A shortage of obstetrician-gynaecologists in Italy willing to provide abortions is making abortion advocates worried. Government figures indicate that the proportion of gynaecologists conscientiously objecting to providing abortion increased from 58.7 per cent in 2005 to over 70 per cent in 2007 and the rate has remained largely constant since then. The pro-abortion group Gynaecologists for the Application of Law 194/78 (LAIGA) claims that the figure is at 80 or 90 per cent in some regions, as some ob-gyns are not officially noted as objectors.
“This requires the health care system to compensate with interns and consultants who cost more and aren’t always able to do therapeutic abortions,” said researcher Sara Martelli at a LAIGA conference. “Furthermore it turns out that the non-objecting doctors are concentrated in the age group of 35 to 50 year-olds (some have reached the age of retirement) while conscientious objection is very widespread among the youngest.” This has led some to call for restricting conscientious objection to abortion as abortion advocates worry about a future in which very few doctors are willing to carry out abortions.
This is not only a problem in Italy. According to the Guardian, fewer than 12 British doctors are willing to carry out surgical abortions up to the 24 week limit and almost none of them work for the National Health Service. In France, according to IGAS, a government agency for social services, the average age of an abortion doctor is 53 years old and the number of facilities providing abortions in the country is decreasing.
The trend is not limited to Europe. A 2006 report by Canadians for Choice found that only 16 per cent of hospitals in Canada do abortions, a two per cent drop from 2003. Since the 2006 report, five more hospitals have no doctors who will perform abortions.
Pro-abortion groups also complain about the lack of abortion training given to medical students. The Toronto Star reported in 2010 that a 2009 Contraception journal survey found 67 per cent of Canadian medical schools had preclinical courses that discussed abortion under the theme of sexual and reproductive health. A 2006 Obstetrics and Gynecology study stated that only half of the country’s obstetrics-gynaecology programs regularly train students for doing abortions.
The same phenomenon is happening in the U.S. The pro-abortion Guttmacher Institute reported that the number of American abortionists declined by 38 per cent from 1982 to 2008. A 2011 survey of 1,144 obstetrician-gynaecologists led by Dr. Debra B. Stulberg from the University of Chicago discovered that 97 per cent had patients who wanted abortions, but only 14 per cent would actually supply them. This was lower than the 22 per cent in a 2008 survey that focused on younger doctors trained after the American Council of Graduate Medical Education issued a requirement in 1996 that “experience with induced abortion must be part of residency training.”
As reported by Heather Rogers of Remapping Debate, an online news journal sponsored by the Anti-Discrimination Center, the proportion of obstetrician-gynaecology residency programs that make abortion a regular part of the curriculum has increased to 50 per cent due to the effect of the policy, with 10 per cent not providing abortion at all and 40 per cent only giving it to residents who opt in. Also in 1996, though, the Coats Amendment was passed in Congress, which declared that residency programs that do not provide abortion training shall still be accredited by all levels of government, effectively overriding the ACGME’s policy.
Medical Students for Choice (MSFC) claims that less than 30 minutes (mostly about ethics) is devoted to abortion during the first two years of medical school. During the last two years devoted to clinical training, a 2005 article in the American Journal of Obstetrics and Gynecology reports that less than a third had at least one lecture about abortion in particular.
Why is there such a decline in abortionists? The pro-abortion side proposes that potential candidates do not want to put their lives at risk, fearing another incident like the murder of late-term abortionist George Tiller in 2009 and they do not want the hassle of pro-life demonstrations outside of abortion facilities. The stigma of being known as a doctor who does abortions and personal ethical dilemmas are also factors. Pro-abortion feminists say the new generation of doctors did not live through the contentious battle to legalize abortion and the passion for providing the procedure is therefore not as strong.
Abortion advocates also point to the lack of training in medical school and residency. MSFC blames Catholic hospital mergers for decreasing the number of hospitals doing abortions, thus depriving students of opportunities to be trained in carrying out abortions. The group’s executive director, Lois V. Backus, told Remapping Debate that American medical schools fear losing private and public funding if they teach abortion and some students have threatened to sue the schools if they taught the subject.
There are also conscience protections. The Canadian Medical Association’s policy PD88-06 on induced abortion approved in 1988 states that physicians have the right to refuse participating in an abortion and that they should not be subject to any discrimination.
A 2007 opinion of the American Congress of Obstetricians and Gynecologists’ Committee on Ethics, though, puts restrictions on American obstetrician-gynaecologists: “Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities.” In fact, physicians have a duty to provide referrals to patients if they are unable to provide the “standard reproductive services” that are requested. “In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care,” the committee also states.
Because of the shortage of abortionists, there is now a move to let other health professionals carry out surgical abortions. On Jan. 9, New York Governor Andrew Cuomo (D) said in his State of the State Address that he would fight in favour of a radical bill that would allow any “licensed health care practitioner” to do abortions before “viability.” In 2012, California, another Democratic governor, Jerry Brown, approved a bill extending a University of California pilot project permitting nurse practitioners, nurse-midwives, and physician assistants to perform first-trimester aspiration abortions. South Africa and Vietnam allow nurse practitioners and physician assistants to do first trimester abortions. Midwives are also authorized to carry out first trimester abortions in South Africa.
Typically, nurse practitioners only perform minor surgical procedures such as removing stitches, or may obtain certification to become first assistants in surgery. The exception is the United Kingdom, where NPs may train to be surgical care practitioners, which authorizes them to do minor operations such as removing varicose veins, skin lesions, and operating on carpal tunnel syndrome, but under supervision. Allowing NPs to perform dangerous surgical abortions would be a significant expansion of their duties.
“The abortion lobby’s effort to lower the standards of medical care for women is a first and an outrage,” Charmaine Yoest, president of Americans United for Life, said regarding the California law. “Given the shoddy treatment and house of horror tales coming from some abortion clinics, it is irresponsible to lower the bar so that women will be even more vulnerable to poorly qualified practitioners.”
