Incomplete Education

Medical Students for Choice fear that abortion rights and access are slowly being chipped away

The hours doctors in training put in are legendary--so why would medical students and residents at the University of Arizona's College of Medicine get involved in an organization that takes time, courage and personal commitment, much less one that's devoted to making their course of study and training more stringent?

They believe in a woman's right to comprehensive medical care, that's why.

Jaime Michaelson, a first year OB-GYN intern in the UA College of Medicine residency program, recently interrupted a rare evening off to talk about Medical Students for Choice, a pro-choice, grassroots network founded by and solely run by medical students and residents in the United States and Canada. The group currently has more than 10,000 members; about 100 UA medical students, interns and residents belong to the local chapter.

Michaelson was involved at both the local and national levels while she was getting her M.D. (She has less time now that she's working 80 hours a week, but is still active.)

MS4C (as they abbreviate their name on the Internet) "stands up in the face of opposition, working to de-stigmatize abortion provision among medical students and residents, and to persuade medical schools and residency programs to include abortion as a part of the reproductive health services curriculum."

But, wait, you ask: Medical schools aren't teaching students how to perform abortions, the most common surgical procedure performed on American women, which an estimated one in three women will seek sometime during her life?

No, they are not. Bowing to pressure from anti-abortion groups and politicians, medical schools across the country have made abortion an elective. They send students who want the training elsewhere, usually to Planned Parenthood clinics, to get clinical experience. Students with moral or religious objections can opt out of the training.

Since 1996, the national accrediting body for graduate medical education has required "that access to experience with induced abortion must be part of residency education" for OB-GYNs, and requires that experience with "management of complications of abortion must be provided to all residents." However, under pressure from Congress, it protects the objections of individual residents by excusing them from the training. It also excuses programs from actually providing it.

Michaelson points out that the UA School of Medicine does what it can by allowing residents to opt out of the clinical training, as it must, but includes the off-site clinical training in the standard curriculum. Most schools of medicine do not even provide this level of support, and most OB-GYN residents must find training on their own, as an addition to an already-packed schedule.

"One of the problems with this," says Marilyn Heins, a retired pediatrician, medical educator and supporter of MS4C, "is that even though this may be a controversial issue, medical education in the United States is designed to assure the American people that every doctor who graduates from an accredited medical school and goes through an accredited residency program is fully trained. An M.D. is a sort of Good Housekeeping Stamp of Approval. Every OB-GYN resident is not being fully trained under the present system.

"Medical Students for Choice is pointing this out to women who don't suspect that when they choose an OB-GYN, they may be selecting a physician who is not fully trained and may not be knowledgeable enough to even counsel them."

Heins forcefully makes a number of other points about abortion: Abortion is legal; not all abortions are elective; half of all women seeking abortions were using birth control when they became pregnant; the mortality rate of women from abortion is one-tenth that of childbirth.

Heins is strongly pro-choice. She saw the results of botched back-alley abortions when she was in training in the early 1950s: "It was the single most common cause of women coming to the emergency room with fever and abdominal pain."

By Arizona law, University Medical Center cannot provide abortions except when the life of the mother is in danger, and is forced to send patients to Planned Parenthood when prenatal exams show severe birth defects, and the physician recommends termination.

The prohibition was attached as a rider to a 1974 education bill that gave the UA $5.5 million for renovations to the football stadium. This was a year after the Roe vs. Wade decision, at a time when lawmakers were making end runs around legalized abortion all across the country.

In a 2000 story in the Tucson Citizen, the former legislator who sponsored the bill, Jim Skelly, is quoted as saying that he deliberately added the rider to a bill the university desperately wanted.

"And it worked," he's quoted as saying. "The university's ideology sure went down the drain when it came to expanding the sports arena, now didn't it?"

Second-year UA medical student Laura Mercer observes, "When you couple this ban with the fact that only two hours in our basic science curricula are devoted to teaching about all forms contraception and abortion, there is definitely a need for more education." Mercer co-chairs the local MS4C chapter.

The anti-abortion movement's long-term strategies appear to be working.

Today, 85 percent of all counties in the United States now have no abortion provider, and the average age of physicians who provide the service is older than 50. A combination of lack of training and systematic intimidation is keeping younger physicians from providing the service. Roe vs. Wade will be irrelevant if women can't find abortion providers, Mercer, Michaelson and Heins all point out.

The wave of violence against abortion providers in the late '90s seems to have subsided--MS4C was founded in response to a threatening 1993 mass-mailing to medical students around the country and a series of murders of physicians that followed--but abortion providers and their families are commonly harassed, finding their names and addresses on lists and their pictures on the Internet. Just belonging to MS4C requires courage.

"You know, I read a book by Laurence Tribe, who teaches at Harvard, that explained why this issue is so explosive," Heins says. "It pits two absolute, fundamental American rights directly against each other: life and liberty.

"What I'd like to see is more research on better contraceptive methods. That would really do something to reduce the number of abortions. In the meantime, we have to keep the dialogue going."