Pro-choice timidity in fighting shortage of abortion providers

March 13, 2013 — As Remapping Debate previously reported, the number of state-based restrictions on abortions has increased significantly over the last two years. Defining a “scarcity” of abortion providers to mean a state where either 60 percent of the women live in a county without an abortion provider, or where there are 200,000 or more people for each abortion provider, we found that fully 32 states were experiencing scarcity as of 2008, the last year for which these data are available.

How are abortion-rights supporters fighting back? More specifically, recognizing that the current environment in many parts of the country is hostile to abortion providers, what are those abortion-rights supporters doing to increase the supply of obstetrician-gynecologists (ob-gyns) who perform
abortions?

Remapping Debate’s investigation found that the efforts being made, particularly when it comes to providing encouragement for, and training to, ob-gyns already in practice but not yet performing abortions, were severely limited; that progress has stalled in providing training for medical students and for doctors completing their residency requirement; and that there is widespread defensiveness among abortion-rights supporters about engaging in aggressive efforts to organize and set out a “counter-narrative” that could support a major increase in the supply of ob-gyns who perform abortions.

Indeed, despite repeated efforts on our part, no representative of the Planned Parenthood Federation of America, which describes itself on its website as “the nation’s leading sexual and reproductive health care provider and advocate,” would agree to be interviewed by Remapping Debate. Several individuals we did speak to when preparing this article urged us, apparently independently of one another, not to run the story out of concern about creating a “backlash.”

Limited outreach to ob-gyns already in practice

Data from the American Medical Association and from the American Congress of Obstetricians and Gynecologists confirm there are far more ob-gyns already in practice than there are in residency programs. And a study, published last year in the academic journal Family Medicine noted that, while “the majority of abortion training currently takes place during residency and medical school…our study suggests that training later in a clinician’s career might yield a higher percentage of abortion providers.”

Dr. Barbara Gawinski, a co-author of the study and an associate professor in the Department of Family Medicine at the University of Rochester Medical Center, told Remapping Debate, “There is not the availability for advanced level practitioners” — doctors who are established and treating patients — “to get the training that they need.”

But little is being done to expand the supply of abortion providers from among the large pool of practicing ob-gyns who do not now offer abortion services. Representatives of three organizations that currently provide abortion training to medical school students, hospital residents, and those just out of residency — the Kenneth J. Ryan Residency Training Program and the Family Planning Fellowship Program, both run out of the University of California, San Francisco (UCSF), and the Reproductive Health Education in Family Medicine program, based at Montefiore Medical Center in New York City — neither agreed to be interviewed nor responded to emailed questions on the need to expand training for ob-gyns currently in practice.

The National Abortion Federation (NAF), an organization that does train current ob-gyns, is not ramping up its efforts. Based on its contact with doctors at various professional conferences and meetings, Vicki Saporta, NAF’s president and chief executive officer, said the organization doesn’t perceive substantial interest among mid-career physicians to learn abortion care. “That is not the reality,” she said, adding that mid-career doctors “have chosen not to provide abortion care” primarily because the practices and hospitals where they work don’t allow it and they prefer to avoid conflict. When Remapping Debate asked if NAF did outreach specifically to this group in an effort to recruit them, Saporta said, “If they want to do abortion training they will find their way to us.”

Dr. Debra Stulberg is a co-founder, current board member, and president of the Midwest Access Project (MAP), a small non-profit that provides abortion training, including to practicing doctors. Stulberg believes that “mid-career doctors are an important workforce for reproductive healthcare.” Yet MAP, which provides training for several medical students and several residents each year, was only able to train practicing physicians at a rate of less than one per year from 2007 to 2012.

Stulberg, who also practices and teaches at the University of Chicago, readily acknowledged that these efforts are “not enough,” adding, “We have to turn away interested trainees all the time.” From MAP’s perspective, she said, the problem is finding enough providers who are willing and able to teach those who want to learn. “Our biggest challenge is the training capacity,” she said. Funders who are supportive of abortion rights, she asserted, need to realize that it is not enough to provide services or sponsor advocacy for the here-and-now; they also, she said, have to understand the need “to train the future generations.”

Lisa Maldonado, executive director of Reproductive Health Access Project, a program similar to MAP, agreed that there is a lack of capacity for training doctors already in practice. The solution to that problem, she said, is straightforward: the current shortfall in training capacity “could all be remedied with funding.”