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Our Training, Ourselves: The Impact of Defunding Planned Parenthood

Approximately one in three women under the age of 45 have had an abortion

Approximately one in three women under the age of 45 have a tattoo.

Think about your community. How many tattoo parlors can you think of? How many can you easily access?

How many abortion clinics can you think of? How many can you easily access?

A cursory, 10-second search for “tattoo” yielded more than 40 results within a five mile radius of our homes. Research from 2011 indicates that 87 percent of all U.S. counties do not include a single abortion clinic.

We find ourselves in a reproductive health access crisis: despite total contraception coverage thanks to the ACA, there are personhood amendments coming up before state legislatures that could threaten access to contraception, IVF and abortion. In 2015 alone, states enacted 51 new abortion restrictions, some of which threaten to shut down additional Planned Parenthood clinics. In addition, last week, two bills were passed in the House of Representatives: HR 3134 — the bill to defund Planned Parenthood — and HR 3504, Representative Franks’ “Born Alive” Bill. As leaders of Medical Students for Choice (MSFC), second-year medical students and concerned citizens, we oppose these bills.

These bills harm our future patients. Although HR 3134 is intended to restrict access to abortion, the funding of Planned Parenthood that federal legislators propose to eliminate does not in fact pay for abortion — use of federal funds for abortion is prohibited. The funds in question would exclusively support the basic reproductive health services Planned Parenthood provides to women in need, including contraceptive counseling and services, screening and treatment of infections, and screening for breast and cervical cancers. Research shows that inconsistent or incorrect use of contraception occurs in about one-third of all women, and can result in 95 percent of abortions among that group. Without publicly funded family planning services, the numbers of unintended pregnancies, unplanned births and abortions in the United States would be 60 percent higher than they currently are. Defunding Planned Parenthood, therefore, only serves to put women in a more precarious situation when it comes to their reproductive health.

In addition to endangering these services and denying access to essential medical procedures and screenings, these bills indirectly eliminate reproductive health training opportunities. Following the House’s passage of HR 3134, the University of Missouri ended its 26 year training relationship with Planned Parenthood; medical and nursing students can no longer pursue and complete contraception or abortion rotations at Planned Parenthood. Decisions like this make us extremely concerned about the state of our medical education and health care system.

At our home institution of Alpert Medical School at Brown University, Planned Parenthood is right around the corner. It has been a profound source of support, education, growth, training and partnership for medical students, residents and fellows. We are devastated to think this relationship could be threatened. We are saddened for our colleagues in Missouri.

Currently, 25 percent of U.S. OB/GYN clerkships report no formal abortion training — despite the fact that 97 percent of OB/GYNs encounter patients seeking abortion care — and less than 10 percent of family medicine residency programs offer routine first-semester abortion training. In addition, research from 2009 demonstrates that 39 percent of OB/GYNs who received abortion training work in hospitals where abortion provision is prohibited. This creates a clear supply-side problem: one of the biggest obstacles to safe and legal abortions is the absence of trained abortion providers.

These bills further limit women’s access to safe, legal abortion services. Limiting access to abortions from doctors in staffed, certified facilities will not reduce the number of abortions. Indeed, it will only push women to seek abortions from unsafe sources, which could result in avoidable medical emergencies, such as infection, sepsis, hemorrhage and death.

To further elucidate the potential damage to our education and the limits on medical practice, we would like to focus on HR 3504, the “Born Alive” Bill, which legislates what a health practitioner is expected to do “when a child is born alive following an abortion.” We believe the bill is medically unsound and severely limits and endangers the doctor-patient relationship.

Bill HR 3504 targets qualified, trusted physicians for providing the services they have been trained to supply. It has the potential to penalize doctors with legal, professional and financial repercussions through fines, imprisonment and murder charges for providing safe, legal, evidence-based abortion services to women. The bill’s vague language makes it impossible to understand exactly what new medical limits will be placed on doctors, both today and in future interpretations of the bill. Key terms are left undefined, legally and medically: namely “born” and “child.”

In medicine, we use the term “embryo” from two to eight weeks after conception, and “fetus” from eight weeks until delivery, at which point we use the terms “neonate” or “newborn.” Colloquially, we may say “baby” or “child.” Medically, the term “child” does not describe a fetus or embryo in the womb. The term “child” is unspecific and unscientific. And, as medical professionals, we are all too aware of the innumerable complications that can arise during pregnancy and make a fetus incompatible with life. Without clear language of what exactly is meant by “an abortion or attempted abortion that results in a child born alive,” doctors are at risk of legal retribution, even when following the evidence-based practice of abortion care. This could place an undue burden on abortion providers and complicate an already overly legislated, though otherwise safe medical procedure.

In essence, the bill’s vague language illuminates a greater overarching problem: the legislation in Congress seeks to create limitations on medical care using emotional, moral and decidedly non-medical terms.

The fact that this bill does not provide any clear, technical language prompts a greater concern: it seeks to legislate limitations on medical care and decisions on moral grounds, forsaking technical, evidence-based medicine. There is no indication of how this bill will be monitored, enforced or documented. Based on the decidedly anti-choice backing of this bill, we cannot be sure that sound medical or legal judgment can be used to implement this bill into medical practice if it is signed into law. This raises further concerns about the enforcement upon healthcare providers, and the potential justification of extreme punishment under uncertain terms. With all due respect, we do not believe Congress is prepared to make these sorts of provisional limits on medical care.

We want to emphasize that we are not trying to debate the morality of abortion, or imply that scientific evidence is always apolitical or purely objective. As medical students who try to be continually critical of the power structures that exist in the production, use and practice of scientific and medical knowledge, we are well aware that medicine does not exist in a social vacuum above and beyond moral and social context.

There are, however, two concerns and arguments that are clear to us. First, abortion is currently a safe and legal medical procedure that health care providers have been tasked to provide. The passage of these bills hinders access to training required for doctors to fundamentally do their job, both directly through limitation of Planned Parenthood resources, and indirectly by engendering a culture of stigma around sexual and reproductive health. Second, the language in HR 3504 is too vague and ambiguous to know with any certainty what it means for health care providers who are already hard pressed to provide a much-needed service. It attempts to legislate medical practice in broad, ambiguous, non-medical language, leaving providers vulnerable to financial and legal punishment under uncertain terms.

While we certainly respect the opinions, beliefs and personal decisions of our patients, peers and colleagues who find the practice of abortion morally unacceptable, this does not change the legality of abortion, nor does it change the medical and public health need for competent, safe, sterile abortion and reproductive health services. We want to re-emphasize that these bills erect harmful barriers to safe and legal medical procedures. These bills endanger patients and disregard the concrete, proven, significant and devastating public health repercussions of limiting abortion access. Ultimately, HR 3134 and HR 3504 undermine patient care, and threaten and endanger our training, duties, skills and abilities as medical professionals.

Despite the fact that 21 percent of all pregnancies end in abortion, this country continues to legislate to restrict access to safe abortions. Neither of these bills are going to help mitigate the reproductive health crisis in which we find ourselves — supporting doctors and listening to women might.

Jennifer Tsai Jennifer Tsai (14 Posts)

Writer-in-Training and in-Training Staff Member

Warren Alpert Medical School of Brown University

The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.

I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!

Kira Neel (1 Posts)

Contributing Writer

Warren Alpert Medical School of Brown University

Kira is a second-year medical student at the Warren Alpert Medical School of Brown University.