How Med Students Put Abortion Back In The Classroom

By Tamala M. Edwards/San Francisco

One might assume that Stanford Medical School, outside San Francisco, would be the model of a progressive, if not liberal, institution. But when Sarah Morgan, 30, entered five years ago, she found there would be almost nothing in her training about abortion. Nothing in epidemiology, the study of common procedures, even though abortion is one of the most commonly performed surgeries; nothing in pharmacology, where mifepristone, now commonly known as RU 486, is mentioned as an anticancer agent but not in the context of abortions; and nothing scheduled in the hospital rotations. "We had an hour lecture on the ethics of abortion. That's it," recalls Morgan.

A visit to Stanford now offers quite a contrast. On a recent afternoon, students and faculty visited a reproductive-health fair featuring displays like "The Politics of Choice," "Barriers to Abortion" and even "Herbal Abortifacients." The fair was part of a nine-week reproductive-health course where abortion is amply covered. Also, Stanford students can now opt to spend their ob-gyn rotation in a Planned Parenthood clinic, where they can observe abortions being performed.

The change at Stanford, and at med schools across the country, is the result of advocacy by Morgan and other members of a group called Medical Students for Choice (MSFC). Overworked med students would seem to make unlikely reformers. But the organization, with 110 active chapters and 7,000 members in the U.S. and Canada, has made considerable headway. Since its creation in 1993, the group estimates that about 50, or a third of all medical schools, have introduced abortion or brought it back into their curriculums, either through mandatory coursework, elective classes, lectures or Planned Parenthood rotations. "They have made a tremendous difference," says Uta Landy, a curriculum consultant to med schools on reproduction issues.

Abortion teaching had been slipping into oblivion until MSFC began to reverse the trend. Though the landmark 1973 Roe v. Wade decision made abortion legal, prompting some med schools to include the procedure in course work, the ruling also fueled an active antiabortion movement that sought to stigmatize providers. (Last week the House passed a bill making it a federal crime to harm a fetus during an attack on a woman, a measure seen by someas the first step toward new limits on the procedure.) Wanting to avoid controversy and often at the behest of conservative legislatures or donors, many hospitals, which serve as the training ground for young doctors, stopped performing abortions. The practice moved instead mainly to clinics that specialized in it, which also proved more cost effective.

As a result, by 1995 only 12% of ob-gyn residents were routinely trained in abortion. The number of doctors who provide the procedure has steadily dropped. There are now only about 2,000, and the majority are in their 50s and 60s. Choice advocates began to fear that the greatest threat to their cause wasn't the Supreme Court or the religious right but the prospect that when these doctors retired or died, no one would replace them.

Jody Steinauer founded MSFC after she and fellow med students at the University of California, San Francisco were mailed a slightly threatening booklet from an anti-abortion group. Weeks later, Dr. David Gunn, a Florida abortion provider, was shot outside his clinic. "It was a wake-up call," she says. At medical conventions that summer Steinauer set up exhibits for the new group and was swarmed by students.

The moment was ripe in part because med schools were becoming feminized. In 1970 only 9% of medical students were female; today the figure is 45%. Traditionally, young white males were not only the usual student at med schools but also the normative patient. The increasing numbers of female students began demanding more attention for women's health.

MSFC has made headway mainly through quiet but persistent lobbying, cajoling professors, for instance, into adding abortion to their lectures or persuading skittish deans to allow a student debate on the issue. At Harvard, MSFC students set up a lecture on abortion and then persuaded administrators to make it part of the mandatory curriculum. At Brown, students urged professors to update their lectures by adding RU 486 and other abortion advancements as topics. The group at the University of Texas-Southwestern, where administrators were originally wary of even allowing a chapter, successfully pushed for a fourth-year elective at a Planned Parenthood clinic.

But students at some campuses, mainly in the South and Midwest, have had less success. Several chapters have had to use euphemistic names, like Students for Reproductive Health, and downplay their interest in abortion. At other places, MSFC says, campus administrators have refused to give permission to start chapters. Jane van Dis started an MSFC chapter at the University of South Dakota last year. "Both students and professors have warned me I might be putting my future in jeopardy," she says. Hostile classmates have called group members "baby killers," according to Van Dis, and the chapter received a bomb threat through an anonymous e-mail.

Some MSFC activists are motivated by their own experiences with abortion. But many join for reasons more educational than political, and plenty are themselves queasy about the procedure. Kerri Faughnan, a medical student at the University of Colorado, split her time in an ob-gyn elective between an in-vitro and an abortion clinic. Swinging between women desperately in love with their eight-week-old fetuses to others desperate to be rid of theirs left her discomfited by abortion. But she echoes others in arguing that with studies estimating that 43% of women will have an abortion by the time they are 45, this is a procedure she needs to understand.

And many med students say they deserve a chance to discover their limits--Do they have the nerve to terminate a first-trimester pregnancy? A second-trimester?--before choosing to specialize in ob-gyn. Faughnan decided she could perform only first-trimester abortions. "People need to come to decisions on their own," says Elizabeth Dodge, a student at the University of Texas-Southwestern. "Before, the choice was effectively taken away because we were given no information."

The most important test of MSFC begins now, as the first wave of members leave their residencies and launch their careers. Will they actually provide abortions? Will those who do be stuck in the specialty clinics that are easy targets for abortion opponents? Or will they lobby to perform abortions in hospitals or in their private offices as a small part of a larger practice? At least now, educated in the procedure, these students are equipped to choose.