus & dangerous) “abortion pills” – and drive more women into back alleys to obtain them.

    Thanks for all the constructive social engineering, hyperchristians!

  4. R Johnston says

    In a sane world 100% of OB/GYNs would provide abortion services. Abortion is a fundamental aspect of women’s health care. Being an OB/GYN who doesn’t do abortions is like being a nephrologist who doesn’t do left kidneys because the left side of the body is “dirty.” It’s absolutely ridiculous, a subsumption of medicine to mythology.

    Emergency care doctors should also be required to perform abortions, and pediatricians and general practitioners should be required to provide abortions or have a local referral agreement for abortion provision. If you’re a doctor who in the regular course of your practice offers primary or emergency care to pregnant people, then abortion is your business.

  5. Pteryxx says

    I wonder what the percentage is of OB/GYNs who won’t provide referral to an abortion provider?

    iknklast: from what I know, OB/GYNs refusing to refer in the field has more to do with whether they work for Catholic-owned medical organizations which consider referral just as blameworthy as if they’d performed an abortion themselves. (And in the US, Catholic hospitals often comprise anywhere from 50% to 100% of the medical facilities in an area.) However, here’s a survey study saying 12% of OB/GYNs agreed that the scenario of refusing both abortion care and referral was appropriate.

  6. Pteryxx says

    Some good news though – California is currently improving abortion access by training nurses and physician assistants to provide them.

    (copying my comment from the Lounge)

    California *improves* abortion access by adding early abortion providers

    Thanks to a law passed last year, California is actually adding abortion providers – nearly fifty nurse practitioners, nurse midwives, and physicians’ assistants, trained to provide aspiration abortions in the first trimester –with more to come.

    The state is bucking a nationwide trend as a wave of new restrictions is forcing abortion providers across the country to shut their doors. In Texas, the second-largest state after California, initial enforcement of a law passed last year initially put a third of the clinics of the state out of commission, and when new regulations go into effect in September, all but a half-dozen clinics are expected to close.


    Until the nurse practitioner was added to the daily ranks, the Eureka clinic only had a doctor who would come one day a week to provide abortions up to 13 weeks and six days.

    For the woman who had lost her transportation, having to wait a whole extra week was going to mean the difference between getting a ride to Eureka and getting a ride to Santa Rosa or Chico, each nearly four hours away.

    Seeing the nurse practitioner would also mean a familiar face. “The idea that abortion should occur in the settings where women get primary care was very important to us,” said Maggie Crosby of the ACLU of Northern California, who also testified that day. “That meant they could get abortions from clinicians they know and trust.”

    And it would be a departure from the status quo in most places, where segregating abortion from other kinds of medical care has helped single out abortion providers for violence and abortion patients for stigma.

    Backed by this study, which required a huge fight to even conduct, showing that not only are nurses and assistants qualified to perform aspiration abortions, but that the procedure’s even safer than previously thought.

    Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver

    Look at that title. Just look at it. *admires*

  7. Pteryxx says

    and from the Stulberg paper cited above:

    While 34.7% of obstetrician-gynecologists who responded to this survey are located in the South, only 8.2% of southern obstetrician-gynecologists provide abortions.

    8.2 %

  8. Pteryxx says

    iknklast, here’s another reference cited by Stulberg:

    On the basis of these results, we estimated that when a patient requests a legal medical procedure to which the doctor objects for religious or moral reasons, most physicians believe it is ethically permissible for the doctor to describe that objection to the patient (63%) and that the doctor is obligated to present all options (86%) and to refer the patient to someone who does not object to the requested procedure (71%) (Table 2).

    When examined by religiosity (see Table 3 here):

    Low religiosity: 82% agree that the physician has an obligation to refer the patient
    Moderate religiosity: 73%
    High religiosity: 56%

  9. K. says

    Let me point out that getting a dead baby out of a woman’s body is not different from getting out a living baby. Meaning that no training in abortion means no training in getting dead babies out of the womb, meaning women will die from sepsis.

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