Abortion Training Sparks Controversy
Abortion Training Sparks Controversy
May. 27, 2002
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NEW YORK (AP) _ A bold expansion of abortion training in the nation's largest public hospital system _ New York City's _ has sparked anger on one side of the abortion debate and admiration on the other.
Abortion-rights advocates, worried about a shortage of abortion providers, hope for a ripple effect as other hospital systems emulate the city and New York-trained doctors move to other states. Abortion opponents accuse the city _ which trains one-seventh of the nation's doctors _ of trying to force a controversial procedure into the medical mainstream.
Starting in July, abortion training will become part of the required curriculum, rather than a generally bypassed elective, for obstetrics and gynecology residents in New York's 11 public hospitals. Unless they opt out on moral or religious grounds, all residents will learn the latest abortion procedures, including use of the abortion pill mifepristone and other techniques requiring neither anesthesia nor an operating room.
If the program thrives ``we'll have changed the face of abortion provision in this country,'' said Cristina Page of the New York branch of the National Abortion and Reproductive Rights Action League. ``It's going to make other programs question how they're delivering this care.''
The New York State Right to Life Committee has accused Mayor Michael Bloomberg, the moderate Republican who approved the initiative, of trying to ``shove child-killing down our throats.'' The committee has warned of ``devastating'' consequences as New York-trained OB-GYN residents start practices across the country.
Olivia Gans of the National Right to Life Committee criticized New York for obligating residents to ``opt out'' of abortion training rather than ``opt in.''
``You put the onus on a young doctor to be brave enough to stand out from the pack,'' she said.
Nationally, however, Gans predicted abortion won't become widely practiced by the next generation of doctors. Technological advances such as ultrasound are convincing medical students that fetuses are indeed living beings who should not be aborted, she said.
``The knowledge available now has made young doctors reluctant to go into abortion, because that would mean ending one of their two patients' lives,'' Gans said.
In South Dakota, home to some of the nation's toughest restrictions on abortions, medical student Jane van Dis already has decided she will perform the procedure _ and has battled to learn more about it.
Van Dis, 33, is finishing her third year at the University of South Dakota School of Medicine in Yankton, where she founded a chapter of Medical Students for Choice despite faculty warnings that such activism could hurt her career.
Van Dis said her curriculum virtually ignores contraception and abortion, and no faculty member has offered to assist, so she helped arrange for a doctor from Minneapolis to visit periodically to discuss abortion-related topics.
``There are pro-choice physicians in this state, but there's a lot of social pressure against speaking publicly,'' van Dis said.
Van Dis plans to pursue an OB-GYN career, perhaps after a residency in New York. The city's training initiative impresses her, in part because it has bipartisan support.
Medical schools and residency programs which avoid abortion instruction create a potentially dangerous gap, she said, citing the scenario of a doctor treating a woman for post-abortion complications.
``It ends up being an ethical disservice to the women they care for,'' she said.
The doctor who lectures periodically in Yankton is Peter D'Ascoli, medical director for Planned Parenthood of Minnesota and South Dakota. He and some colleagues from Minneapolis also work rotating shifts at a clinic in Sioux Falls, the only facility in South Dakota that acknowledges performing elective abortions.
With no options nearby, even women living 350 miles away in far-western South Dakota travel to Sioux Falls for abortions, D'Ascoli said.
``You send them back, and they have to deal with any complications in their home town,'' he said.
New York's initiative may bring little short-term change to South Dakota and other largely rural states with few abortion facilities. Planned Parenthood says about 85 percent of U.S. counties don't have abortion providers.
A more likely impact of the New York program, abortion-rights advocates say, will be to rejuvenate the national pool of abortion providers. Of the roughly 2,000 doctors who now perform abortions, more than half are over 50, and many are nearing retirement.
About 150 OB-GYN residents rotate annually though New York's public hospitals, and abortion-rights groups hope the new program will inspire other residency programs to expand abortion training options. At present, most OB-GYN residency programs don't require abortion training, though many offer it as an elective.
Lois Backus, executive director of Medical Students for Choice, said many medical students are pressing residency programs to make the training mandatory.
``On a 120-hour-a week schedule, there's just not any energy to pursue an elective,'' she said.
Backus said many medical students remain wary of anti-abortion extremism, although violence has subsided since the 1998 murder of abortion-providing obstetrician Barnett Slepian in upstate New York.
At a recent meeting of Backus' group, students questioned experienced abortion-providers about coping with harassment and anxiety.
``There was a lot of fear, a lot of concern about 'What will I be getting myself into,''' Backus said. ``It was a relief to hear how rewarding and positive these physicians' lives actually were.''
About 1.3 million American women have abortions annually; it is one of the nation's most common surgical procedures.
Dr. Allan Rosenfield, dean of Columbia University's School of Public Health, estimated that 15 percent of OB-GYN residents might refuse abortion instruction for reasons of conscience. For the others, he said, ``no procedure should be singled out as not part of the training.''
On the Net:
New York City Health and Hospitals Corp.: http://www.nyc.gov/html/hhc/home.html
New York State Right-to-Life Committee: http://www.nysrighttolife.org
National Abortion and Reproductive Rights Action League: http://www.naral.org