Author(s): Darney PD
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Abstract PIP: Despite the lessening of federal restraints to abortion providers and the fact that the US Supreme Court has not overthrown Roe vs. Wade, access to abortion still remains a problem for women because there are not enough providers, especially in rural areas where the number dropped 51\% from 1977 to 1988. A 1985 survey showed that only 34\% of gynecologists perform abortions, with two-thirds doing no more than 4/month. Yet, 84\% said abortion was necessary in some cases, and only 13\% said it should never be done. These percentages have not changed since a survey 14 years earlier, but the number of disincentives to performing abortions, including harassment by anti-abortion forces, has grown. Also, financial renumeration has increased little in 2 decades, and younger physicians are not inspired by memories of the damage caused by illegal abortionists. Physicians who begin to perform abortions immediately after their residencies are not benefitting from as much training as was given in the past, despite the fact that studies show that residents have higher complication rates than experienced physicians and that proper training reduces complications. One explanation for the failure of residency programs to include abortion training is the fact that 90\% of abortions occur in free-standing clinics rather than in hospitals. If abortion training is offered at all, it is usually offered as an elective, not part of a required rotation. There are some residency programs, however, which offer exemplary training in abortion, many at their own clinics. In these cases, residents rotate through the abortion training in their second or third year, with exemptions for those with moral objections. Abortion issues should also be covered in the public health, reproductive medicine, or ethics courses of medical schools; in fact, long before the students see abortions performed. The training programs which are failing to train gynecologic specialists are also ignoring medical generalists. In addition, abortion is rarely included in postgraduate refresher or continuing education courses. The shortage of physicians willing to provide abortions has raised the possibility of nurse-practitioners, physician's assistants, or even lay persons being trained to provide abortions. However, in some areas, paramedical personnel are in greater demand than physicians. In addition, they may not be able to obtain the necessary insurance and state laws would have to be changed to allow them to perform this procedure. Of course, the same disincentives that exist for physicians would exist for them. The solution to this problem lies in providing abortion education to all health care professionals and in making abortion training readily available to all interested physicians. Laws governing harassment and violence should be enforced, and compensation should be comparable to that of other medical procedures.
This article was published in Womens Health Issues
and referenced in Journal of Depression and Anxiety