The article started out saying more doctors are refusing to provide abortions, but as I read on, it sounds like really the doctors are choosing different specialties.

Therefore, it's different than pharmacists refusing to fill EC / BCP prescriptions. It's not like these are doctors who are SUPPOSED to be providing abortion care, and then when women come to them they say "No way you slut!" which is much more analogous to our pharmacist situation here.

Not that it's not very concerning. And I wonder, is anti-abortion sentiment responsible for the movement of doctors choosing other specialties? Or is it just that doctors don't understand how incredibly crucial care it is, because for instance, they weren't around when abortion was unavailable?

Just as abortion rights are being reconsidered in Mexico, access is declining in the UK. Speaks to the need for united, worldwide action on behalf of women's reproductive rights.

In the article, Ann Furedi, of the British Pregnancy Advisory Service, suggests nurses may begin to fill the role as abortion providers. I've long thought that such care should be available from a wider array of health practitioners, even as an in-home service. (similar to midwifery care in home-births.) BUT, as long as we have a political/cultural climate that allows doctors to opt out of specific aspects of women's health care, women's freedoms are at risk. What if 10 years down the road, a majority of nurses "choose" not to provide abortion care?
This is unacceptable in medicine and a very dangerous precedent.

I don't know as much as I should about how the specialization of ob/gyn services works. If someone becomes an ob/gyn, would abortion be part of their training? Or does someone who provides abortion services generally only do that procedure? I know that in the US clinics that provide abortion services are usually private, free-standing facilities, rather than hospitals.

It seems (to me), like early-term abortion should be a basic part of women's healthcare, and if someone was trained to handle miscarriages, births, contraception, pelvic exams, breast exams, etc., they should also know how to provide early-term abortions. (I understand that late-term abortions are much more complicated, dangerous, and usually connected to a severe medical problem . . . and thus it makes sense that a specialist would be brought in).

Note: I don't know absolutely loads on the subject so forgive me if i make a huge oversight.

I'm from the UK myself and one of the campaigns at my uni at the moment is about more abortion rights for women. Although we are lucky that abortion is legal in this country under more circumstances than others, it still is actually pretty limited, and the law states that 2 doctors have to say that they will allow the abortion to go ahead. And i don't mean they'll allow it in terms of the risk to the woman's health but of their own political/religious/generally backwards beliefs.
Whilst this does not matter generally in private care (ie specialised abortion clinics), it means that if you happen to be allocated a doctor on the NHS who doesn't agree with abortion, you can't have one. You also have to suffer large waiting lists on NHS for abortion too.

As I said before I don't know all the ins and outs, as far as I am aware all the above are true but there are many different factors- ie like someone said above doctors choosing to specialise in areas other than ob/gyn.

Our NHS is in crisis, sadly this doesn't surprise me.

Nurse-Practioner/Midwives should be allowed to perform early-term abortions and oversee chemical abortion procedures (RU486). Delivery of a baby is more of a health-risk than early term abortion--so why shouldn't (or can, anybody know?) Midwives also be able to perform this? A few years ago, there was an article out about how fewer and fewer medical schools are giving doctors the opportunities to learn abortion procedures--state schools especially. I don't know how that issue has progressed, but it seems to me that so many women after miscarriage actually need extraction of the fetus and surely that is the same procedure--my mother had a miscariage before I was born and without her D & E, her womb could have been damaged by the presence of a dead fetus for an extended basis (plus, ugh, just the thought).

Surely the "quiverful" people and their ilk want women's wombs to be ready for "new life" at the drop of a hat. Knowing these procedures is crucial for women's health, yet again, politics, not MEDICALLY ACCURATE SCIENCE dictates policy. All OB/GYN's ought to be familiar with abortion procedures, if not for the least pressing issue of when a woman's life is in danger (early, tubal pregnancies, for example). If they don't want to choose "elective" abortion specialties, fine, but in terms of basic care, it ought to be taught. But overall, if the elitist MD's won't learn, then give Midwives licenses.

Peace

In talking with health provider friends, I have long heard about the decline of training in surgical abortion services. From my lay position, I understand that such training was universal for OB/GYN care, and even for family practice. That is no longer the case. Doctors specialize, medical schools no longer require such training and so on. This article from Z magazine is dated (2003) but I think covers the issue quite well.

Thanks for the article link, owlhouse. Sounds like in the U.S. at least, TRAP laws are making abortion care a very unattractive specialty b/c dr.'s have to put up with all that shit.

I'm also reminded that in general, obgyns are dwindling b/c of the enormous malpractice insurance. Doctors are also specializing away from family practice b/c it doesn't make enough money.

i think that women's health organizations (i.e. planned parenthood) need to start actively seeking out medical students who might be interested in being abortion providers. maybe they do such a thing already, but not that i'm aware of. don't other specialties do this? i've always kind of wished that i had any interest AT ALL in science/medicine so that i could work as an abortion provider. it's such a necessary but "undesirable" profession. but, alas, it didn't work out that way.

