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A new generation of OBGYNs square personal views on abortion with their training


Ashley Womack was in her OB-GYN residency program at the University of Texas at Austin when, as part of her training, it came time to assist in performing an abortion. Womack is Catholic and deeply opposed to abortion.

ASHLEY WOMACK: I just didn't want to be involved with that. But everyone knew that I wasn't going to do that.

PFEIFFER: So instead...

WOMACK: You know, they had me basically in the recovery room, cleaning chairs, giving patients crackers. Like, what? I don't want to do this. This is not educational.

PFEIFFER: Womack is one of many OB-GYNs nationwide who spoke with journalist Emma Green for an article she wrote in The New Yorker. It's about how the next generation of obstetricians are reconciling their educational choices with their personal beliefs. And Emma Green is with us to talk about what she learned. Hi, Emma.


PFEIFFER: Emma, I think many people who support abortion rights might assume that most obstetricians and gynecologists also support abortion rights. But you spoke with many people training to be OB-GYNs who oppose abortion and do not want to perform them. I first wonder, were you surprised to encounter so many OB-GYNs who oppose abortion?

GREEN: You know, I think it's a correct assumption that in general, the field of obstetrics is pretty supportive of abortion rights. But what surprised me as I started reporting this story is that there's a lot of variation when it comes to how those doctors and doctors-in-training want abortion to play into their practice.

PFEIFFER: And you noted in your article that the American College of Obstetricians and Gynecologists firmly maintains that abortion is a form of health care. So some of these young doctors are going to be expected to learn how to perform abortions even though they believe that performing abortions should not be part of their job. Did they talk to you about how they reconcile that in their minds?

GREEN: Yeah, and it can be complicated. The formal body that accredits medical institutions and accredits residency training has mandated abortion training as part of obstetrical training for years. But there are many, many students and institutions that don't feel comfortable with this or want to opt out of a certain aspect of abortion training. Technically, there are legal protections that make sure that any institution or doctor that doesn't want to offer or perform abortions doesn't have to. So the formal training standards of the field are somewhat in conflict with the law. And certainly they come into conflicts on the ground.

So when I talk to these students and residents, they had thought about everything from where they were going to apply to do their residency, trying to suss out whether that school would be hostile to them, trying to think about their rotations, when they might have to step out of performing duties and how they could make sure that they weren't creating extra work for their fellow residents...

PFEIFFER: Interesting.

GREEN: ...Trying to think through how they would talk to their residency program directors ahead of time so that the residency program directors didn't feel like they had been bait and switched with a candidate who wasn't going to participate in the way that they expected.

PFEIFFER: Emma, you spoke with an OB-GYN professor at the University of California San Francisco named Jody Steinauer. And she made this point.

JODY STEINAUER: All medical students need to learn about abortion. They will take care of patients who have had or will have an abortion. It's part of the medical experience, the reproductive health experience of our patients. So we have to be able to provide care for them.

PFEIFFER: If Roe is overturned, some people in states where abortion is illegal will end up going to other states for an abortion. And when they return home, they might have complications that require immediate care. Or maybe they won't leave the state but will get a prescription-based abortion rather than a surgical one, and they'll still have a complication and need immediate care. If a local doctor is unprepared to help them, what then?

GREEN: One of the things that people who support abortion rights within the medical field have been preparing for is the widespread increase in medication abortion. For the small proportion of situations where a patient is taking their medication at home and experiencing a complication, there are going to be doctors, academic medical institutions, all sorts of practices that are having to take care of these women and deal with the consequences. So, you know, I think the question is, are the current cohort of doctors unprepared to deal with that? Probably some of them are because ultimately abortion training is still not comprehensive and, you know, covering everybody in the obstetrical field.

And the bigger question is, in the future, if a whole generation of medical students and residents don't get this kind of training, will there be gaps in their knowledge and education? People like Jody Steinhauer, who advocates for abortion and has spent her life trying to train residents in abortion - they would say, yes, there will be big and potentially damaging and harmful gaps, dangerous gaps in their education. And people who come from a more pro-life perspective would say, they have everything they need to deal with those situations because they already have the toolbox that they would develop at medical school.

PFEIFFER: You wrote in your article that even 20 years after the Roe v. Wade decision, only 12% of OB-GYN residency programs included abortion training. So it seems that thinking of abortion as a form of health care is a relatively new concept. Would you tell us more about that history?

GREEN: I think there's an assumption by people outside of the medical field - certainly this was my assumption - that it's a standard part of every OB-GYN's practice to perform abortions. But in fact, most residency programs didn't really have robust training around abortion until, say, the late '90s and early 2000s. And when it comes to the number of doctors actually performing abortions out in the field as a regular part of their practice, that's far lower than I was expecting it to be. It's something like a quarter of obstetricians are regularly performing abortions.

PFEIFFER: Why so few, by the way?

GREEN: Yeah.

PFEIFFER: Why so relatively few?

GREEN: Certainly some of it is political. It's the restrictions put in place by state legislatures. It's the restrictions put in place by the hospitals where those doctors are performing their services. But it's also a lot of other reasons. But what I did realize and think about a lot as I was reporting this story is that these questions about how they're going to practice, what they choose, where they move, the specialties they pursue - all of that is about to get a lot more complicated if the legal situation around abortion shifts in a radical way.

PFEIFFER: Yeah, and explain that. How could it get complicated?

GREEN: If the Supreme Court overturns Roe v. Wade, then in about half of U.S. states, abortion will likely become all but illegal. And what this means is that the training institutions are not going to be legally able to offer the kind of training that they are now. So as young doctors and aspiring doctors are making choices about where they want to train, that's factor No. 1. Do you want to learn about abortion? And that can totally determine where you choose to go train. Then after that, if they're thinking about what kind of practice they want to have, if they want to perform abortion, they'll have to choose states where that's legal. And if they don't, then they'll be practicing in states where the choices that women have and the situations that they're in - they'll be handled in a radically different way from a medical perspective.

So if you're a patient in Texas coming in and you're 10 weeks pregnant and there's a problem with the pregnancy, the doctor will have different choices, different tools in their toolbox for how to respond to that situation. So I think that is going to be in the background for the medical education of young obstetricians in the coming years if, in fact, the legal situation does change as we expect it will.

PFEIFFER: Emma Green is a staff writer for The New Yorker. Emma, thank you.

GREEN: Thank you very much.

(SOUNDBITE OF AGNES OBEL SONG, "CITIZEN OF GLASS") Transcript provided by NPR, Copyright NPR.

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Sacha Pfeiffer is a correspondent for NPR's Investigations team and an occasional guest host for some of NPR's national shows.
Jonaki Mehta is a producer for All Things Considered. Before ATC, she worked at Neon Hum Media where she produced a documentary series and talk show. Prior to that, Mehta was a producer at Member station KPCC and director/associate producer at Marketplace Morning Report, where she helped shape the morning's business news.
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