By Christian Viveros-Fauné
By Miriam Felton-Dansky
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But only a select subgroup is capable of the ultimate pro-choice act: providing abortions. As the number of providers dropsabout 87 percent of the nation's counties have nonemore medical students have recognized that a woman's choice to get an abortion depends on a doctor's choice to give one.
Meanwhile, pro-lifers are salivating over the reconstituted Supreme Court; South Dakota's ban of nearly all abortions is only the most extreme state effort to maim or kill Roe v. Wade. The provider shortage and legal threats have energized Medical Students for Choice (MSFC), a California-based group founded in 1993. Since Bush's re-election, MSFC's national listserv has jumped from 7,000 to 10,000 recipients. In New York, members describe increased interest on campuses. Aiming to mobilize the faithful and educate the student community, chapters host events including mixers with law students and a teach-in at sex shop Toys in Babeland. Miriam Sheinbein, a coordinator of Albert Einstein College of Medicine's chapter, notices a new sense of urgency. "I've worked at Planned Parenthood," she says. "I'm a predictable MSFC coordinator." One of her friends, however, "is so not an activist, but she really feels like she needs to provide abortions. She would never have gotten involved if abortion weren't threatened."
New York is the nation's capital of abortion. The state, one of a minority that fund abortions for Medicaid recipients, has none of the restrictions, such as parental notification laws, that hamper access in many states. In 2004, 40 percent of pregnancies in the city ended in abortion (the estimated national average is 24 percent). The city is also a mecca of medical education: Cornell, Columbia, SUNY Downstate, NYU, Mount Sinai, and Einstein, all of which have MSFC chapters. In the words of Cristina Page of NARAL-NY, New York has "the best academic programs in the world, training the best physicians in the world." That's one reason pro-choicers rejoiced when Bloomberg adopted NARAL's Residency Training Initiative in 2002. Under this unique policy, abortion training is now a standard part of all OB-GYN residencies in the city's public hospitals. (Residents can opt out, but few do.)
The pro-choice medical community welcomes such policies, but it also has a broader agendato introduce comprehensive reproductive-health education into the medical curriculum. As Dr. Christopher Estes, a fellow in family planning at Columbia, puts it, the idea is not to say to all students, "You guys have gotta learn how to do an abortion." Rather, "Contraception is something everybody needs to know. Teaching someone how to counsel someone who has an unplanned pregnancy is incredibly important. Whether you're a family medicine doctor, a pediatrician, or an orthopedic surgeon, you may encounter this one day. One in three American women has an abortion in her life. Do the math."
Despite these numbers, abortion occupies an uneasy place in medicine. "Even other doctors call us the baby killers," says Estes, although he adds that it's "tongue-in-cheek." Although the medical ed mainstreamas represented by the American Medical Student Association and the Accreditation Council for Graduate Medical Educationadvocates routine abortion training, the procedure is somewhat isolated within medical culture.
Abortion will always be more fraught than tonsillectomy or knee surgery. But the procedure's isolation has as much to do with logistics as with politics. Abortions are performed largely in clinics; residents are trained in hospitals. While pro-life activism, including terrorism, surely didn't help provider recruitment, NARAL cites research indicating that young doctors more often point to "lack of proper training" than fear or moral qualms as the reason for not providing. Clinics, a pro-choice development, offer efficient, relatively affordable abortion care. But there are benefits to integrating abortion into hospitals and other health care settingsand not only for training purposes. As Sheinbein says, "There's a move away from being an 'abortionist.' You should be able to go to one place for all your health care needs."
By and large, med school courses have not entirely assimilated abortion either. As MSFC regional coordinator Erika Levi notes, "It's just not something that's been historically included"after all, it was illegal for much of American history "and medical school curricula are slow to change." In New York, curricula vary. Einstein and Columbia get thumbs-up from MSFC members for their progressive approach to family planning. At Mount Sinai, students are working with faculty to address emergency contraception and medical abortion (the abortion pill) more fully in the pharmacology class, and to create a reproductive-health elective. Overall, the New York institutions are more abortion friendly than average, says Levi: "I have friends at other medical schools where they're not even allowed to talk about contraception."
Since New York educates such a disproportionate percentage of the nation's doctors, these increasingly inclusive programs, combined with Bloomberg's training policy, could in theory have widespread effects on the provider shortage. Still, the average pro-choice liberal is not necessarily yearning to relocate to, say, Arkansas (where one enterprising physician could double the provider population). Sheinbein acknowledges this conflict. "Do I go one place once a month?" she asks herself. "It's something we all need to think about seriously." In any case, providers are needed here too. As restrictions tighten in other states, "this will be a refuge city," says NARAL's Page.
Already, New Yorkers have taken measures to ensure access to out-of-staters. A group of locals called the Haven Coalition puts up women who trek here for late-term abortions, illegal or inaccessible in many states. In a hypothetical post- Roe America, are today's dedicated pro-choice med students prepared to copy the underground provider networks of the pre- Roe era? Some acknowledge that civil disobedience is a real possibility, noting that the abortion pill would be a popular method in such circumstances.
But no one wants to have to break the law. Providers would prefer, as Estes says, "to work ourselves out of a job. Contraception is our first and most important mission. . . . If I never had to do another abortion in my life, I'd be happy." Of course, the demand is unlikely to disappear soon. From her time at Planned Parenthood, Sheinbein recalls a 14-year-old who'd been sexually active for two years, but "didn't know what sex was"she had no concept of its relationship to reproduction. Another patient got migraines from hormonal birth control and was allergic to latex. She used a non-latex condom and got pregnant. As long as heterosexual couples have sex, and education and contraception are imperfect, there will be jobs for abortion providersand if MSFC and its allies succeed, there will be enough abortion providers to fill them.