Without Providers, There is No Choice

Julia Kaye

A steady decline in abortion providers, due to violence and/or the threat thereof, and a shortage of new providers among young doctors and medical students, underscores that legality does not guarantee access.

“The Last Abortion Doctor.” “The Abortion Evangelist.” “Abortion Stigma Affects Doctors’ Training and Choices.” In the wake of Dr. Tiller’s murder last May, news articles are finally trumpeting a steadily emerging reality: the number of abortion providers in the U.S., and particularly providers that perform abortions after the 20th week of pregnancy, is plummeting.  An article in the Washington Post this week attributes this steady decline to a toxic combination of violence and/or the threat thereof, and a lack of urgency among young doctors and medical students who never had to witness the horrific consequences of back-alley abortions in the pre-Roe era.  The result is that legality doesn’t guarantee access to abortion, even—especially—for women and families in the most desperate and dangerous of situations.

There now remains only a handful of doctors in the country specializing in the 1 percent of abortions that take place after the 20th week—including Dr. Warren Hern and Dr. Leroy Carhart.  The doctors work in war-time conditions, driving bulletproof cars and avoiding rooms in their clinics where the windows are too exposed.  They are the ones who care for a woman whose fetus would be born with a lethal heart abnormality, or without a face. The ones who help a woman who may face a life-threatening uterine rupture were she to carry the pregnancy to term.  The ones who provide relief to a rape victim who would rather commit suicide than carry to term a fetus whose every kick induces flashbacks of the attack.  They provide life-saving care to women and families in dire situations; they are doctors in the most heroic sense.  But they are few, and they don’t have enough hours in the day.  Though they are doing all that they can to cover the patients that Dr. Tiller would have seen, his death was a profound loss that has made it all the more difficult—and in some cases, impossible—for women to find the care they may desperately need.

It is not only post-20th week abortions that threaten to become inaccessible for lack of providers; the number of doctors willing to perform even first-trimester abortions has also dropped precipitously in recent decades.  The Post reports that, “although nearly one-third of American women will have an abortion by age 45, according to the Guttmacher Institute…the number of abortion providers dropped from 2,908 in 1982 to 1,787 in 2005. Eighty-seven percent of counties in the United States and 31 percent of metropolitan areas have no abortion services.”  In Mississippi—the state with the greatest number of women living in poverty — a woman seeking an abortion at any stage must travel and wait to see 65-year-old Dr. Joseph Booker, the sole abortion provider in the state.  For poor women, who may struggle to take time off work, find childcare, or afford transportation, abortion’s legality provides little comfort if it cannot be accessed.

And therein lies the troublingly effective strategy of many segments of the anti-choice movement: weed out existing abortion providers through harassment, violence and scare tactics, and stomp out new growth by denying medical students, or convincing them that they do not need, fundamental and sometimes life-saving information on one of the most common procedures in American medicine.  According to the Post, “veteran antiabortion activist Randall Terry says he is gratified that Tiller’s killing and recent media interviews given by Hern, who drives a bulletproof car and works behind four layers of bulletproof glass, have succeeded in scaring young doctors who might contemplate providing abortions.”  Kristan Hawkins, the executive director of Students for Life of America “said her group’s goal is to drive abortion out of medical school and residency training altogether. Both those of us who fight to protect the right to choose and those who fight to deny it recognize that without providers, there is no choice. 

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Fortunately, groups like Medical Students for Choice (which has seen an “unprecedented outpouring of support” since Dr. Tiller’s murder) and the National Abortion Federation are on the case.  And Dr. Carhart has received calls from three physicians since Dr. Tiller’s murder who want to learn how to do abortions—two of whom have already begun training.  Many students take up medicine in order to provide the critical care that people need at their most vulnerable moments. Providing abortions is squarely in line with that moral goal.  

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