Med schools: Next abortion battleground

Sara Stoesz describes the latest ruling by the Eighth Circuit Court as an additional obstacle to access to legal abortion care ("In South Dakota, a blow to abortion rights," July 2).

With the strictest laws in the nation, South Dakota has been a bellwether state for the erosion of reproductive rights. Now the court's approval of a law requiring what doctors must tell their patients gives other states hell-bent on limiting abortion another way to drive a chink into Roe v. Wade. But if you think the threat to choice is coming from the state legislatures, court rulings or who's appointed to the Supreme Court, you're missing the real battle -- which may already be lost.

First, some history.

In 1967, my home state of Colorado became the first to reform its abortion law, permitting abortions if the pregnant woman's life or physical or mental health were endangered, if the fetus would be born with a severe physical or mental defect, or if the pregnancy had resulted from rape or incest. This same year, my high school girl friend -- her family rigidly fundamentalist, mine Catholic -- thought she was pregnant. Although it proved not to be the case, I still remember how isolated, powerless and bereft of options we felt, living in the place with the greatest reproductive choice in the country.

Other states began reforming or repealing antiabortion laws, most along the lines of Colorado's. In 1970, two years before the Roe v. Wade ruling, Alaska, Hawaii, New York and Washington made abortion legal. All but New York imposed a 30-day residency requirement for women seeking an abortion.

But if you were pregnant in say, a small Colorado town, without money or connections, and wanted a legal abortion, you might as well have lived on the moon.

According to an analysis by The Alan Guttmacher Institute, just over 100,000 women did leave their own state to obtain a legal abortion in New York City in the year before the Supreme Court's decision in Roe v. Wade. The institute found an estimated 50,000 women traveled more than 500 miles to obtain a legal abortion in New York City; nearly 7,000 women traveled more than 1,000 miles, and some 250 traveled more than 2,000 miles, from places as far as Arizona, Idaho and Nevada.

I don't have firm statistics, but I would say most of the physicians providing abortion services in Minnesota today are my contemporaries or older. That is, people who experienced the days of illegal abortion and the complications that ensued. That is, doctors within a decade of retirement. The late Dr. Jane Hodgson, who tested Minnesota's law by deliberately performing an illegal abortion in 1970, continued to perform abortions until age 76, traveling from St. Paul to Duluth, because doctors there would not. She was born in 1915 and reached reproductive maturity about the year nearly 2,700 women in America died from reported self-induced or illegal abortions.

Most of the subsequent generations of doctors, including those who completed OB-GYN residencies in the early '80s who will soon be leaving practice, received no training in terminating pregnancies, and the attitude in medical schools still seems to be "don't ask, don't tell." Residents who want to learn about the full range of women's health issues are free to arrange their own training, if they can find someone to provide it. The barriers don't just involve learning medical procedures that are not mentioned in class; there are also issues about malpractice coverage and getting institutional approval.

Today's medical residents were born in post-Reagan America, went to college in during the Rehnquist/Scalia era and have only known a post-Roe existence. Faced with roadblocks in their already stressful training regimens, even strongly prochoice residents may not pursue this on their own.

Meanwhile, practicing physicians who believe in choice may advise patients about all their options in handling a pregnancy, but they aren't going to provide all the options -- especially without having the training. But also because of outright harassment, fear of bad publicity or concern for their family's safety, they have quietly decided to let reproductive freedom become not just the patient's decision, but the patient's problem.

We may think the abortion issue will be decided contentiously on the Capitol steps, in Supreme Court cloisters or on the Planned Parenthood sidewalks. But more likely, Roe v. Wade will be nullified where none of us have any voice, by a medical profession with an ever-diminishing memory of the past -- and with fewer and fewer physicians who have the skills to keep choice a reality.