Panel: Abortion Providers Are People, Too

NASHVILLE — Abortion providers are fighting an uphill battle against a societal narrative that has attached so much stigma to the procedure, and trying to regain some of their humanity as people, not just abortion providers, a panel said here.

The panel at the American College of Obstetrics and Gynecologists (ACOG) annual meeting included several abortion providers, who offered their views on the “incendiary” coverage of abortion, and that the abortion providers themselves can get lost in the rhetoric and the politics — even when it’s their practice that is affected the most.

Sarah Horvath, MD, the ACOG Darney/Landy Fellow, said that in the first 3 months of 2019, there have been more than 300 pieces of abortion-related legislation introduced at a state level, which can make day-to-day patient care especially difficult for doctors on the front lines.

“I had a maternal-fetal medicine specialist call me, who said ‘There’s a 20-week [abortion] ban making its way through the Pennsylvania legislature. I have a woman with a very sick twin pregnancy at 21 weeks, I’m supposed to do a fetal reduction tomorrow, and I don’t know if I’m legally allowed to do it,'” she told MedPage Today.

“There was so much obfuscation out there, that it was unclear what we were and weren’t allowed to do as physicians,” Horvath added.

Jennifer Villavicencio, MD, a practicing ob/gyn who was once anti-abortion, but now provides abortion care, offered an analogy between having open discussions about being abortion providers to being open about one’s sexuality.

“When you become an abortion provider, you make that decision if you’re going to be ‘out’ or if you’re not going to be out,” she told MedPage Today. “After [a media interview], I was put on a website and I was essentially doxxed. And in our world, it’s sort of like ‘Well, that happens when you’re an ‘out’ abortion provider.”

Indeed, the abortion provider is missing from most of the coverage about abortion, according to a media audit conducted by Amy Simon, a founding partner at Goodwin Simon Strategic Research. She looked at the last 2 years of media coverage of abortion, up through 2017.

Simon not only found that abortion was covered mainly as a “movement” — abortion rights advocates groups versus anti-abortion groups, but that “providers are covered as institutions, not human beings.” Rarely do stories include references to maternal care doctors, or physicians specializing in maternal-fetal medicine — in other words, the doctors actually performing the procedures.

In fact, when doctors who perform abortions are covered in the media, much of the coverage is focused on the danger to them as a result of providing abortions. As a result, “abortion is seen as inherently dangerous,” Simon said.

Not only is the doctor behind “the abortion provider” missing from media coverage, but providers feel this stigma from society. Rachel Flink-Bochacki, MD, of Albany Medical Center in Albany, New York, presented her research during the panel discussion, which was an online survey of 321 abortion providers over the course of 2 weeks.

Nearly all respondents to this qualitative survey were women, one-fifth were not currently providing abortions, but three-fifths said they did >10 abortions per month.

Flink-Bochacki said that providers discussed the “false dichotomy” between being pro-choice and pro-child, adding that it “provoked tension for the provider, and created a burden they had to constantly defend against.”

Three-quarters of the respondents were women, and Flink-Bochacki discussed the societal dichotomy between “women who have abortions” and “women who love children,” even though 59% of women who have an abortion already have children, she said.

But according to the survey, providers sharing their own reproductive experiences helped to stimulate a stronger therapeutic bond with the patient, and allowed them to be seen as “a whole person, more relatable, not just ‘the abortionist.'”

Moreover, she said that a provider becoming a parent tended to reinforce her commitment and passion for her profession. Flink-Bochacki said that this provider/patient bonding through shared experiences could also potentially help to prevent patients from feeling marginalized, given the stigma that both provider and patient experience together.

“One respondent said ‘A patient asked me if I was a mom, and when I said I was, she said ‘Then you understand,'” Flink-Bochacki said.