Graying’ providers: Will abortion care be limited?
Take a look at the results of a just-released survey of practicing members of the Washington, DC-based National Abortion Federation (NAF), the professional organization of abortion providers in North America.1 The majority of surveyed abortion providers is at least 50 years old, and nearly one-third is over age 55, according to the survey findings. Does the "graying" of skilled practitioners raise concerns about the future availability of abortion?
The National Abortion Federation first identified this threat to women’s access to abortion more than a decade ago, says Vicki Saporta, executive director of the organization. In 1990, NAF convened a symposium, "Who Will Provide Abortions?" to address the growing shortage of health care providers offering such services. NAF’s Access Initiative Project was specifically created to pursue the recommendations that grew out of that symposium, Saporta comments.
NAF established the Berkeley, CA-based Medical Students for Choice to educate and involve a new generation of physicians in the provision of abortion services, notes Saporta. The student organization has more than 4,000 members at more than 100 campuses across the country, she reports.
The Access Initiative project is working to integrate abortion care into obstetrics/gynecology (OB/GYN) residency training and has developed curricula for residency programs, a "values clarification" module for physicians and residents, and a comprehensive textbook on abortion practice, reports Saporta. The project also has organized Clinicians for Choice, which identifies pro-choice advanced practice clinicians who are committed to advocating for the full spectrum of women’s reproductive health care within their professions, she reports.
The project’s physician clearinghouse helps physicians who want training or would like to perform abortions to connect with a facility that is providing this service, says Saporta. NAF also conducts workshops to pair residency training programs with NAF member clinics willing to be training sites in areas where training opportunities are otherwise lacking.
Commitment to increasing education on the residency level is an important aspect of enlarging the provider pool, agrees Steve Lichtenberg, MD, MPH, medical director of Family Planning Associates Medical Group Limited of Illinois and a clinical instructor in obstetrics and gynecology at Northwestern University Medical School, both based in Chicago. Lichtenberg, who serves as lead author of the recently published survey results, says residency programs are being encouraged by the Washington, DC-based American College of Obstetricians and Gynecologists to make elective clinical courses for abortion training.
Medical abortion eyed
How will the 2000 addition of mifepristone (Mifeprex, Danco Laboratories, New York City) impact the number of U.S. abortion providers? (See the Contraceptive Technology Reports supplement, "Gauging the Effectiveness of Mifepristone and Misoprostol," inserted in the February 2001 issue of Contraceptive Technology Update for more information on the medical abortion regimen.)
"Over time, medical abortion holds the promise of expanding access to abortion services for women, says Saporta. "Some health care providers who do not provide surgical abortion services are already offering medical abortion services to their patients."
NAF is working to ensure that those providers who want to add medical abortion to their practices have all the necessary information through its provision of educational materials and seminars.
"Of the 3,400 health care professionals who have attended our educational programs, many do not currently perform abortions and are interested in possibly adding medical abortion to their practices," reports Saporta. "Over time, we expect more clinicians to offer medical abortion as more women request this safe abortion option."
Medical abortion now constitutes 3%-5% of first-trimester abortions in the United States, Lichtenberg estimates. It is yet to be seen whether that number will increase, but the regimen holds the possibility of increasing access to early abortion, he believes. Lichtenberg and his co-authors will conduct a second survey in 2002 that will include information on medical abortion services.
What is the role of the midlevel practitioner in increasing access to abortion services?
"We have found that there is enormous interest among advanced practice clinicians in providing their patients with a full range of reproductive health care, including abortion," says Saporta. "In fact, across the country, advanced practice clinicians are currently providing medical abortion services to women under the supervision of a physician."
NAF is encouraging interested clinicians to seek training and become more involved in the provision of surgical and medical abortion care, including pregnancy options counseling, assisting in abortion service delivery, and post-abortion care, as allowed within the professional standards and regulations of their state, says Saporta.
"We know that with proper training, these clinicians are capable of providing patients with safe, high-quality, first-trimester medical and surgical abortion care," she notes.
Reference
1. Lichtenberg ES, Paul M, Jones H. First-trimester surgical abortion practices: A survey of National Abortion Federation members. Contraception 2001; 64:345-352.
Resource
For more information on abortion, contact:
- National Abortion Federation, 1755 Massachusetts Ave., N.W., Suite 500, Washington, DC 20036. Telephone: (202) 667-5881. Fax: (202) 667-5890. Web: www.prochoice.org.
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