Abortion care is getting harder to access.
Here is a scary fact: According to the Guttmacher Institute, in 2014, people seeking abortion in the US often had to drive between 180 and 330 miles to access the procedure. The number of clinics in the country has decreased from 851 in 2008 to 788 in 2014, and five states have only a single clinic. Not surprisingly, the amount of abortion providers is woeful as well – 83% of US counties do not have one, so if you live in one of those counties, you have to figure out how you’re getting to a county, or a state, that does have one, and that’s going to increase both the time it takes to access the abortion, and how much it will cost.
Why are there so few abortion providers? Well, for one, abortion isn’t part of the curriculum in most medical schools, although it’s an extremely common procedure, which 1 in 3 people with vaginas will undergo in their lifetime. “Abortion isn’t covered in formal curriculum because it’s controversial,” said Lois Backus, Executive Director of Medical Students for Choice. MSFC works to increase the number of abortion providers by increasing opportunities for medical students to become providers, as well as working with medical schools to expand their curricula around all facets of reproductive health. Currently, MSFC has activists working at 90% of US medical schools, and in 25 countries, and its alumni provides abortions all over the US and the world.
Abortion isn’t commonly addressed in residency programs, said Backus, not just because most abortions don’t take place in hospitals, but because residencies are often pressed for time, and some institutions, such as Catholic hospitals, refuse to address it. There’s also the matter of abortion stigma, which dictates how others regard abortion, and that includes perpetuating falsehoods about abortion (it causes breast cancer, it ruins your fertility), and ideas that it’s a dirty, unsafe procedure, which “real” doctors don’t perform. Providers contend with this, as well as potential backlash from anti-choice forces, Backus said, and it stops newly minted doctors, as well as medical students, from pursuing training in abortion care. “People are told by their employers that they can’t perform abortions on the weekends,” she said. “Job offers have been rescinded.”
It’s not uncommon to not know if your doctor is trained to perform abortions – you might not think to ask about it until you need it. “I guess I never really thought about abortion in the case of a wanted pregnancy, until I was in that position,” said K. She knew her original OB/GYN was a provider, but after learning that she had a higher than preferred risk for birth defects, she found out more about what it would take to actually terminate a pregnancy. “Basically my doctors were like, we are trained to do this, but in order to get it done while California law still protects you, you’ll probably need to go to Planned Parenthood. It was an unexpected glitch I had never really considered, that even in states where there are deep protections around abortion rights, that facility access is often a barrier.”
Jackie, who lives in New York City, was in her second trimester when she learned her fetus had a serious genetic disease, and she and her husband decided on abortion. “Finding any doctor to terminate after 12 weeks was very difficult,” she said. She spent days calling around the city to find a provider, and eventually did. Second trimester abortions are more complex than first trimester, and because of that, providers need to be trained specifically in them. Since we’re talking about a shortage of providers in general, the scarcity of second trimester providers is great, while the need, of course, still exists.
In West Virginia, where Caroline Vu is finishing medical school, there’s one abortion provider, no Planned Parenthood, and a law was recently passed prohibiting the use of telemedicine to administer medical abortion (the abortion pill). Vu, who was the MSFC Board of Directors President for the 2017-2018 year, sees changes in the landscape of abortion care when it comes to increasing the number of providers, especially after the 2016 election. More OB/GYN programs are getting funding for abortion training, and there are fellowships available to encourage folks to learn how to perform abortions. “It’s not just about learning to provide abortion,” she said. “People also learn that access to choice is different for different people.”
It’s important to have a conversation with your doctor about abortion before you need one, not just because statistically, you will probably seek abortion care at some point in your life, but because it’s a good way to bust abortion stigma, and your doctor might be nervous about bringing it up.
“Doctors are often fearful of raising that issue, they assume patients will react badly,” said Lois Backus. “Raising the issue will help establish that you think it’s important and want to talk about it.” Backus herself won’t go to a doctor who doesn’t provide abortions, but she recognizes that that’s not what everyone can do, especially given the shortage of providers, especially in rural areas. “Depending on where you live, you might not have that option.”