Pro-choice timidity in fighting shortage of abortion providers

“Are [doctors] really doing all they can to provide a counter-narrative?” Blewett asked, noting that established doctors could use their status to, among other things, speak out on the public health ramifications of the scarcity of abortion providers. They could do this  in public statements, at conferences, or through caucuses they create within existing professional organizations, she said.

If doctors don’t speak out, especially to each other, about abortion being a standard, legal part of health care, Blewett said, then “they’re abdicating their responsibility.”

Accommodation or self-defeating muzzling?

Any individual or entity that either provides abortion services or seeks to broaden the availability of abortion education and training can face a backlash. Given this reality, what is the appropriate approach?

To judge from the responses and lack of responses from the people we interviewed, the most popular idea is to do one’s work unobtrusively — to try to stay beneath the radar.

For example, Planned Parenthood of the Rocky Mountains (PPRM), based in Denver, has its Clinical Training Program for medical students, residents, and physicians. But the organization’s spokesperson would not elaborate on the number of students, residents, and practicing physicians it trains, or on the scope of the program overall.

The national umbrella organization Planned Parenthood Federation of America neither granted Remapping Debate an interview nor answered emailed questions about its role in facilitating abortion training. And instead of referring us to its own affiliates that offer this clinical training, such as PPRM, it pointed us away from Planned Parenthood, suggesting that we contact other programs it named.

And 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.”

Indeed, it would appear as though some groups are trying to lower their abortion-rights visibility.  Some groups have rebranded themselves. An organization that until last fall was called the Abortion Access Project now goes by the harder-to-decode name Provide. The organization, which works in the South and Midwest, had as its initial mission encouraging doctors already in practice in areas with a shortage of abortion providers to start offering such care. Over the last six years, however, Provide has largely shifted its focus from abortion training to counseling and referral, hoping to draw in doctors and other health care workers who otherwise avoid even talking about abortion to their patients.

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.”

Even when it comes to enforcement of training requirements of the ACGME, the residency oversight board, there is not unanimity.

The long-time abortion provider Laube said that the ACGME should “crack down” on ob-gyn residency programs that don’t offer integrated abortion training. He considers the opt-in approach to be in violation of the ACGME abortion-training rule because the resident must initiate the training.

But others in the abortion rights world, including Goodman, who runs the TEACH program, have a different view. 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.”