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A D V E R T I S E M E N T
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A D V E R T I S E M E N T
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Pressure Point
Few Texas medical students have the option to learn abortion procedures.
By NAUREEN SHAH
“Mac the Knife is his name; abortion is his game!” reads a postcard sent to medical students at Texas Tech School of Medicine for the past three years. “He turns unplanned pregnancies to fast cash, by killing unborn babies” it continues, listing the address of an abortion provider who visits the area. An arrow directs the eye to a boldfaced box: “ABORTION is the fastest way to ruin your medical career!!!”
When second-year medical student Brenda Grant received the postcard in the mail, she was spooked. But she didn’t take the threat seriously, and she wasn’t afraid for her life. Perhaps that’s because even if Grant wanted to “ruin” her career by performing abortions, she couldn’t. At Tech and other Texas medical schools, abortion training for students like Grant is rare and probably insufficient. In some places, it’s non-existent.
According to the Institute For Reproductive Health Access, abortion is the second most commonly performed medical surgery in the United States. Yet only about 2,000 providers exist to perform the 1.3 million abortion procedures, and of those about 85 retire each year. The numbers are so low that “we’re looking at having a moot point of whether or not abortion is legal,” said institute director Cristina Page.
Fort Worth’s Southlake Clinic may be the next victim of the provider shortage that has been alarming activists for the past decade, said a Fort Worth abortion provider speaking on the condition of anonymity. “The youngest doctor [performing abortions] when I was working was in his upper 40s, but it was okay then because there were enough of us,” said the physician, who has worked at Westside, Southlake, and Trinity Valley clinics. “Now the squeeze is beginning to start, and I know that a clinic here is about to close that would [have been] an opportunity for a young doctor.”
Lynn Cooper, director of the Southlake Clinic, said that clinic personnel are “thinking about” closing but declined to say why. If it closes, that leaves Tarrant County with six abortion clinics, according to the Texas Department of Health. In a county where more than 22,000 abortions were performed last year, the loss of one facility could have a significant impact.
Nationally the availability of training for interested medical students is on the increase after decades of decline. But in Texas, it’s hard to paint a picture of what kind of abortion training is available or where. Last July, the Texas Abortion and Reproductive Rights Action League (TARAL) sought to conduct a survey about the availability of abortion procedures and abortion training at hospitals. The survey asked questions about what sorts of birth control are provided and the types of abortion procedures performed. Not a single one of the state’s teaching hospitals provided answers about abortion training. “Medical schools were anxious about participating in the survey,” said Sarah J. Wheat, TARAL director of public affairs. “For them it was just easier not to respond than to provide answers that could be used against them politically. We were totally unsuccessful in finding out what is happening.”
In the 1990s, the group Medical Students For Choice began a crusade to bring to light the decreasing numbers of new abortion providers. The national group, which has chapters at several Texas medical schools, including the University of Texas Southwestern Medical Center, Baylor College of Medicine, and Texas Tech School of Medicine, pressed for routine training and a national requirement for abortion education. In 1996, the Accreditation Council for Graduate Medical Education approved a requirement that such training be included in residency education, but Congress passed legislation effectively nullifying the requirement. Locally, the UT-Southwestern chapter of MSFC has hosted several luncheon talks and lectures without encountering active anti-abortion protests other than vandalized fliers.
Matt Cusick, UT-Southwestern coordinator for the group, said that, nevertheless, faculty hardly mention abortion in the classroom. In a carefully worded statement to Fort Worth Weekly, Dr. George Wendel, director of resident education for the school’s obstetrics-gynecology program, said that UT-Southwestern, as part of comprehensive training in family planning, makes available “access” to abortion procedures but that no such procedures are performed.
At Tech, Brenda Grant said, the MSFC chapter, which started three years ago in response to the anonymous postcards, faces a community hostile to open discussion of abortion and unwilling to acknowledge the existence of a pro-choice viewpoint. “There’d be a lot of criticism if we were open about our beliefs, [so] people are very much undercover about their interest. We have only about 10 people who come to lunch talks, but about 50 on our e-mail list.”
In the Metroplex, recruiting newly trained doctors to perform abortions is difficult. At Planned Parenthood, recruiters are always on the lookout for a new helping hand but don’t necessarily look to new graduates. The reason isn’t an aversion to young doctors, but a recognition of the fact that there is no point to fishing in an empty pond.
“Even people who are very interested don’t necessarily get trained, [so] it’s rare that we get anyone right out of residencies or their internships. We are constantly talking to medical professionals, but most of them are older,” said Kathryn Allen, a community relations official at Planned Parenthood of North Texas.
At other clinics, the recruiting story is somewhat different. An air of secrecy shrouds the question of need for more doctors at clinics like Dallas’ Fairmount Center. Furtive in their efforts to find reliable doctors and unrelenting in their desire to keep the details of their situation under wraps, high-end abortion providers like Fairmount pay little lip service to the idea that the shortage of abortion-trained doctors has or will have any effect on them. “The doctors we use here are the same doctors we’ve been using for 11 years,” said an official at Fairmount, which charges up to $750 for abortion procedures. “We don’t have a need [because] we’re very loyal to our doctors and they’re very loyal to us.”
TARAL plans to reinitiate its investigation into the practices of medical schools and the options offered to medical students this fall with the help of a coalition of groups, including its New York City counterpart NARAL/NY. In a survey of their own state in July, New York abortion activists found that 62 percent of obstetrics and gynecological residents would like to be able to provide their future patients with abortion services, but that training for most residents in nearly every abortion method was below the number of procedures needed for proficiency.
Page said part of the problem is that abortion training is not integrated into the curriculum, and in most states students must opt-in to learn the procedures instead of opting-out (43 percent of residents consider abortion training “routine” in New York City, the reproductive rights capital of the country, the Institute for Reproductive Health Access reports). The precedent, she said, suggests that the opposite should be true.
“Jehovah’s Witnesses are against blood transfusions but it would be gross negligence on the part of a medical education program to use that as a reason for making learning to perform blood transfusions, an opt-in part of the curriculum,” she said. Even medical residents who observe abortions in the hospital setting are not being adequately trained, she added, because most abortions are performed in clinics with an outpatient setting (less than 7 percent of abortions are carried out in hospitals). “The methods are easy [to see and learn] in the private practice but are not available for residents to see,” she said.
But requiring abortion training for medical students disregards the moral aspect of the decision, said Joe Kral of Texas Right To Life. Some students “find this procedure morally reprehensible,” he said. “If the abortion rights advocates are really about choice, then ultimately it’s the choice of the doctor whether or not to be trained.”
Present-day medical students lack the impetus that came from witnessing the effects of back-street or “coat-hanger” abortions — the then-illegal abortions that frequently led to patient infections or death and drove young doctors in the 1970s to seek training, said the Fort Worth abortion provider. Because doctors fear the taboo associated with abortion and the physical dangers posed by radical anti-abortion activists, they are unlikely to integrate the procedure into their private practice or even be trained in the first place, he said.
A TARAL report released last fall indicates that 89 percent of surveyed staff at 222 Texas hospitals said their hospitals do not provide abortions, and less than half give referrals to a provider. Nonetheless, abortion procedures are occurring at a steady rate, and some fear that down the road, the demand for abortion will be met by individuals without the training necessary for safety. “If a woman’s life is on the line and her doctor won’t perform [a medically necessary abortion], that just puts her in a crisis situation,” Wheat said. “People who are untrained will step in to fill the void, and women by necessity will see them. Women’s health is going to be jeopardized.”
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