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Monday, November 22, 2010

The Abortion Provider's Dilemma?

There was an article on the weekend in the Toronto Star by Megan Ogilvie called "A Young Abortion Provider's Dilemma." The following comments are from SW.

Ogilvie focuses on the issues doctors may have in deciding whether or not to be an abortion provider and in doing so, makes it sound as if the paucity of services in smaller centres or rural areas is one of provider shortage. Not so. There is lots of interest in attaining skills coming from both OBGYN and FP residents. But why bother training them if there is nowhere to practice?

There is another way to approach this and create more providers. If smaller centres and regional hospitals had the political will to set up an abortion care program or at least provide some weekly OR time, then perhaps a few more providers would come out of the woodwork.

Medical schools contribute to the problem by failing to provide adequate training in the entire field of sexual and reproductive health, particularly to family practice students. Abortion training, if there is any, may amount to as little as an optional one hour lecture. Contraception education is equally pathetic. One doctor told me that the only contraception training she got was a talk by an Ortho pharmaceutical rep. Lack of training and lack of programmed services mixed in with a few hostile anti-choice zealots in a community create an environment where it is dangerous for doctors to speak out for better care for women.

It is much easier for our hospitals and medical schools to ignore the reproductive health needs of women. When they require abortion care, quietly shuffle them off to the big city. And in the big cities, limit the number of procedures by establishing quotas or restricting clinic days or the number of facilities. Then, voila – you have a rate of abortion that appears to never change or even drops because women are accessing uninsured services or leaving the province and going to a neighbouring province and in both instances, don’t get counted because they are paying out of pocket.

By ghettoizing abortion services, we not only make it more difficult for women to obtain care, we make it more difficult for medical students and residents to incorporate it into their practices.

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