At Embracing the Risk, Douglas linked to a New York Times Magazine story by Emily Bazelon that described changes that she and others hope for in the way that abortions are provided. He has some good comments on the article, which is quite long but worth reading as a way to understand where abortions are performed and also offers insight into the culture of abortion provision. Southern Baptist Theological Seminary’s president Albert Mohler also has some good comments.
Bazelon writes that abortion and abortionists are often not integrated into or respected in the medical profession. Doctors and hospitals rarely perform abortions, meaning that clinics do the vast majority of them. The main thrust of the article is to chronicle how some are trying to change that and provide more linkage between abortion providers and the medical profession by impacting medical school training and encouraging the provision of abortion in doctor’s offices and hospitals. It was especially interesting to read this in light of James D. Hunter’s theory of cultural change, which essentially states that cultures are changed more by elites and institutions than by ordinary individuals because of the importance of cultural power in shaping culture. This institution-building aspect of the article is what I want to focus on.
Bazelon writes that an important step for the push to integrate abortion into medical curricula was the founding of Medical Students for Choice in the 1990s. After that,
The next important moment came in 1995. With new studies showing how low the training rates for residents had fallen, the National Abortion Federation, with M.S.F.C. as an ally, began pushing for change. The Accreditation Council for Graduate Medical Education — which represents the medical establishment — decided, for the first time, to make abortion training a requirement for all OB-GYN residency programs seeking its accreditation. The anti-abortion movement tried to smother the new mandate. The following year, Congress passed the Coats Amendment, which declared that any residency program that failed to obey the Accreditation Council’s mandate could still be deemed accredited by the federal government. But the council had spoken, and medical schools and teaching hospitals listened. Today, about half of the more than 200 OB-GYN residency programs integrate abortion into their residents’ regular rotations. Another 40 percent of them offer only elective training.
To establish a secure foothold in academic medicine, abortion-rights supporters knew that along with residency programs they needed the kind of advanced training that attracts the best doctors and those who want to join medical-school faculties. A physician at the U.C.S.F. medical school set up the Family Planning Fellowship, a two-year stint following residency that pays doctors to sharpen their skills in abortion and contraception, to venture into research and to do international work. In recent years, the fellowship has expanded to 21 universities, including the usual liberal-turf suspects — Harvard, Columbia, Johns Hopkins, Stanford, U.C.L.A. — but also schools in more conservative states, like the University of Utah, the University of Colorado and Emory University in Georgia.
When Salt Lake City and Atlanta are home to programs that train doctors to be expert in abortion and contraception, the profession sends a signal that family-planning practices are an accepted, not just tolerated, part of what doctors do. That helps draw young physicians. The first generation of providers after Roe took on abortion as a crusade, driven by the urgent memory of seeing women become sick or die because they tried to induce an abortion on their own, in the days before legalization. Out of necessity, the doctors pushed ahead with little training or support. “We did it by the seat of our pants,” says Philip Ferro, an 82-year-old OB-GYN at the S.U.N.Y Upstate Medical University in Syracuse. “There was no formal source of knowledge.”
As Ferro wryly puts it, “That would not stand today.” Abortion and contraception have become the subjects of rigorous, evidence-based research. The younger doctors who are coming through the residency training programs and the Family Planning Fellowship “have invigorated this field beyond my greatest expectations,” Grimes, the researcher and abortion provider, says. “We are cranking out highly qualified, dedicated physicians who are doing world-class research. There is a whole cadre of people. I helped train some of them, and I’m very proud of that. In the 1980s, I wasn’t sure who would fill in behind me when I retired. I’m much more optimistic now.”
Many of the protégées Grimes is talking about are women. In the first generation after Roe, abortion providers were mostly men because doctors were mostly men. Since then, women have streamed into the ranks of OB-GYN and family medicine. They are now the main force behind providing abortion.
As Mohler’s post reminded me, there are also some wealthy elites interested in this movement, including Warren Buffett. If Hunter is right about the way that culture changes, this new movement could make an impact. There are still many challenges facing the abortion-rights movement, since many of the doctors impacted by this initiative do not end up providing abortions, even if they want to. But it seems like the kind of strategy that could have an impact over time. What will our response be?
© 2010, Scott Kistler. All rights reserved.