Many countries are facing a shortage of doctors who are willing to perform abortions as their current providers are nearing retirement.
- Younger doctors are unwilling to face the social stigma that comes with abortion.
- Abortion is seen as an unexciting field of medicine.
- In New Zealand, abortionists need to be recruited from overseas.
- Nursing staff are unwilling to assist at second and third trimester abortions.
- British medical schools have started to restrict the number of Muslim students, because they refuse to learn about abortion.
Obstetrics is the care of women during pregnancy, birth and after delivery. Gynaecology deals with disease and the routine care of female reproductive systems. An Obstetrician/ Gynaecologist combines the two specialities.
There are several reasons for the declining number of abortion providers:
- The "greying" of current providers. In the US, the majority are close to retirement.
- Picketing and violence that targets abortion providers (not in NZ)
- Social stigma and marginalisation
- Professional isolation and peer pressure
- The perception of abortion as an unexciting field of medicine.
In New ZealandIn December 2003, the New Zealand Abortion Supervisory Committee reported that overseas abortionists need to be recruited because of problems with "recruitment and retention" of New Zealand abortionists.
The Level J Unit at Wellington Hospital and the Lyndhurst Clinic in Christchurch recruited overseas doctors and nurses specifically for abortions.
A letter (10th May, 2001) to Canterbury GPs from the Director of Gynaecology Services at Christchurch Women's Hospital, requested them to refer patients for earlier terminations:
"A higher than acceptable percentage of patients are being referred late, when the pregnancy is quite advanced. These women are more difficult to operate on, and some are too advanced and require prostaglandin termination of pregnancy (PGTOP). This is an unpleasant procedure for staff and patients alike."
Abortion quickly lost its stigma, once the Act was supported by the British Medical Association and other medical professional bodies. Most O&Gs saw themselves as helping women exercise their legal right to safe abortion under the best medical conditions.
Another important factor was the philosophical change to a more utilitarian approach. Abortion came to be officially and professionally regarded as a routine health service to which women were legally entitled.
"Abortion is an essential element of sexual health services as can be seen by the fact that one-in-three women in the UK has an abortion," (Anne Weyman, Chief Executive of the Family Planning Association, BBC News 29 July, 2004)
Younger O&Gs trained after the 1967 Abortion Act are considered to have little institutional experience of dealing with the results of back-street abortions. Those working in the NHS hospitals are routinely rostered to perform first and second-trimester abortions.
The reason why more hospital doctors are exercising their right to opt out of abortion, can be understood in the remarks of Professor Stuart Campbell at London's Create Health Clinic, reported in the BBC News website 29th July, 2004.
British medical selection panels in general, regard the provision of abortion services as a primary health service and a woman's legal right. NHS hospitals usually roster staff for a daily schedule of abortions, and when O&Gs and nurses chose to opt out on the grounds of conscience, the workload is increased for the other staff.
Therefore, it appears logical to fill training and hospital posts with doctors who are prepared to provide abortion services.
The situation in America (as of June, 2003):
- 87% of all U.S. counties and 97% of all rural U.S. counties have no abortion provider
- Since 1982, the number of abortion providers has decreased by 37%
- 58% of all OB/GYN doctors providing abortions are 50 years of age or older. This means the number of providers will continue to decline as they reach retirement age, unless younger clinicians learn to perform abortions.
- In 1983, 42% of all OB/GYN doctors performed abortions. In 1995, only 33% did. The overwhelming majority of abortions are performed by a small group of doctors. Only 2% of U.S. OB/GYN doctors perform more than 25 abortions per month.
- 72% of OB/GYN residency programmes do not train all residents in abortion procedures.
- From 1982 to 2000, the number of hospitals providing abortions decreased by 57%.
- Only 15% of chief residents in family medicine residency programmes, have experience providing first-trimester abortions.
- "Physician-only" laws in most states require careful legal research to ascertain whether advanced nurses and midwives can provide medical and surgical abortions.
- Many nursing programmes do not adequately prepare students to care for women having abortions, contributing to a shortage of nurses willing and trained to assist abortion providers.
- Abortion is one of the only medical procedures with a "conscience clause", allowing doctors and nurses to refuse to participate in the care of a patient.
"Working conditions for clinicians providing abortions are frequently unsatisfying. For clinicians who have spent years honing their diagnostic skills, abortion largely underutilizes their abilities and relegates them to the role of a technician. As noted by Potts (Lancet, 1975): ?When the patient was a client who had decided on the prescription (abortion), this eliminated half the medical mythology and demoted the doctor to technician or tradesman.'"
"Both the evolution of new clinic personnel (abortion counsellors and nurse-practitioners), and the rapid flow of patients in clinics, have depersonalised the abortion experience, not for the patient but for the clinician. For some, communication may be limited to a brief discussion with the patient on the operating table before surgery."
"Isolation can occur. Clinicians whose practice is limited to abortion services may become estranged from the medical community. The tedium of largely repetitive operations can be compounded by the emotional stress surrounding unwanted pregnancies and families in crisis. A practice limited to women with personal crises, differs markedly from the usual mix of patients in an obstetric and gynaecological practice. On the other hand, some physicians find helping women to resolve personal crises especially rewarding."
Proposed solutionsDr Grimes recommends more integration of abortion training into residency programmes, increased pay and training nurses and midwives to perform first-trimester abortions.
He concludes: "Abortion is the most divisive social issue of our time. Despite strong professional support for legal abortion from the American College of Obstetricians and Gynaecologists, one of their 1985 news releases observes: ?There remains a lack of enthusiasm and even opposition from many gynaecologists, who consider abortion a distasteful chore. The medical profession must be educated to the fact that abortion is no longer a favour to bestow, but rather an obligation to perform.'"