More Abortion Training Urged by Health Group

The growing shortage of physicians performing abortions in the United States prompted a group of doctors and public-health experts Tuesday to call for an overhaul of doctor-training programs and a nationwide push for physicians to include abortion in their practices.

The group, organized by the American College of Obstetricians and Gynecologists and the National Abortion Federation, is making the first concerted effort to bring embattled abortion services and providers into the mainstream of medical training and practice.

“I think many of us, particularly in academia, are not aware of the scope of the problem and its consequences down the road for women,” said Dr. David Grimes, a USC professor of obstetrics and gynecology who served as chairman of the group.

While most obstetrician-gynecologists say they support the use of abortion in certain situations, only about one-third perform abortions, polls show. Two-thirds of those do fewer than five a month; only 2% are believed to do more than 25 a month.

Since the mid-1970s, studies indicate there has been a steady decline in the number of physician-training programs offering abortion training. Similarly, there has been a drop in the number of hospitals offering first-trimester abortions.

As a result, the vast majority of the estimated 1.6 million abortions performed each year are done by relatively few physicians, usually in outpatient clinics. Four out of every five counties in the United States have no abortion provider at all, one study found.

“This is a community problem,” said Ruth Roemer, a past president of the American Public Health Assn. and an adjunct professor of health law at UCLA. “If we’re concerned about the health of women . . . we had better look at the health personnel resources for solving it.”

The recommendations were disclosed in Chicago at the annual meeting of the National Abortion Federation, a Washington-based group representing abortion providers as well as individuals and organizations active in abortion rights and reproductive health. The proposal emerged from a symposium held late last year by the abortion federation and the doctors’ group that was funded by the Ford Foundation and the George Gund Foundation.

The symposium’s 26 participants included prominent professors of obstetrics and gynecology, researchers in reproductive health, public health experts and other specialists in the fields of health care and women’s health.

The group’s findings and recommendations are to be presented for discussion, and perhaps adoption, by organizations and institutions involved in educating, training, and representing obstetrician-gynecologists.

Abortion critics condemned the recommendations.

“Many doctors won’t do abortions because doctors know every abortion stops a beating heart,” said Nancy Myers of the National Right to Life Committee. “There should be and is a personal and professional stigma attached to people who make a living tearing unborn children’s limbs apart.”

The shortage has been traced to a combination of factors, including the anti-abortion movement, the failure to train young doctors in abortion and the retirement of physicians old enough to have seen the lethal consequences of illegal abortions.

Some abortion providers have faced harassment, violence and social stigma. Others have encountered peer pressure not to do abortions. Similarly, some hospital boards have not been willing to offer abortions; military hospitals do not offer them routinely.

According to the new report, 28% of all medical residency programs for young obstetrician-gynecologists offer no abortion training. Many that offer it as an option report relatively low participation, the group found.

Because most hospitals, including public ones, do not offer routine abortions, young doctors in training are not regularly exposed to the practice. They could moonlight at abortion clinics but many training programs discourage such activity.

Finally, the report called attention to the retirement of many older obstetricians-gynecologists who have been willing to do abortions despite the drawbacks, largely because they remember when 1,000 women died each year of infections and bleeding as a result of lack of access to safe abortion.

“Younger physicians don’t know what the bad old days in America were like,” said Grimes of USC. “ . . . That leaves an indelible impression in the mind of a physician and an unswerving dedication to see that that never will happen to women again.”

To address those conditions, the group recommended that abortion be integrated into medical residency training, that abortion providers receive greater professional and community support and that other health professionals be trained to do abortions.

Specifically, the group said abortion should be included in curriculum guidelines, minimum training standards, board exams and residency reviews, and that hospitals should insure that there are opportunities for physicians-in-training to do abortions.

Physicians with moral reservations about abortion would not be required to participate, members of the group said.

The group also proposed international training fellowships to expose doctors to the consequences of insufficient access to safe abortion, and financial and educational incentives to attract young physicians to the field.

The group urged medical groups to issue formal statements supporting abortion and its providers, and called on doctors to promote community support of abortion providers through education, fund raising and public relations.