Buried in one of Mike Bloomberg's campaign documents is a bold plan: to make abortion a standard part of OB-GYN instruction in the city's hospitals. Because his election seemed so improbable, Bloomberg's Blueprint for Public Health barely made a ripplelet alone a splashwhen it was first unveiled. But should the new mayor make good on the document's controversial promise, the result will be groundbreaking. No other city is known to have institutionalized abortion training in its public hospitals. Jubilant pro-choice advocates say the move would not only improve services for the city's uninsured women but also help alleviate a shortage of abortion providers nationwide.
"It's extremely brave," says Lois Backus, executive director of the California-based abortion training group Medical Students for Choice. "No other publicly funded system has had the courage to say, 'We're going to spend our tax dollars pursuing this priority,' to my knowledge."
Until recently, the public has known little about the new mayor's thoughts on abortion, save that the Republican mogul is at least nominally pro-choice and reportedly once told a pregnant employee to "Kill it! Kill it!" (The comment, which Bloomberg has denied making, was cited in the legal papers of Sekiko Sakai Garrison, a former Bloomberg News staffer who brought one of three publicized sex-harassment cases against him or his company.)
Before they were contacted by the Voice, even many pro-choice advocates were unaware of the mayor's scheme. But whether because of a genuine commitment to abortion rights or a naïveté about the tangled politics surrounding it, the novice mayor remains poised to support proposals more experienced politicians might dismiss as unfeasible.
"You're kidding me!" said Roger Rathman, spokesperson for Planned Parenthood of New York City, upon hearing of Bloomberg's intention to institute abortion training at city hospitals. "Wow. Don't we love Mayor Mike!"
"I think it's terrific!" said a delighted Vickie Saporta, executive director of the National Abortion Federation. "Do you think he's really going to do it?"
Asked to answer that question, spokesperson Jerry Russo said only that "everyone knows that Michael Bloomberg has been an advocate for choice and he will continue to do so as mayor." Jane Zimmerman, senior vice president for communications at the Health and Hospitals Corporation, which runs the city's public hospitals, says HHC supports the Bloomberg proposal. If the plan is implemented, some 100 OB-GYN residents at the city's 11 public hospitals will learn how to perform abortions and provide counseling as a matter of course, though those who "object on moral grounds" will be allowed to opt out, according to the proposal.
Since one out of seven of the country's doctors is trained in New York, the change will almost certainly increase the number of abortion providers nationwide. Pro-choice advocates hope it might embolden other municipalities to follow suit. "Already we're talking about how this might translate to other cities," says National Abortion and Reproductive Rights Action League (NARAL) president Kate Michelman.
There is some dispute about the degree to which public hospitals already train their residents to provide abortions. HHC's Zimmerman says all of the city's public hospitals provide some abortion training. But according to NARAL-NY, only two of the city's public hospitals make abortion training standard for residents, rather than an elective they can choose in addition to their required courses.
The problem is even worse elsewhere in the country. Though the percentage of OB-GYN programs that teach students to perform first-trimester abortions as part of their normal curriculum is thought to be creeping back up, in 1997, the last year for which statistics are available, that percentage had fallen to only 12 percent, down from nearly 23 percent in 1985.
As a result, the number of abortion providers has dwindled. Abortion is the second most common surgical procedure (cesarian deliveries are the first), yet 84 percent of all U.S. counties have no one qualified to provide it, according to the Planned Parenthood Federation of America. Nearly one in four women has to travel more than 50 miles to get an abortion. And most of the 2000 doctors who do now provide abortions are over 50 years old.
"Over the past 10 to 15 years, there's been a concerted effort by anti-choice groups to intimidate medical schools into eliminating abortion training," says NARAL's Michelman. "Our concern," she adds, "is that we'll run out of providers."
NARAL-NY staff members expressed such fears at a June meeting with Bloomberg, using the opportunity to suggest the training proposal, which the candidate eagerly embraced. "He took it word-for-word directly from our materials," says Kelli Conlin, the group's executive director, who was at the meeting. (Despite Bloomberg's enthusiasm, national NARAL remained neutral in the mayoral race, and NARAL-NY endorsed Mark Green.)
The new policy would be unlikely to increase the number of abortions performed in New York City each yearabout 100,000, of which roughly 6500 are performed in HHC hospitals. But the widespread abortion training could help eliminate delays that some advocates say women encounter in the city's hospitals. "An average woman comes into HHC to schedule an abortion and has to wait two to three weeks, which can move her from the first trimester into the second," says Cristina Page, program director of the residency training initiative at NARAL-NY. "The delays are absurd." HHC's Zimmerman says there is no evidence of "significant delays" in the city hospitals.
Bloomberg's plan is particularly notable because it commits public resources to abortion when, nationally, the trend has been in the other direction. Since a 1992 Supreme Court decision allowed the state of Missouri to refuse to use public funds to pay for abortions, government involvement in abortion has become particularly dicey. Pro-life groups are unlikely to let the mayor's proposal go unchallenged.
"Abortion is an elective procedure that indisputably ends the life of a child. For the mayor to elevate this to the level of medical care is dreadful," says Lori Hougens, spokesperson for the New York State Right to Life Committee. "I'm sure it's going to be a violation of the law."
Hougens wouldn't say whether her group is planning a lawsuit. But even in New Yorkwhere abortion was legalized three years before the Supreme Court established the right nationally and which is now one of only 15 states that allow Medicaid to pay for abortionsthe pro-choice movement's new best friend can expect hurdles ahead. Some of the medical schools that have training contracts with HHC, such as New York Medical College, are associated with the Archdiocese of New York, which is opposed to all abortion. And while the mayor has also suggested that Medicaid recipients shouldn't be assigned to managed-care plans that don't provide abortions, Right to Life's Hougens warns that such a move would discriminate against Catholic managed-care plans.
Bloomberg has floated yet another pro-choice proposal: to require hospitals to offer emergency contraception to all victims of sexual assault brought to their emergency rooms. In sum, Hougens refers to the new mayor's reproductive-policy plans as a "tragic disgrace."
Abortion war veterans are used to the rhetoric. "There will be some concerns raised," predicts Joan Malin, CEO of Planned Parenthood of New York Citybut she is nonetheless optimistic that, if he turns out to have the political will, Bloomberg will be able to push through his plan.
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