Pro-Choice Movement in a Quandary over Shortage of Abortionists

Pro-life protestA fascinating article entitled “Pro-Choice Timidity in Fighting Shortage of Abortion Providers” appeared last week on the website Remapping Debate.

We’ve known that abortion supporters have been wringing their hands for years about the dearth of doctors willing to actually become abortionists.

And according to Remapping Debate reporter Heather Rogers, the “pro-choice” side has no unified strategy for solving what is, for them, a major problem.

Here’s the gist of Rogers’ article:

Remapping Debate’s investigation found that the efforts being made, particularly when it comes to providing encouragement for, and training to, ob-gyns already in practice but not yet performing abortions, were severely limited; that progress has stalled in providing training for medical students and for doctors completing their residency requirement; and that there is widespread defensiveness among abortion-rights supporters about engaging in aggressive efforts to organize and set out a “counter-narrative” that could support a major increase in the supply of ob-gyns who perform abortions.

Rogers then notes, interestingly:

Indeed, despite repeated efforts on our part, no representative of the Planned Parenthood Federation of America, which describes itself on its website as “the nation’s leading sexual and reproductive health care provider and advocate,” would agree to be interviewed by Remapping Debate.

This should come as no surprise. Unless an interview request comes from a major news outlet, the nation’s leading abortion chain usually doesn’t condescend to answer questions.

She continues:

Several individuals we did speak to when preparing this article urged us, apparently independently of one another, not to run the story out of concern about creating a “backlash.”

Exactly. Because abortion is toxic.

“If They Want to Do Abortion Training They Will Find Their Way to Us”

Although most doctors currently receive abortion training as medical students or during residency, Rogers points to some evidence suggesting that providing abortion training later in a doctor’s career might produce a higher percentage of abortion providers.

So Rogers contacted the Kenneth J. Ryan Residency Training Program and the Family Planning Fellowship — both run out of the University of California, San Francisco (UCSF) — and the New York based Reproductive Health Education in Family Medicine Program, all of which provide abortion training to med students, hospital residents, and doctors who have just completed residency.

But like Planned Parenthood, all three programs declined to answer questions about what they were (or were not) doing to try to increase the number of abortion providers among practicing ob-gyns who are not already doing abortions.

National Abortion Federation (NAF) CEO Vicki Saporta did agree to be interviewed, and when asked if NAF has a particular outreach to physicians already in practice to try to convince them to become abortionists, Saporta replied, “If they want to do abortion training they will find their way to us.”

In other words: No.

Rogers also interviewed Dr. Debra Stulberg,

…president of the Midwest Access Project (MAP), a small non-profit that provides abortion training, including to practicing doctors. Stulberg believes that “mid-career doctors are an important workforce for reproductive healthcare.” Yet MAP, which provides training for several medical students and several residents each year, was only able to train practicing physicians at a rate of less than one per year from 2007 to 2012.

Meaning that for at least one year out of the past six, MAP trained zero doctors to become abortionists.

Stulberg acknowledges that the biggest problem faced by MAP is finding current abortion providers who are “willing and able” to teach others who want to learn.  And because current abortionists aren’t going to teach for free, programs like MAP are chronically short on funding.

Limited Abortion Training in Medical Schools

Clearly, then, most currently practicing ob-gyns who are already in practice and have, from the outset, opted not to do abortions are not likely to become abortionists later in their career.

So from the perspective of the abortion industry, they have to get to doctors before they actually become doctors.

But if you ask groups like Medical Students for Choice (MSFC) — whose 2010 conference was infiltrated by the Pro-Life Action League — that’s not happening anywhere nearly as much as they wish it would:

According to MSFC, even those medical schools that do offer abortion education in the first two years dedicate less than 30 minutes to the topic. The group claims that most of this instruction is limited to ethics discussions, and not education and training.

And during the final two years, when medical schools focus on clinical training, less than a third of all medical schools have at least one lecture specifically about abortion, as reported in a 2005 article in the American Journal of Obstetrics and Gynecology, an academic journal.

[MSFC executive director Lois] Backus said that many medical schools are reluctant to teach abortion out of fear of losing public and private funding. She also said that there were instances of students threatening to sue medical schools if they were made to study abortion. [emphasis added]

Mark well, pro-life medical students: if your program tries forcing you to learn how to do abortions, get ahold of a good pro-life attorney.

Pro-Life Law Overrides Rule Forcing Residents to Undergo Abortion Training

Residency programs are a different ballgame.  Rogers notes that in 1996, the sole accreditation body for residency programs in the U.S., the American Council of Graduate Medical Education (ACGME), instituted a requirement that “experience with induced abortion must be part of residency training.”

The rule had an impact: whereas only a small fraction of residency programs routinely integrated the training into their curricula prior to the rule, 50 percent of residency programs do so today (residents retain the ability to opt out).

