Younger generation produces fewer abortion doctors

The first thing a visitor sees at the Planned Parenthood of Western Pennsylvania clinic is a… The first thing a visitor sees at the Planned Parenthood of Western Pennsylvania clinic is a looming metal detector, separating the patients in the small waiting area from the rooms and offices beyond. Next to the structure and behind a sheet of glass sits a security guard who is watching several video surveillance monitors of locations throughout the clinic.

Planned Parenthood instituted these measures nationwide after a shooting by anti-abortion protesters at a Boston Planned Parenthood ended in the deaths of two people.

But there may be another threat that no amount of metal or bulletproof glass can ward off: what Linda Locke refers to as the “graying of abortion providers.”

Locke, a nurse practitioner and registered nurse, is the chief operating officer of the 13 locations of American Women’s Services, which provides abortions. In the years she has served in the abortion field, Locke has seen many abortion physicians age. She worries that no one will be there to fill the gap left by the retiring doctors.

From 1996 to 2000, the national abortion rate — the number of abortions per 1,000 women aged 15 to 44 — decreased by 5 percent, but the number of abortion providers decreased by 11 percent, according to a study released in 2003 by the Alan Guttmacher Institute. The two largest areas in the country without an abortion provider were both in Eastern Pennsylvania: the Scranton-Wilkes-Barre-Hazelton area and Lancaster. More current national data will not be available for a couple of more years, according to Rebecca Wind, a spokesperson for the institute.

In Pennsylvania, the abortion rate from 1996 to 2002 decreased by 5 percent, but the number of abortion providers decreased by 12 percent, according to the Pennsylvania Health Department. From 2002 to 2003, abortion providers in Pennsylvania decreased by an additional 5 percent, leaving 101 providers throughout the state.

Fewer abortion providers could mean less access to abortion services, especially in rural areas, where many people already have to travel for hours to get to an abortion clinic.

If there’s no access to abortion, the risk of women going to untrained physicians or trying to abort the fetuses themselves increases, Locke said.

Anna Grayson doesn’t want to see that happen.

After being raped and becoming pregnant in December 2003, Grayson decided her best option was to get an abortion.

“I am not an advocate of abortion. My case was rather difficult, but I do believe in the right to choose,” Grayson wrote in an e-mail. “I think that since abortions will probably always happen, the best idea is to have providers who are safe so that women don’t get hurt by going to the wrong place.”

Before the Supreme Court’s Roe v. Wade decision legalized abortion in 1973, women who got abortions could encounter a number of problems: excessive bleeding, infertility, mutilation and even death. The ob-gyns of this era saw all of these complications, so when abortion was legalized, Locke said, a number of physicians wanted to do it legally.

“The younger people coming in don’t know what it was like,” she said, “so there isn’t that zeal.”

Claire Keyes, the director of the Allegheny Reproductive Health Center, agrees that abortion training “doesn’t seem as crucial” to younger physicians.

Training can be part of the normal rotation for all ob-gyn students, or a student may have to express an interest in abortion procedures. Generally, instruction would consist of reading about, observing and then practicing the procedures with an experienced physician.

Students and doctors in Pittsburgh can receive training from Magee-Women’s Hospital and some Planned Parenthoods and private-practice doctors, she said.

Michele Baum, assistant director for the news bureau of the University of Pittsburgh Medical Center, issued a written statement saying that Magee “provides a full range of medical services available to women throughout their reproductive lives and beyond.” Baum refused to answer questions or grant interviews.

Dr. Mitchell Creinin, the director of gynecologic specialties and family planning research at Magee, did not return phone calls to answer questions about abortion training for Pitt medical students.

The Penn State Milton S. Hershey Medical Center offers training at its facilities in performing abortions and managing the complications of abortion, but anyone who is uncomfortable participating does not have to, said Amy Buehler Stranges, the team leader of communications. This is in accordance with the requirements set forth by the Residency Review Committee of the Accreditation Council for Graduate Medical Education, she said.

All accredited institutions must make abortion training available to interested students, either at their own facilities or elsewhere, regardless of the moral or religious beliefs of the institution, according to the review committee guidelines.

To add to the problem of fewer people learning to perform abortions, there is also a “drain of physicians” in the state, making it especially hard for abortion providers in Pennsylvania to find new physicians to fill in the gap left by retiring ones, Keyes said.

Once students graduate from Pittsburgh medical schools, they generally leave, she said. Pittsburgh does not offer a lot for singles and young people, Keyes said, but a bigger factor is that Pennsylvania has one of the highest malpractice insurance rates in the country.

Doctors in the ob-gyn field pay especially high rates because of the large number of lawsuits, most of which are related not to abortion procedures but to the birthing process, Keyes said.

“Everyone wants a perfect baby,” she said, explaining that a baby’s defects could be blamed on delivery procedures.

Some ob-gyn physicians have stopped delivering babies because of these malpractice rates, said Chuck Moran, spokesperson for the Pennsylvania Medical Society. But Moran wasn’t aware of a similar trend for abortion physicians.

The number of malpractice lawsuits for abortion does increase with the age of the fetus, though, making it hard for some providers to find physicians who perform late-term abortions.

Although American Women’s Services used to provide abortions as late as the state limit of 23 weeks and four days, it currently provides abortions only until the 14th week of pregnancy.

Planned Parenthood of Western Pennsylvania has not had any trouble finding physicians, but it caps the abortion procedure at 19 weeks, said Kimberlee Evert, the president and CEO of the Western Pennsylvania branch.

Some physicians are not comfortable performing abortions later in the pregnancy term because of increased risk to the mother, moral dilemmas or external pressure from anti-abortion organizations.

Physicians and staff of abortion clinics already deal with harassment and threats, but those who perform the dilation and extraction procedure of late-term abortions can encounter harsher “scare tactics and intimidation,” said Ronni Murphy, the district manager of American Women’s Services.

The dilation and suction curettage procedure is generally done in early-term abortions. This procedure uses a suction machine to extract the fetus from the uterus. Late-term dilation and extraction procedures, referred to as partial-birth abortions by anti-abortion activists, usually involve dilating the cervix and inserting forceps into the uterus to extract the fetus, sometimes one body part at a time. The head is then crushed and also taken out.

Anti-abortion organizations try to get personal information about abortion physicians, particularly those who perform late-term abortions, and put it on the Internet so people can picket outside of doctors’ homes or private practices, Murphy said.

Although physicians used to be the main target, protesters have recently taken to looking at an abortion-providing organization as a whole, including managers and staff, to close the clinics, Murphy said.

“I’ve had personal acts of violence put out against me,” she said. “I’ve had to deal with anthrax mailings.”

But years on the job can take an emotional toll, too.

“We all feel for our patients,” Locke said, explaining that each woman comes into the clinic with her own story. Although Locke makes a point of never asking about personal details, “many times, women do just talk about their experiences, and many times it is just very, very sad.”

Amy Beck, the director of Pregnancy Care Centers in Oakland, said providing abortions could be “emotionally tough.”

“Going through and doing them every day is hard to do,” Beck said — even for those who consider it a worthy cause.

“Some physicians believe in the service, but don’t want to be the ones providing the service,” Allegheny Reproductive Health Center Director Claire Keyes said.