MSFC Update - February 2005

Beyond Medical School: The Voices of Medical Students and Physicians in the Battle for Reproductive Rights
By Amy Bryant

In the spring of 2004, Dr. Eleanor Drey, Assistant Clinical Professor of Obstetrics and Gynecology and Reproductive Sciences at the University of California, San Francisco and Medical Director of the Women’s Options Center at San Francisco General Hospital, testified against the Federal Abortion Ban before the United States District Court for the Northern District of California. In preparation, Dr. Drey was trained in how to effectively speak to the press about the Federal Abortion Ban by Physicians for Reproductive Choice and Health®, an organization whose mission is to enable concerned physicians take a more active and visible role in support of universal reproductive health.

“It makes me feel really good that I can do something very immediate to serve women’s medical and emotional welfare while working in a political sense to train future providers, do research, and hopefully broaden women’s access to abortion and reproductive care,” Dr. Drey said.1

Sadly, political agendas, and not the best interests of a constituency, are often the driving force behind legislation. Therefore, it is imperative that all medical professionals and the media look beyond the rhetoric and decipher what politicians really mean. The Federal Abortion Ban is a prime example, as it is not about late abortions as supporters purport, but would ban procedures as early as twelve to fifteen weeks. In almost all states late abortions (third trimester) are already illegal unless there is a threat to the health of the woman. This new ban is so vaguely worded that it would apply much earlier in pregnancy and cover abortions that doctors think are safest in certain situations.2

It is the physician’s job to make sound medical decisions based on their training and judgment. When politics get in the way of medical decisions, patients invariably suffer. It is not unusual for a doctor to have to make split-second medical decisions to save the life of a patient in a medical emergency that threatens a woman’s health or ability to have children in the future. Physicians need to be able to make these decisions without fear of criminal repercussions imposed by the government. It is doctors who should make medical decisions, not politicians.

Abortion is in decline in America. This is because of easier access to contraception, better emergency contraception, and better education about reproductive health. In order for the rate of abortion to continue to decrease, American women must have better access to contraception, to quality reproductive health care, and to education. Dr. Drey, an abortion provider, is not the only one who can help. As respected members of society, physicians and medical students have an influence over politicians and the media that other citizens donot have.

Younger providers in particular are encouraged to take a more active role as there are far fewer new abortion providers today. Currently 57 percent of all abortion providers are over the age of 50. In addition, most medical students are graduating with little more than circumstantial knowledge of abortion. Many older physicians witnessed women die of botched and self-induced abortions and see abortion provision as a public health necessity. For younger physicians, in whose lifetimes abortion has always been legal, the decision seems to be based more on the assumption of a political viewpoint: they believe in a woman’s right to choose. This is a result, in part, of the politicization of abortion specifically and reproductive health care in general. These developments, accompanied by increased harassment and deadly violence against physicians, have resulted in fewer young doctors becoming providers. However when medical students and physicians have opportunities to be active and vocal in front of lawmakers and the media, more doctors-to-be will feel motivated and see the need to include abortion in their future practices.

Anti-choice forces are gaining speed in their efforts to limit or eliminate access to contraceptives, safe abortion services, and emergency contraception (EC). What is so discouraging is that all of this is politically driven, and not at all concerned with medical evidence, science, or the clinical implications of policies. In 2004 the Food and Drug Administration (FDA) rejected the application for over-the-counter (OTC) access to EC, despite the fact that based on research and clinical experience, its own Advisory Committees voted 23-4 to approve OTC status. It is important that both the FDA and the media hear the voices of health professionals who can provide objective information about the safety of OTC access to EC, so that this politically-driven decision does not stand.

Religious health care restrictions also represent a significant threat to patients’ health and access to care at hospitals, clinics, and even doctors’ offices. Across the nation, there is growing conflict between religiously-sponsored health systems and the diverse communities they serve. Basic services such as sterilization, in vitro fertilization, contraceptive counseling, and abortion are forbidden by The Ethical and Religious Directives for Catholic Care Services, the governing principles for Catholic-owned hospitals developed by the U.S. Conference of Catholic Bishops. Such restrictions are threatening patients’ health as well as their rights to complete medical information and informed consent. In addition, residents at Catholic hospitals are not able to observe and be trained in these reproductive health services. By supporting these institutions, policymakers are ignoring the health needs and rights of patients. Medical professionals are in a unique position to speak out about this threat to patients’ access to care, and to counter the rhetoric that is shaping policymakers’ decisions. Medical students and residents, in particular, can protest their reduced access to training in critically important reproductive
health services.

Our nation is also faced with a dangerous shortage of trained abortion providers. As of 2003, 87 percent of all U.S. counties had no provider. Unless more physicians are trained to provide services, this percentage will only increase. Physician and medical student activism has never been more important.

Although the United States District Court for the Northern District of California declared the Federal Abortion Ban unconstitutional, in December, The Department of Justice appealed to the 9th U.S. Circuit Court of Appeals. The legal battle to permanently invalidate this vague and burdensome law will continue, possibly all the way to the United States Supreme Court. In addition, The Bush Administration has made restrictions on women’s health a priority for this term. Now more than ever, physicians and medical students must speak out on behalf of women’s health and on behalf of their duty to practice safe, responsible medicine.

The following national and state medical organizations, representing hundreds of thousands of doctors all over the country, do not support the Federal Abortion Ban: American Medical Association, American College of Obstetricians and Gynecologists, American Public Health Association, American Medical Women’s Association, Association of Women Psychiatrists, American Nurses Association, American College of Nurse Practitioners, National Association of Nurse Practitioners in Reproductive Health, Association of Schools of Public Health, American Medical Student Association, California Medical Association, Rhode Island Medical Society, Association of Reproductive Health Professionals, Physicians for Reproductive Choice and Health.

Amy Bryant is Project Manager at Physicians for Reproductive Choice and Health®.

1 Choice Notes, Physicians for Reproductive Choice and Health, Vol. 9, No. 3, September 2004.
2 Additional information from www.banonabortion.com.