But another 10 percent do not offer the training at all, and fully 40 percent only offer it on an “opt-in” basis, even though the American College of Obstetricians and Gynecologists [ACOG] has found, “The nature of elective or opt-in training places the burden to create a clinical experience on the residents, and prior data show that the majority of residents participate in training when it is integrated whereas a minority of residents participate when it is elective.”

Clearly, as a result of ACGME’s 1996 rule change, signifcantly more residency programs now require abortion training, although residents can still opt out.

But what about the 40% who offer abortion training as “opt-in” only, and the 10% who, to their credit, refuse to offer it at all?

A central obstacle to full enforcement of the ACGME’s abortion-training requirement is the Coats Amendment, named for Senator Dan Coats (R-Ind.), and passed by Congress as an amendment to the Public Health Service Act of 1996. The Coats Amendment states that governments at all levels “shall deem accredited” any residency program that would otherwise be in noncompliance with abortion-training requirements. In other words, the amendment overrides the ACGME’s ability to revoke the accreditation of a program that is not offering abortion training. [emphasis added]

Let the record show that the Coats Amendment is yet another example of pro-life legislation that works.  Although ACGME changed its rules in 1996 with the specific intention of requiring all residency programs in the U.S. to offer abortion training, the Coats Amendment has effectively nullified it.

No Unified Strategy

What is the response of the abortion industry as to how to expand abortion training?   That depends on whom you ask.

Some, like longtime abortionist Douglas Laube, believe the ACGME should “crack down” on ob-gyn residency programs that don’t require abortion training.

But others, including Suzan Goodman, executive director of UCSF-based Training in Early Abortion for Comprehensive Healthcare (TEACH), favor a somewhat different tack:

While Goodman agreed that ACGME requirements should include abortion training and that the enforcement tools (like the issuance of citations) that Laube described should be employed by the ACGME, she emphasized her concern that drawing too much attention to the issue could be “polarizing.” She said, “sometimes our efforts go further without the banner” of abortion rights, adding, “We need to be cautionary in our attempts to broaden the requirements so that we don’t just elicit more opposition than we started with.”

In other words, a go-slow approach.

Others favor a don’t-say-anything approach.   In one of the article’s most eye-opening paragraphs, Rogers writes:

…[A] leading academic researcher in the field, who had already spoken with Remapping Debate on the record, sent us an email cautioning against the publication of this article. The researcher, who did not want to be identified by name as the author of the email, warned about “the possibility of negative effects of writing about [abortion training].” The email continued: “Drawing attention to training in the media inspires legislators to write and pass training restriction bills. That would cause a lot of problems for training and worsen access.”

Rogers goes on to point out that it appears as if “some groups are trying to lower their abortion-rights visibility,” noting that an organization called the Abortion Access Project has recently changed its name to simply Provide.

What’s more:

On Feb. 12, 2013, Physicians for Reproductive Choice and Health changed its name to Physicians for Reproductive Health. Asked about the change, the organization’s director of communications asserted that the word “choice” was “redundant.”

Recall that Planned Parenthood, of course, began moving away from “choice” rhetoric just a few weeks prior.  Now Physicians for Reproductive Health has done the same.

Initial Interest in Abortion Often Wanes

Midway through the article, Rogers has a sidebar with the heading, “Why does initial interest in providing [abortion] services often not translate into practice?”

She quotes sociologist Lori Freedman, who authored a 2010 Guttmacher Institute study that found that “60 percent of [ob-gyn residents] surveyed had wanted to offer elective abortions after their residencies. Ultimately, however, just 10 percent were doing so.”

Note the various reasons for the steep drop-off:

“There are a lot of problems with integrating abortion into practices,” Freedman told Remapping Debate. “The reasons for policies barring abortions are stigma, fear of lost business through controversy, or people protesting. And sometimes it’s just logistics.” The barriers can range from highly charged political and religious objections to the more mundane. For example, if a group practice or clinic starts offering abortions, this may slow down the number of patients its doctors can see in any given week. “They may not have a huge opposition to it, but it would create a disruption to the flow of the clinic,” Freedman said. “If it’s not a priority and if it’s very easy to send them to Planned Parenthood, why bother?” [emphasis added]

Take another look at the last sentence quoted above.

It’s widely known that for the past several years, the Wal-Mart of the Abortion Industry has been gobbling up an ever larger share of the abortion market.

Pro-lifers know this, but so too does the other side.  Some small-time abortionists have even voiced their frustrations publicly about the difficulty they face competing with the nation’s largest abortion chain.

With this mind, and in light of Freedman’s remarks, we see that Planned Parenthood actually serves as a barrier to doctors to do abortions within their own independent practices.

Note also, once again, a fact that simply cannot be repeated often enough.  Chief among the reasons that keep doctors from doing abortions are “stigma, fear of lost business through controversy, or people protesting.”

Hence the need to continue doing what the Pro-Life Action League has been doing since 1980: robust pro-life activism. Because it works.

HT: Dennis Byrne

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