Doctors Lack Access to Abortion Medical Training in Texas

Every year, more than 100 new obstetrician-gynecologists graduate from a Texas residency program and enter the medical workforce. Theoretically, all have had the opportunity during their four years of residency to learn about what's called "induced abortion" — named that to distinguish it from a miscarriage. However, the closure of abortion clinics in Texas — more than 20 since 2013 — has made that training increasingly difficult.

The Challenges of Residency Training

Texas has 18 residency programs in the field of obstetrics and gynecology, but only one allowed me to observe how abortion is taught. While medical residents can opt out of abortion training for religious or moral reasons, a resident identified as Jane felt a professional obligation to learn the procedure. "This is part of OB-GYN — it's not an optional part, per se," Jane said. She emphasized that "Women can choose if they want an abortion or not, but you as their doctor need to be able to provide them with all the choices available."

Clinical Experience and Skill Acquisition

Jane spent about a month at this family planning clinic during the third year of her residency. Being able to perform the abortion is just one set of skills she learned; she also learned to counsel patients about abortion, contraception and sexually transmitted diseases, and learned techniques for pain management and dilation of the cervix. Furthermore, doctors do ultrasounds before abortions in order to date the pregnancy, which helps determine which technique will be used to terminate it. As Jane noted, "Before in residency, we were doing ultrasounds maybe once during a clinic afternoon... but here we do 30 ultrasounds in a morning, so it's a lot of good learning about how to do ultrasounds."

Institutional Pressures and Career Risks

In Texas this training happens quietly, almost in secret. "Doctors working in these institutions are walking a very delicate line," said Carole Joffe, a medical sociologist at the University of California, San Francisco. Academic medical centers in Texas receive tens of millions of dollars a year in state funding, and they are fearful of the other sectors of the university coming down on them and saying, "You're threatening our funding."

It's understandable why an OB-GYN resident in Texas might think twice about providing abortions. Doctors who provide the service must think about security issues for themselves and their staff, and they also have to deal with the scrutiny of state inspectors as well as anti-abortion protesters. Moreover, surveys and other research show that doctors who do abortions may have fewer job opportunities. This is because many hospitals and group practices refuse to employ doctors who do abortions, even if they do so during evenings or weekends, on their own time.

Statistical Overview of Abortion Access and Training

• Annual OB-GYN Graduates in Texas: More than 100
• Texas Residency Programs in OB-GYN: 18
• Abortion Clinics Closed Since 2013: More than 20
• Active Abortion Doctors in Texas: Dropped from 48 to 28 recently