Next Generation Access: Medical Students Fill A Void
by Mary Lou Greenberg
I remember the first time I heard about Medical Students for Choice. I don't remember the exact date but I remember the atmosphere. Anti-abortion fanatics had been targeting abortion providers for years by firebombing clinics, harassing and stalking doctors and their families, blockading medical facilities and assaulting women who came to them. And anti-abortion violence had just escalated horribly with the coldly-calculated murder of Dr. David Gunn outside the Pensacola, Florida abortion clinic where he worked.
It was 1993, and although dedicated women and men had been defending abortion clinics across the country, the reality was that 84 percent of U.S. counties had no known abortion provider. So when reproductive justice activists heard that young medical students had formed a new organization, Medical Students for Choice, we were elated. These students were literally putting their futures and lives on the line by taking on the medical establishment as well as the anti-abortion zealots to bring forward new generations of abortion providers. It was one of the few bright spots in a dangerous and daunting landscape.
And it still is.
Medical Students for Choice (MSFC) now has 148 chapters, including several in other countries, with a network of over 10,000 medical students. The organization's executive director, Lois V. Backus, MPH (Master of Public Health), said in an interview that while much remains to be done, more Ob-Gyn residents are getting some level of training today. Chapters of Medical Students for Choice – its slogan is "Creating Tomorrow's Abortion Providers and Pro-Choice Physicians Today" -- fill in the gaps in medical school curricula with their own training and educational events, and continue to advocate for more comprehensive training within the formal training at medical schools.
At the same time, accessing abortion is even more difficult today than it was when MSFC began, with a staggering number of new state restrictions and even more counties -- 87 percent -- without abortion providers. The harassment and assaults on providers and clinics continues -- just two years ago, Dr. George Tiller, the foremost provider of later abortions, was murdered in the lobby of his church in Wichita. It needs to be emphasized over and over again: Without providers, there can be no choice.
The number of abortion providers today continues to decrease, although the decline appears to be slowing, according to Backus. From 1995-2000, the number of abortion providers declined by 11 percent; from 2000-2005, the latest figures available, the number of providers went down by "only" two percent. This is still not acceptable to Medical Students For Choice, but the "tide is starting to turn," said Backus.
Papaya Workshops Build Skills
When the organization was founded in the mid1990s "some medical students began realizing that as the number of older abortion providers retired from practice or passed away, the new generations of physicians weren't being trained in what is one of the simplest and most common medical procedures," said Backus. One of the first national projects of Medical Students for Choice was to petition the Accrediting Council for Graduate Medical Education (ACGME) to require that all Ob-Gyn programs make learning about abortion available to all Ob-Gyn residents – only about 12 percent did so in 1994.
New standards passed in 1995, and latest statistics indicate that 50 to 70 percent of residency programs make this training available as part of the curriculum --"a big improvement," said Backus. But "still a long way to go," she concedes. "Family planning and abortion deserve to be significant elements of the curriculum, taught along with pregnancy and related topics," said Backus.
Two-thirds of medical schools have some curriculum elements related to abortion, Backus said, but "most of this is limited to a discussion of ethics in the context of medical ethics, as opposed to MSFC's goal that every physician has some understanding of abortion as a medical need." Typically, the curriculum element is less than 30 minutes. "While there is a lot to learn and not a lot of time in medical school," Backus continued, "erectile dysfunction medication, for example, gets up to three hours, as compared to one hour on topics related to conception."
To fill in gaps in the curriculum, chapters conduct about seven educational events for students every year, many of them workshops on abortion techniques. One is training in vacuum aspiration, a simple procedure where the content of the uterus is suctioned out, demonstrated by an experienced physician who uses papayas as surrogate uteruses. Medical Students for Choice provides and ships the equipment for these trainings, and last year there were more than 25 "papaya workshops." "It's fair to say," Backus commented, "that more education comes out of those events than out of the very slow progress made in changing the curriculum."
The "conservative culture" of medical schools in general is an obstacle for students seeking training in abortion services, said Backus. "When medical schools force people to work an average of 80 hours per week in an intense work environment, they want people who will say 'yes sir' and not cause any problems," said Backus.
As a result, medical students can feel vulnerable, she said. For example, when third year students apply to residency programs, they need to secure a letter from the dean of their medical school assessing their capability for future medical school training. Some students tell Backus that they are concerned they will get "a bad dean's letter" because of their MSFC activism. One MSFC activist said a dean's letter called her a "troublemaker," and she felt that she failed to make a match with the residency program because of it. "Our students are incredibly smart and courageous," said Backus.
Wearing the White Coat
Tracey Wilkinson, a pediatrician in the Northeast, came across Medical Students for Choice "as a fluke," she said, "and then it shaped my career." In 2002 she attended a conference and learned about the barriers to all reproductive health care. "I felt suddenly impassioned about the issue, " she said, and started an MSFC chapter at Vanderbilt University Medical Center in Nashville, Tennessee, in her words, the "buckle of the Bible Belt," with" three churches on four corners of many intersections."
"When I stated organizing," she said, I was "intrigued and nervous about the response I would get. I went to a student organization fair with MSFC materials and was really surprised when I got 75 sign-ups out of 400 students there." Why did she get so many? "I think there had been a void -- a lot of people had probably been pro-choice, but there hadn't been an opportunity to express it." Vanderbilt, she noted, also has a reputation for diversity. "It was 100 miles an hour after that," Wilkinson said.
In Tennessee, knowing that religion was important on a campus rife with prayer groups and Christian societies active at the medical school, the new MSFC chapter founded by Wilkerson reached out with the message that "being pro-choice and having religious beliefs were not mutually exclusive." They brought pro-choice clergy, including a protestant priest and a rabbi, to speak at lunchtime lectures.
The national umbrella group run by Backus tries to ensure that student activists have everything they need – from funds drawn from private donations to the national organization, a nonprofit, to support when they are frustrated or scared, equipment for trainings and connection with mentors from the pro-choice community who will support them. "Medical education is still a very formalized, non-feminist environment," Backus said. "One of the most powerful things about MSFC is that it provides a strong feminist environment for both men and women in medical school. The community we provide for people is as powerful a change-maker as the education work we do."
Since graduating, Wilkinson has brought her commitment for ensuring women's reproductive choice to her specialty, pediatrics. "My real passion is preventing unplanned pregnancies…I remember the first time I met teen moms on the labor and delivery floor in the hospital. Girls are having sex at earlier ages, and I thought about the missed opportunities to prevent unwanted teenage pregnancies. I feel strongly that pediatricians could do more to prevent unplanned pregnancies among adolescents. Emergency contraception and unplanned pregnancies should be general pediatric topics," said Wilkerson. "Pediatricians should be on the front lines of this question," she added, not just Ob-Gyns.
She also has one powerful image that carries her forward. In 2004, while in medical school, Wilkinson and several other Vanderbilt med students attended the March for Women's Lives in Washington, D.C., wearing their white medical coats and carrying signs. Wilkerson's read, "I am tomorrow's abortion provider." She recalls that "out of nowhere, people started applauding us. It was one of the most memorable moments in my medical training."
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