I guess I'm in a quandry here.

As one who supports to notion of COs when it comes to war, I feel like I have to support application of the idea to other areas. Doctors can certainly choose to not carry out a procedure that they see as taking life, just as my dad refused to go to war in the 60s, or my philo prof in the 40s.

And as somebody pointed out above, it's not quite the same as pharms refusing to give a script out.

I think we need to look at this in a different way: what can we do to encourage doctors who are choosing other, probably more lucrative and less, uh..."controversial" specialties to provide a necessary service.

[dons flame retardant suit, pours a drink]

I think I understand what you are saying NTodd, but I don't think the situations are exactly analagous. No one is conscripting people into the medical profession as people were conscripted into the soldier's profession in the past.

Medicine is such that we NEED people who are going to act as impartially as possible on matters relating to the choice of their patients. We place our health in the hands of these people and we need to be able to trust that they are going to keep their personal beliefs out of it.

It should be a recognized part of becoming a medical professional that personal beliefs about "moral decisions" be kept out of the operating room.

That said, of course we require a certain amount of ethical capacity in our doctors and nurses, but I don't think that is quite what we are talking about here.

"And I wonder, is anti-abortion sentiment responsible for the movement of doctors choosing other specialties? Or is it just that doctors don't understand how incredibly crucial care it is, because for instance, they weren't around when abortion was unavailable?"

Or is part of it that more doctors are choosing cardiology, gerontology, psychiatry, etc. instead of choosing primary care or gynecology?

also, abortion provider is not exactly a glamorous profession. i imagine that anyone who performs abortions would have to be pretty passionate about the cause to be willing to put up with protesters, death threats and the pay that's lousy in comparison to what a lot of other doctors make.

Mina -- absolutely, that too. Ob/gyns are dwindling (insurance costs are huge, making it less profitable) and primary care is not as lucrative as it once was, due to the shoddy ways/amounts insurance pays (I worked for an insurance co., so I should know!). It's a huge problem.
It's why we have family doctors trying to supplement their incomes by offering plastic surgery on the side.

I don't think health care providers should be forced to perform surgery that is against their personal ethics.

No one will be happy until 100% of ob-gyns perform abortions? Even when abortion was outlawed in the US you could still find doctors who did them on the sly...are women in the UK actually not able to get abortions?

it's an issue of accessibility, crella. there are places in the US where women have a lot of difficulty getting abortions. i know for a fact that there is only one abortion provider in the entire state of SD. which means that a lot of women, poor rural women who don't have the means to travel, don't get a choice.

Even though I'm pro-life, I'm sympathetic to the worry people who are pro-choice have about abortion services becoming scarce. However I strongly believe that no one should be forced to provide services that they have moral objections to.

If the thing that people feel is immoral is the whole of a job you should not be doing it, - say you were anti-death-penalty you should not take work as an executioner.
But in the case of being a doctor, there are lots of other things that need doing as well as abortions, so I feel that there is no need to insist that all people who want to be doctors must perform abortions.

To get a perspective on it, I find it helps to imagine a situation that you can be very sure of your feelings on. For example if you imagine that in a possible future euthanasia is legal - but horribly (to your sensibilities at least) families are allowed to request the 'removal' of old, useless, or disruptive family members. Clearly this, to you, is immoral, and you would not want to be forced to provide this service, but you'd still want to be a doctor. And this is how I would view the suggestion that we might force people to choose between doing things they feel are immoral, or to leaving their profession.

No one is conscripting people into the medical profession as people were conscripted into the soldier's profession in the past.

That's a good point. Although, I'd note that even those who have enlisted in the military can file for CO status. Would that more of them did that during our current conflict.

Anywayz, I agree that something needs to be done to make sure necessary medical procedures are available.

crella- Yes, women in the UK have access to abortion. The issue is that if current trends continue, access will be extremely limited within the next 5-7 years. My point less that I want or expect every OB/GYN to perform abortions BUT that I want the medical schools they attend to offer and require training for students pursuing studies in female reproductive care. How can doctors accurately advise their patients or educate and support one another when their training is incomplete?

Sure, women have always found ways to limit child bearing- including pursuing illegal abortion pre-Roe. In no way does this give me comfort about the current trend. Women deserve full access to reproductive care with competent and compassionate doctors in their own communities.

Bluth- to get another prospective (a very imperfect analogy because few issues are as weighty as abortion)- Say a pediatric medical student is opposed to some immunizations as they have been linked with autism and other disorders. The student wants to specialize in pediatric oncology anyway, so the medical school school doesn't require, or even offer education on childhood immunizations.

