Friday, July 16, 2010

If a revolution were organized by women...

New York Times Magazine had an amazing article this week,
The New Abortion Providers, by Emily Bazelon. It talks about efforts over the last thirty years to make abortions a part of mainstream medical practice.

This approach reminded me of a discussion that I had with a couple of ladies at church. Despite their age (or because of it), they were die-hard feminists and progressive Christians. They talked about how their grandmothers were also feminists, but in a quiet way, behind the scenes. They opined that behind any social movement that was successful had women doing the cooking and organizing while the men were doing the blustering. But at the same time, they didn't embrace the dominant narrative of feminism. Jo Cranson mentioned Ashley Montague interviewing a grandmother who ask why she should settle for equality when it's less than what I had before. Robinmarie McClement cited Susan B. Anthony being very concerned about women losing their quiet power behind the throne, if they pursued feminism as a public battle.

Protests and gauntlets in front of free-standing clinics are effective because abortions are a marginalized medical practice. If more doctors performed abortions in their offices or in a hospital, it would make it much more difficult for protesters to single out patients. This change would involve making abortion a standard procedure in the practice of family doctors, internists, and OB/GYN.

In 1995, Accreditation Council for Graduate Medical Education made abortion training a requirement for all OB/GYN residency programs, meaning that medical students would be receiving mandated hours of lecture on how to perform abortion. This motivation behind this move was to make abortion part of the professional qualifications of a doctor. Even if the student never performs an abortion, they needed to be educated about it.

The next step was to make in-roads into academic medicine by establishing fellowships to provide advanced training and to support research.

"A physician at the U.C.S.F. medical school set up the Family Planning Fellowship, a two-year stint following residency that pays doctors to sharpen their skills in abortion and contraception, to venture into research and to do international work. In recent years, the fellowship has expanded to 21 universities, including the usual liberal-turf suspects — Harvard, Columbia, Johns Hopkins, Stanford, U.C.L.A. — but also schools in more conservative states, like the University of Utah, the University of Colorado and Emory University in Georgia."

International work was an important component because it exposed the fellows to countries where back alley abortions were still common. Another side effect of the residencies is that the physicians need to perform enough abortions to "train to competency." In other words, they need to do enough procedures to be able to handle complications. This process often involves performing many, many abortions in a hospital setting, because the complication rates for first-trimester abortions are so low (about 1%). This training usually occurs in hospitals, which means greater, safe access for women. Coming out of these fellowships, residents are equipped to make decisions about the place of abortion in their own practice. The decision whether or not to offer thee treatment is not necessarily a simple yes or no, but possibly choosing a cut-off, such as 7, 9, or 13 weeks.

These small changes are brilliant, because they don't involve direct confrontation with the protesters on the front lines. They make abortion more available by changing the context. If physicians could bring the simple procedure into the medical fold, it would reduce the need for free-standing clinics and the vulnerability of their patients. (An abortion at 9 weeks gestation produces no recognizes fetal parts and takes less than five minutes by a skilled provider, using device that is "about 10 inches long, costs only $30 and looks like the kind of appliance you might find in a kitchen drawer.")

There are still other obstacles in the way, such as hospitals being squeamish about associated with abortion and the cost of extra medical insurance, but change is afoot. Moreover, this is a change brought about largely by women for women, with the support of male colleagues, away from the glare of publicity and politics.

Many of the protégées Grimes is talking about are women. In the first generation after Roe, abortion providers were mostly men because doctors were mostly men. Since then, women have streamed into the ranks of OB-GYN and family medicine. They are now the main force behind providing abortion.

Let's hear it for social revolutions organized by women.

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