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Abortion Services Scarce in US - 2003-01-18

Thirty years ago, the U.S. Supreme Court issued a ruling that has shaped American politics and women's lives ever since. The short-hand for this landmark decision is one you've likely heard if you follow U.S. politics: Roe vs. Wade. It cleared the way for women to have legal abortions. But it did anything but put the abortion issue to rest. The question of whether a woman should have the right to terminate her pregnancy continues to be extremely divisive.

In one of his first executive decisions, President Bush reinstated a provision that withholds U.S. foreign aid from organizations that pay for, or even talk about, abortion as a reproductive option. Here in the United States, Medicaid, a federally funded health insurance program for poor people, does not pay for abortions. Critics say that policy restricts women's access to a procedure that's perfectly legal. The lack of federal funding isn't the only challenge facing abortion-rights advocates 30 years after Roe vs. Wade.

It's been estimated that by the time they reach the age of 45, 43 percent of American women will have had at least one abortion. Every year, more than one million abortions are performed in the United States, making the procedure the most common form of surgery among women. Yet, 86 percent of U.S. counties don't have even one abortion provider, and many women particularly those living in rural areas have to travel hundreds of kilometers if they want to end their pregnancies.

Fewer than 2,000 doctors in this country are willing and able to perform an abortion, and their average age is 55. Robert Roose is a second-year medical student at George Washington University. He says the problem is that at his school and at most medical schools abortion is hardly discussed in required courses on reproductive health. And just 12 percent of gynecological residency programs, where doctors receive specialized training, require students to learn how to do a first-trimester abortion.

"Without putting too much blame on medical schools in general, I think it's happened just because there's been an overall politicization of the issue," he said. "Abortion is no longer viewed just as a personal health issue between a woman and her physician, and maybe her partner. But also as this much more broad issue which also has implications, you know, in religion and in morality. So because of that, I think a lot of medical schools avoid the issue all together."

Robert Roose belongs to an organization called "Medical Students for Choice". The group attempts to compensate for the lack of formal instruction about abortion, by organizing special seminars that present the latest technology and research on abortion and contraception. Mr. Roose says there are some doctors who don't perform abortions, because they believe it's immoral to kill a fetus. But he says most don't do it simply because they weren't exposed to the procedure as students. And he says even when students are exposed, they often don't put much effort into learning about the medical issues surrounding abortion, because they aren't asked about these issues on their standardized board exams.

"Until that is tested on the boards, that's going to be a topic that people don't consider to be 'high yield' when they're studying," said Mr. Roose. "When you're getting inundated with mass quantities of information, that's just something that becomes on the fringe and continues to become on the fringe."

But while few doctors would deny that abortion is a controversial subject in America, politics may not be the only reason future doctors aren't being taught how to perform abortions. Dr. Eric Schaff is chair of the National Abortion Federation and directs the University of Rochester's Reproductive Health Program. He says students and resident doctors aren't exposed to abortions because they're trained in hospitals - where the overwhelming majority of abortions no longer take place.

"At one point, abortion was fairly dangerous," he said. "It required you to be in the hospital, the technology was pretty primitive. Over time, it's gotten to become a much simpler, safer procedure, so there's been a trend to make it more available away from hospitals, and it is concentrated in free-standing abortion clinics. "

Dr. Schaff says the desire to keep the cost of abortions down has been driving this shift away from hospitals. But even though the trend toward clinics has meant fewer medical students are now able to observe abortions, Dr. Schaff says the same technological innovations that made the shift possible could also allow people who aren't doctors to perform abortions.

"There are some states that do allow midwives and clinicians such as nurse practitioners and physicians' assistants, who are often more committed to providing these services, to provide abortion services," said Mr. Schaff. "They're few now, but hopefully that will expand. There's no reason not to allow them to provide it, as the services become safer. "

No reason, that is, except for the fact that 30 years after Roe vs. Wade, many Americans, including several key political leaders still believe abortion is murder, and should be outlawed.