I'm trying to make that point that personal ethics should not exclude a doctor from having to learn and train in the full spectrum of health care. I believe that the decline of these training programs feeds the stigma and isolation of both women seeking abortion and the doctors who care for them.

another aspect to this issue: if a woman has a pregnancy that is not viable, what does she do about the tissue in her uterus if there is no local doc that knows how to do a D&C?
what i'm seeing above is that folks aren't LEARNING how to provide abortions, rather than are learning but won't. that's scary beyond the issue of choice (an enormous issue indeed) but also because a woman's body doesn't always miscarry all the way by itself. and if docs aren't learning how to do a procedure to prevent infection, how dangerous for women and scary is that?

ps - lots of planned parenthoods do train med students on performing standard abortions. i don't know numbers, but i know it certainly does happen.

"BUT that I want the medical schools they attend to offer and require training for students pursuing studies in female reproductive care."

They do. Do you mean by this that all students should learn to perform abortions? I wasn't clear as to what you meant. Students who persue studies in female reproductive care ARE trained. Not performing abortions (one procedure out the total experienced in gynecology)really does not limit their scope as ob-gyns.

For those to whom a fetus is a life, and to whom abortion is extinguishing that life, there is a world of difference between a D&C and an abortion.I don't know of a doctor who won't perform D&Cs post miscarriage, but many do not want to do abortions. I doubt that you'll ever be refused a D&C.

Should there be trouble in recieving a D&C because of doctor availability, the option of medication is still available. I had an anesthesia goof-up, my heart stopped when I was intubated, and a D&C I was scheduled for due to miscarriage was stopped as they didn't want to re-try anesthesia. A course of pills for 5 days worked fine.

i see what you're saying, crella, but with no abortion provider, women are going to have to go through extra effort to find a doctor willing to prescribe the medication for a chemical abortion. i imagine that if a doctor refuses to perform abortions, he or she will also refuse to prescribe abortion-inducing medication. another VERY large issue is education. the poor, rural women who would be most affected by a shortage of abortion providers are not necessarily going to know that chemical abortions exist-- a lot of rich, urban women probably don't know that.

i'm in no way supporting a rule where all doctors have to perform abortions. i know that i sure as hell would not want a doctor who was morally opposed to abortion performing one on me. i'm saying that we need to find a way to recruit doctors into this kind of work and make sure that training for OB/GYNs is mandatory.

Hey crella- I wrote last night - including links to a number of studies/articles, it's held up but I hope will roll around. In short- by 1995 only 12% of OB/GYN programs provided abortion training. To address the lack of education, the Accreditation Council for Graduate Medical Education put out new guidelines. The Coats Amendment to the Omnibus Consolidated Rescissions and Appropriations Act of 1996, in addition to legal response by many state governments, have allowed programs to continue to avoid such training. Currently, at absolute most, about 70% of OB/GYN include some training (2 days-8 weeks) in residency programs. Only about 10% of this training is directed through the teaching hospitals- the rest is clinic-based, usually with clinics initiating the program (and sometimes creating the curriculum).

Family Practice students, who serve as the primary reproductive care providers for 75% of US women, do not receive abortion training as part of their OB/GYN study.

I know none of this speaks directly to the UK article, but my concern is that the decline in available care and doctor training we've experienced here- is beginning in the UK. My hope would be that our failures would serve to prompt action in the UK before these experience the crisis predicted.

The sign-off by 2 doctors isn't a big deal. Some feminists have theoretical problems with abortion having to be 'authorised' as opposed to a right. But, if you want an abortion, there's no effort needed to find two doctors (enough are pro-abortion that they'll sign you off automatically), in practice it's a formality.

This isn't conscientious objection, it's just a labour shortfall. It's not lots of doctor oppose abortion - they don't - it's just they want to work in other areas of medicine than providing abortions.

As for "conscientious objectors", it's not really new. It was a concession needed to get the Abortion Act passed. If your doctor does have a objection to abortion, he can not participate, but is still under a duty to refer you to another doctor who doesn't object.

There are issues here. GP's who will refer women for abortions get paid the same as those who don't. You could argue that they shouldn't be paid for work they're not doing. Or that refering women for abortions is a part of their job and they shouldn't be employed if they're not willing to do it. But people don't want to create that sort of fuss.

leed-
um. "The sign off by two doctors isn't a big deal."?!?!
I have much more than a "theoretical"problem with this. You write as though you know that it's easy, in all cases, all the time to find multiple "pro-abortion" docs to complete the "formality". That is contrary to many stories I've heard first hand. Easy or not, it's a step that doesn't belong in women's reproductive health care. Period.