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. But the closure of abortion clinics in Texas — more than 20 since 2013 — has made that training increasingly difficult.
The Impact on Medical Residency Programs
Texas has 18 residency programs in the field of obstetrics and gynecology, but only one allowed me to observe how abortion is taught. Because of the political pressures facing abortion providers, NPR agreed not to reveal the doctors' full names or the clinic's location. Medical residents can opt out of abortion training for religious or moral reasons, but some feel a professional obligation to learn the procedure. A resident identified as Jane said, "This is part of OB-GYN — it's not an optional part, per se. 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 Skills and Professional Development
Jane spent about a month at a 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. The rotation taught her things that will be useful in other practice areas, as OB-GYNs use ultrasounds for many different reasons. Doctors do ultrasounds before abortions in order to date the pregnancy, which helps determine which technique will be used to terminate it. In some states — including Texas — an ultrasound is also mandated by state law.
Political and Institutional Pressures
It may be good learning, but 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. Many of those centers sponsor residencies, which are the training programs that come after medical school. Some doctors are fearful of the other sectors of the university coming down on them and saying, "You're threatening our funding."
Doctors who provide the service must think about security issues for themselves and their staff. They also have to deal with the scrutiny of state inspectors as well as anti-abortion protesters. Surveys and other research show that doctors who do abortions may have fewer job opportunities.
Guidance for Finding Safe Medical Care
Step 1 is finding a clinic or provider that is pre-screened, safe, legit, and right for you. Every clinic is different, and things like cost, anesthesia, and available services will be different at different clinics. You can find a clinic or abortion provider by going to any of these websites:
- ineedana.com
- National Abortion Federation (Call 1-877-257-0012)
- Planned Parenthood (Call 1-800-230-PLAN)
- GynPages
- Abortion Clinic Pages
- Abortion Care Network
Identifying Legitimate Providers
Avoid centers that refuse to give a straightforward answer. There are some places out there that call themselves “clinics” but don’t actually perform abortions. These “Crisis Pregnancy Centers” are often listed in phone books under Abortion or Abortion Alternatives. They are anti-abortion and they will try to convince you not to have an abortion, often by giving you false, medically inaccurate information about the risks or costs of abortion. To protect yourself, you should ask whether they have doctors or nurses on staff and what training the doctors have received.