I don't know how to perform an in-clinic abortion (also known as a surgical abortion), or how to counsel a person about one; I also don’t know how to provide follow-up care, or how to identify and manage the rare complication that might arise—at least, no more than any other literate adult with access to the internet. The trouble is, I am a physician of internal medicine: my theoretical purview is all the organs of the adult body.
It’s true that my clinical job is what the poet John Berryman would’ve called “thinky”—fewer hands-on procedures; more diagnosis, counseling, and prescription—but I ought to know more than I do. Surgical abortion is a common procedure performed on an organ half the people on the planet possess. The fact that most doctors like me—and even my colleagues in obstetrics and gynecology—don’t know how to perform abortions is one of the great scandals of contemporary medicine in the US. As the recent Dobbs decision accelerates the 21st century’s steady dismantling of abortion rights in America, it’s worth examining how the medical profession has, for generations, systematically limited the extent to which doctors come to learn and practice the procedure.
Currently only 24 percent of ob-gyns nationally provide abortions. The American Medical Association (AMA) continues to refuse to make abortion education a curricular mandate across accredited schools, and half of all medical schools provide either zero or just one lecture on abortion. Even among specifically ob-gyn programs, only half provide routine abortion training to residents; there is currently no mandate that education or training on abortion be provided during students’ ob-gyn clinical rotations. Eighty-nine percent of US counties have no abortion providers in them at all. It is not by accident that the medical profession on the whole is bad at abortion and its accompanying care, counseling, and discourse.
With the end of the Roe era upon us, I share the general worry about a rise in unsafe abortions for people without other options, although I’m also heartened by the fact that the patients I know are often astonishingly creative at obtaining medications, procedures, and forms of care that their doctors can’t or won’t provide, often with great adaptability and courage. What worries me more is that given the moral authority still accorded to us doctors—the second most respected profession in the US for its ethics, after nurses, according to Gallup—our collective ineptitude around abortion might make it seem like maybe there is actually something wrong or untoward about abortion itself, that maybe the “safe, legal, and rare” Clintonism really is the decorous response. After all, there’s a reason why contemporary doctors are also inept at bloodletting, phrenology, and lobotomy. Mustn’t incompetence signal an essential noncentrality, a certain dodginess?