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Laurie and Debbie say:
The closing of abortion clinics around the United States is reasonably common knowledge, but neither of us knew how few doctors perform abortions in the U.S., or how a grass-roots organization of women is working to change that. In “The Future Abortionists of America,” published at Medium, Malcolm Harris takes us on a long detailed walk through the current landscape by attending a conference of Medical Students for Choice (MSFC), an organization almost entirely of young progressive women who are circumventing the current medical school norms of barely mentioning, let alone teaching, abortion procedures.
For two decades after Roe, the number of residency programs for obstetricians and gynecologists—the medical specialty where most abortionists train—that included abortion instruction declined steadily, until 1996 when the American Council on Graduate Medical Education (ACGME) began requiring access to abortion-training as part of residency accreditation.
Though the requirement halted the decline, there’s little evidence it has been meaningfully implemented. An ACGME clarification issued in June 2017 stated that, due to moral/religious opt-out provisions, no students necessarily had to receive abortion education in order for programs to be in compliance. In the most recent national survey of medical schools on the topic (2005), only 19 percent reported a single preclinical lecture on abortion, and two-thirds reported no knowledge of any formal abortion education at all in the first two years of instruction. Only 10 percent of third-year OB/GYN clinical rotation programs reported any clinical abortion experience (think, a field trip to Planned Parenthood), in which most students participated.
MSFC is working to change that, from the ground up, knitting the modern knowledge and techniques of abortion into the centuries-old world of women helping women, women transmitting women’s knowledge. Their work is desperately needed: according to Harris, right now about 1700 providers around the U.S. perform somewhere between 650,000 and 750,000 abortions each year, or one per provider per day, every day. Ninety-five percent of these procedures are performed in clinics, such as those run by Planned Parenthood. That shockingly low number is due to a combination of right-wing pressure on the laws, right-wing pressure on the clinics and doctors, and right-wing pressure on the medical schools — a small minority acting like a 1000-pound gorilla, successfully.
So MSFC members have their work cut out for them.
Nationwide, students at over 150 med schools are organized in campus chapters of MSFC, where they support and train each other in an extracurricular fashion, as well as lobby their schools for resources and for abortion to be incorporated into standard syllabi. At the annual conference, organized by the small Philadelphia-based national office, students from around the country meet to steel their collective resolve and to learn.
Harris salts the nuts and bolts information about where they learn and what they learn with who the students are. The article is low on quotations from the students themselves and (tellingly) uses initials for all of them, with a disclaimer at the end saying they didn’t necessarily request anonymity–it was an editorial choice.
Although they were nearly all progressive young women, the attendees had the kind of racial and regional diversity that’s hard to achieve without intention. Unusually for this kind of event, students from elite schools were proportionally represented, which is to say they were nearly absent. Universities are concentrated in East Coast cities, but those students don’t have the most to gain.
The article simultaneously downplays and highlights the dangers of the path these young women are taking.
Emily Young, a doctor from Charlottesville, Virginia, reassured students that as providers, they would not have to live in daily fear; they could be both the doctor on the block and an abortionist. Simply by virtue of being themselves and doing the work, they would be advocates. “Everyone knows I’m the abortion provider in Charlottesville,” she said, “and I like that.”
[Dr. Sarah] Horvath agreed, saying that by doing abortions in addition to a full-range of medical practice she hopes to normalize it. Medical students want to be doctors, and the roomful seemed happy to hear that performing abortions would not automatically forfeit all the benefits and prestige of being a doctor. There was a relieved sigh when the audience heard that psychiatrists are more likely to be murdered in the course of their work than abortionists are.
And yet … the article starts by describing how secretive the conference chooses to be about its meeting. It refers to the high-profile 2009 murder of Dr. George Tiller for performing abortions. It does not say what Lizz Winstead of (soon to be renamed) Lady Parts Justice League says elsewhere, which is that abortion providers almost invariably hear that their neighbors are getting letters saying “A murderer lives on your block.” Eighty percent of Americans may support some sort of legal abortion, but the other 20% are mighty comfortable with threats and intimidation.
Perhaps the most surprising statistic in the article is the extraordinary safety of abortion procedures.
While American maternal mortality has increased alarmingly in recent years (an increase of almost 60% from 1990 to 2015), the number of abortion mortalities is so low that the Centers for Disease Control and Prevention (CDC) calculates using five-year averages. Over the last three years for which there are data (2011–2013), the CDC reported 10 total abortion deaths, and the agency has not recorded a fatality due to an illegal abortion since 2004.
Harris doesn’t say this, but that increase in maternal mortality is very strongly skewed to women of color; somehow, even though women of color are nine times as likely as white non-Hispanic women to have abortions, this seems to be one area where the outcomes are not disproportionately affected by race (or if they are, the risks are still vanishingly small for everyone).
Women helping women, women learning the skills they need to take care of women’s needs, and women organizing to teach each other — this works. And since what we have now is not working at all for women in need of abortions, MSFC is helping move the country in the right direction.