SAN JOSE, Calif. - This is the face of the new foot soldier in the battle to maintain access to abortion: the girl next door. Graduating in record numbers from medical schools, young women are increasing the ranks of tomorrow's abortion providers, bringing the procedure out of the margins and into mainstream medicine - and securing its place within academia's safe and supportive structure.
The University of California-San Francisco, and Stanford are among the universities leading the way.
Their efforts come at a time when the procedure is once again the center of emotionally charged debates. State legislatures and the U.S. House are considering limits on access.
"It is not at all a radical mission. It's really simple," said Dr. Merrie Warden, 33, a Kansas native with stellar academics who came to UCSF because of its leadership in family planning education.
"Abortion is part of women's reproductive health care, so it should be part of our training. You can't really argue with that - although people do," she said, her voice tightening.
Almost four decades after Roe v. Wade legalized abortion, one of the big obstacles is access to a trained doctor. Eighty-seven percent of U.S. counties have no known provider.
For years, mainstream medicine largely distanced itself from abortion care. Doctors outsourced the procedure to clinics. Few med schools offered it as part of their curriculums. There were no fellowships, special training programs or national conferences. Now only 2 percent of ob-gyns perform half of all abortions. Many are approaching retirement. Others are weary of stigma, threats and violence. The number of providers has declined by 37 percent since 1982.
In response, young doctors are being educated or trained through three new programs, all conceived at UCSF: Medical Students For Choice works to expand abortion education in medical schools; Family Planning Fellowships pays residents to learn abortion and contraception; and Ryan Programs gives schools seed money for abortion training. Nonexistent only a decade ago, Ryan-funded programs now train abortion providers on 58 campuses. And women now make up 81 percent of all students studying to be ob-gyns, up from about 30 percent in 1980.
The new generation of female students "has more belief in themselves," said Lois Backus, 56, director of Medical Students For Choice. "They don't want to be told what they can't do."
The shift is possible, despite political opposition, because private dollars are supporting programs that can't get public funding, said bioethicist Arthur Caplan of the University of Pennsylvania.
"Education about abortion is not the same as advocating for abortion," he said. "Medical schools feel that abortion is a medical procedure that doctors need to know about. We have all kinds of topics in medical education, like physician-assisted suicide, but that doesn't mean we're in favor of them."
A 2009 Gallup poll suggested a shift in public opinion on abortion, with more Americans (51 percent) now calling themselves "pro-life." And efforts are under way to cut public funding for programs like Planned Parenthood. Many abortion-rights opponents find it troubling that medical schools are spending more time teaching about family planning.
"Medical schools are teaching something that is not medicine," said Troy Newman, president of the group Operation Rescue. "Doctors are supposed to save lives. This is no cure, or treatment. This is no advanced technical procedure that needs special training. … It's murder, not medicine."
Stanford followed UCSF's lead in expanding abortion education and training in 2007. That's when the university recruited Dr. Paul Blumenthal, a national leader in family planning research, away from Johns Hopkins.
Stanford, "like many major university medical centers around the country, increasingly recognizes that family planning services, including abortion care, are an integral mainstream component of women's health care," Blumenthal said.
"Education about abortion is not the same as advocating for abortion. Medical schools feel that abortion is a medical procedure that doctors need to know about. We have all kinds of topics in medical education, like physician-assisted suicide, but that doesn't mean we're in favor of them."
Arthur Caplan,
is a bioethicist at the University of Pennsylvania
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