"Legal abortion in America will be meaningless if there are no doctors to perform them."
-Linn Duvall Harwell, founder of the Duvall Project
Access to safe and legal abortion for all women requires well-trained and committed physicians to perform the procedure. The widespread lack of comprehensive training programs in elective abortion for residents has left thousands of new ob/gyns insufficiently trained in this simple procedure. In a 1992 national survey of residency directors, 47% of graduating chief residents said that they had never performed a single first-trimester abortion.
As the generation of physicians who experienced the tragedies of illegal abortion and who staffed the first legal abortion clinics in the post Roe vs. Wade era reach retirement age, clinics are finding it increasingly difficult to recruit replacements or expand their services. Physicians who are trained are often unwilling to perform abortions under the constant threat of harassment and violence against themselves and their families. A Planned Parenthood clinic in Pennsylvania spent two-and-a-half years searching for two physicians to perform abortions one day a week.
In recent years, anti-choice activity has focused on targeting individual physicians and clinic staff in intense campaigns of intimidation. A "Wanted" poster with a photograph and clinic schedule of Dr. David Gunn was circulated in the months prior to his murder by an anti-choice protestor in March, 1993. Four months later, an anti-choice organization in Chester County, Pennsylvania, distributed posters and postcards, captioned "Not Wanted" and "Abortion, Inc," bearing the names, photographs, addresses and phone numbers of two physicians who work at a local women's clinic.
The intimidation of physicians begins before they are even practicing medicine. In the spring of 1993, 33,000 medical students received a comic book in the mail from an anti-choice organization called Life Dynamics. Titled "Bottom Feeder," it contained dozens of "jokes" about abortion providers, many violent in nature:
Q: What would you do if you found yourself in a room with Hitler, Mussolini and an abortionist, and you had a gun with only two bullets?
A: Shoot the abortionist twice.
Medical students who have advocated for increased abortion training at their institutions have also been picketed at their homes, and student organizers must be concerned with protecting the identities of fellow activists, further adding to the atmosphere of danger and intimidation.
Many medical school curricula do not include comprehensive explorations of sexuality and reproductive issues. Some students report receiving as little as 45 minutes of training on reproductive health issues in four ears of medical school. In addition to limited knowledge of the technical aspects of the procedure, many students have not had the opportunity to adequately explore their concerns about the highly charged issue of abortion. Without such opportunities, many are understandably left confused about their roles and responsibilities. Despite the fact that 1.2 million women obtain abortions every year in this country, the relative silence on the topic can give medical students the impression that abortion is not an essential component of health care delivery.
The stigmatization of abortion and lack of training opportunities for residents can be attributed to the shortage of hospitals offering comprehensive reproductive care. With only ten percent of abortions occurring in hospital settings, many hospitals do not perform enough abortions to offer significant learning experiences for their residents. And, as untrained physicians take on positions in teaching hospitals, it becomes harder to find qualified staff to serve as role models for residents. In addition to managing heavy work loads within the hospital, residents who wish to familiarize themselves with elective abortions are forced to moonlight at outside facilities.
A majority of residents participate in abortion training when it is presented as a standard, required component of residencies. However, few programs have mainstreamed abortion training in this manner. Between 1985 and 1991, the percentage of ob/gyn residency programs in the United States with routine training in abortion procedures declined by 45%. In a 1993 survey of Pennsylvania ob/gyn residency programs, less than ten percent required training in first trimester abortions.
Although changes have been proposed, the current objectives on abortion required by the Council on Residency Education in Obstetrics and Gynecology (CREOG) do not require that physicians be able to carry out the procedure as long as they can "arrange contact with a facility or personnel" who can do so, perpetuating the idea that individual competency in abortion procedures is not important for doctors concerned with women's reproductive health. This endangers the lives of women who may need abortions in emergency settings, and limits access to therapeutic abortion.
In addition to indicating a widespread shortage of training in abortion procedures, national research shows that gynecologists and obstetricians do not receive thorough instruction in a full range of contraceptive options. Residents only receive substantial training in tubal ligation, oral contraceptives and Norplant, with the rapid introduction of the latter credited to the influence of the pharmaceutical industry. A teaching program guided by the needs of women would include elective abortion, the most common surgery performed on women, as well as all available methods of contraception, backed by specific competency requirements in these areas.
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