In med school, they don't teach abortions

Arthur Caplan

June 25, 1992|By Arthur Caplan

THE BATTLE over abortion has taken yet another strange twist. Pro-Choice Resources of Minnesota, a nonprofit abortion rights organization, has awarded a $1,500 scholarship to a third-year medical student who is enrolled at the University of Minnesota's medical school.

There is certainly nothing wrong with an organization making money available to financially strapped students.

But this scholarship came with a condition. To qualify for the award, recipients must pledge to be willing to perform abortions as one of the services they will provide when they become physicians.

According to officials at Pro-Choice Resources, their scholarship is the first in the country of its kind. The group wants to make sure that in the years to come there will be physicians trained and willing to perform abortions.

While the young woman who received the award this year has not yet decided on her medical specialty, she says she wants to provide comprehensive medical care to women and children and that such care will include first-trimester abortions.

The announcement of the scholarship set off the predictable tantrum so familiar in the abortion debate in this country. Anti-abortion leaders spoke of creating a counter-scholarship fund to educate young physicians about the evil of abortion. Some true zanies talked about creating a Joseph Mengele prize for physicians who perform abortions.

Abortion rights groups all around the United States do have reason for concern about the availability of doctors competent and willing to do abortions. Vast regions of the country have no doctors or clinics willing to do the procedure. In some states, such as North Dakota, there is only a single doctor doing abortions.

According to experts at New York City's Alan Guttmacher Institute, the number of abortion providers, including both individual doctors and clinics, has declined by more than 10 percent in the past five years.

Why the decline?

Some states have enacted legislation that makes it difficult to offer the procedure. Many states and the federal government have restricted funding for women who rely on government programs to pay for the procedure.

The prospect of harassment, picketing and death threats undoubtedly has led some doctors, clinics and hospitals to stop offering abortions. And undoubtedly shifts in medical thinking about the morality of elective abortion played a role.

Pro-Choice Resources hopes that, by funding young doctors who are pro-choice, it can ensure the availability of abortion. But, even if there are students willing to learn and perform abortions, is medicine willing to teach them how?

Fewer doctors are expected to know how to do abortions as part of their medical specialty training. Abortions are not taught in medical school. The procedure is taught after medical school in specialty training. And in the specialty where specialists are most likely to be asked to do abortions, obstetrics and gynecology, training is on the decline.

A recent survey by Dr. Trenton McKay of the obstetrics and gynecology department at the University of California, Davis Medical Center, of students in residency programs in obstetrics and gynecology showed that only 12.4 percent of all students are routinely taught how to do first-trimester abortions and only 6.7 percent learn second-trimester abortion procedures. More than 30 percent of all programs do no training in the procedure.

In 1985, the numbers reported for routine training for first- and second-trimester abortion, according to officials at the American College of Obstetrics and Gynecologists, were 22.6 percent and 20.6 percent respectively.

So, in the past seven years, there has been a precipitous decline of more than half in the number of obstetricians and gynecologists who are required to know how to do abortions.

The battle over abortion usually takes place in very public places: at abortion clinics, in marches on the nation's capital, on the floors of state legislatures and in the nation's courts.

But the battles over abortion are being waged in much more private arenas such as the medical school classroom and the teaching rotation. Ultimately, as Pro-Choice Resources realizes, these battles may be as important as any other in determining what happens to abortion in this country in the future.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota Medical School.

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