THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, August 21, 1994 TAG: 9408210077
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DIANE TENNANT, STAFF WRITER
LENGTH: Long : 121 lines
Say you only have two bullets, went the ``joke,'' and Adolf Hitler, Pol Pot and an abortion doctor are in the room. What do you do?
Put two bullets in the abortion doctor.
A book of such hate ``jokes'' was mailed last year to about 33,000 medical students around the country, attempting to frighten them from performing abortions.
But the book was not really that necessary. Out of hundreds of medical schools in the country, only a handful offer comprehensive training in abortion, and their number is dwindling.
Abortion-rights advocates say it's time to reverse the trend by requiring medical schools to put abortion in the curriculum, at least as an option, for future obstetricians and gynecologists. Opponents of increased training say the move would be unnecessary, as OB/GYNs now are trained in a medical procedure commonly used in early-term abortions.
As the number of medical schools teaching abortion techniques dwindles, many abortion providers are in their 60s and 70s. Abortion-rights advocates worry that, if the trends continue, there will be even fewer abortion providers in the United States.
``At this point, 94 percent of the rural counties in the entire country have no (abortion) provider and 84 percent of counties nationwide have no provider,'' said Susan Yanow of the Abortion Access Project. ``We know that in South Dakota there's only one provider in the entire state, and she's flown in under armed guard.''
Terrorism frightens doctors away, but the real problem is that medical schools do not provide comprehensive instruction in abortion, Yanow said. Eighty-eight percent of OB/GYN residency programs do not require abortion training, she said, and only 7 percent require training in more complex second-trimester abortions. Likewise, few schools offer training in the counseling of abortion patients.
Eastern Virginia Medical School in Norfolk, for example, does not have a formal curriculum for abortion. It does teach dilatation and curettage, a procedure done to empty the uterus after miscarriage or fetal death, or in early abortions.
But Yanow said that the procedure - called D&C - is used in only a fraction of abortions, and that other techniques are ignored by many medical schools, as is the counseling and emotional support that most women also need before and after abortion.
``They (medical students) are learning a tiny range of the spectrum, but by not calling it abortion services, they're conveying an attitude about abortion,'' Yanow said. ``Numbers of women trying to do it themselves will be on the increase. Because these physicians work in emergency rooms, if a woman shows up with a self-induced abortion and all they know how to do is a D&C, she's in trouble.''
As a solution to the shortage of abortion providers, Planned Parenthood of New York set up its own training program last year, said spokesman Steve Plever. ``Before we began this effort, all of our doctors were over 60,'' he said. ``This has been a failure of the medical education system in this country to take this action.
``The medical profession really needs to put itself on record right now, both because of the need for providers and because they're under violent attack.''
Nationally, the number of OB/GYN residency programs that routinely include abortion training has fallen 50 percent since 1985, Planned Parenthood says.
The executive board of the American College of Obstetrics and Gynecology recommended in January that abortion training ``programs'' be encouraged. The council that sets residency requirements will consider it this fall.
Dr. Matthew J. Bulfin, head of the American Association of Pro-Life Obstetricians and Gynecologists, said he thinks mandatory training will be defeated, although voluntary training might be supported. ``There is so much protest from obstetricians that wouldn't put up with the killing of unborn babies in the uterus,'' he said. ``There really is no reason why it should be mandated, because every OB in practice who went through a residency program had many opportunities to take care of women with miscarriages. A woman who miscarries needs a D&C, and he actually is doing the same procedure as a doctor who performs an abortion.''
In the meantime, a group of medical students has taken matters into its own hands. Medical Students for Choice sent 3,600 signatures on a petition to professional organizations, urging that they add abortion training, along with other women's health issues, to residency training.
``I really hope that by the time our generation comes out, we've made a difference,'' said Jody Steinauer, one of the group's national coordinators and a third-year student at the University of California at San Francisco. ``It is true that we do see that doctors are getting killed, but I think the important thing for us, instead of not hearing about abortion in our curriculum . . . is that first of all we talk about it, because it is a medical procedure.''
Dr. John Marks, medical director of the Raleigh Women's Health Organization in North Carolina, helps train residents from the University of North Carolina. ``There are a lot of programs where they're not permitted (to learn abortion),'' he noted.
He has been with the clinic for 10 years, and he has developed a growing appreciation for his work.
``You get a tremendous feeling like you're appreciated, because of the shortage,'' he said. ``You do get a sense that you're providing a service.
``I definitely am on the fringe of my profession, but within that capacity (my colleagues) are supportive of me. I don't know if they'd come down and counterpicket, but they do tell me they appreciate I'm here.''
Marks said his community is quieter than most, and he doesn't fear the anti-choice protesters or the violence that has sprung up elsewhere.
``I've had my home picketed on one occasion and I've had some letters sent to me, nothing that threatens my life or anything. This is something that is a constant, ongoing discussion at home. My kids are aware of what's going on. I think the longer I'm at this job the more I feel how important it is, whereas before I didn't want people to know that's what I did. Now I'm really very proud of it.''
Steinauer said she was approached at a meeting of medical students by an abortion doctor who is nearly 80 years old.
``She said, `Finally, I can retire, knowing you exist,' '' Steinauer recalled. ``We hope we can live up to this.'' ILLUSTRATION: Color photo
IAN MARTIN/Staff
Robbie Robinson, right, and other anti-abortion activists put
Norfolk's Hillcrest Clinic on the front line of an escalating war.
STORY ON PAGE A8
by CNB