Who wants to be an abortionist?

By Lachlan de Crespigny

Dr. Evan James never wavered in his determination to become an abortion provider. But he is unusual – few trainee doctors have a driving ambition to become abortionists. The U.S. has seen a 40 per cent drop in the number of doctors who perform abortions since the early 1980s. Those in the field say there's likely a similar trend in Canada. Few Canadian hospitals provide abortions and numbers are dropping. Other countries, including Australia, have similar service provision problems.

Abortion is lawful in at least some circumstances in almost all western countries. Yet most have too few providers and current providers are aging with few replacements coming through.

Why would a young doctor choose to be an abortionist? The work can be unpleasant. It may be threatening socially – most doctors performing abortions do not wish to be identified publicly. Indeed abortionists may expect public vitriol, premises being staked out by anti-abortionists and hate mail. Even violence and murder are not uncommon, particularly in USA but they also occur elsewhere including my home town Melbourne. The motivation of individuals to subject themselves to such an onslaught is varied. But they need to have a passion for the cause. However few doctors choose a career in order to fight for a cause.

Those performing late-abortions may face even greater risks, as can be seen by the following exchange between a 60 Minutes reporter Tara Brown and Dr Leroy Carhart, one of the few offering late-abortion in USA:

TARA BROWN: How do you cope with the hate you have to deal with?

DR LEROY CARHART: At a personal level, I have to ignore the hate, because I truly believe what I'm doing needs to be done, and I'm one that's willing to do it – and there are a lot of people that are not…

DR LEROY CARHART: Yes, I think we're fighting a war, and I think, you know, the potential casualties are those thousands of women that will die if abortion becomes illegal.

TARA BROWN: And what about you as a casualty, do you think that they have you in their sights?

DR LEROY CARHART: I'm sure some of them do

TARA BROWN: Is this a cause worth dying for?

DR LEROY CARHART: It is as far as I see it, yes ma'am.

I carried out an abortion in 2000 of a woman who was suicidal after her 32-week-old fetus was diagnosed with dwarfism. Without any enquiry the hospital suddenly reported the case to the media and (falsely on most counts) claimed they reported doctors to multiple investigatory bodies – actions that at best were incompetent, at worst the opportunistic response of antiabortionists. I was fired by the Royal Women's Hospital and later reinstated. The media did not identify me; their reasons for not doing so remain obscure to this day. My name was later suppressed by the courts but subsequently, despite advice to the contrary, this was lifted at my request. Despite multiple subsequent enquiries there was no criticism of the doctors’ management.

I felt a fear of vitriol and violence, and was particularly concerned that my family might suffer. I removed my private contact details from all registered lists but still feared any mail when its source was not identifiable.  Soon after a guard was murdered in a local abortion clinic, confirming the need for vigilance. I received plenty of personal vitriol but no violence.

In jurisdictions around the world in which it remains a crime, decriminalization of abortion is gradually being achieved. It is vital to cease making criminals of those women who make the difficult decision to have an abortion, and their doctors who provide the service. But law reform is a necessary beginning, not the solution.

The important outcome is that women in need can access abortion, even poor women and those who are geographically isolated. Access requires having doctors who are prepared to offer an abortion service. This necessitates undergraduates as well as postgraduate trainee general practitioners plus obstetricians and gynaecologists being taught, witnessing and performing abortions. As long as the current tendency to think that trainees need ‘protection’ from the horrors of learning about abortion persists, few doctors have an opportunity to consider that it is a service that is worthy of their professional involvement.

But community attitudes also must change. Abortion must be part of mainstream medicine, not commonly being provided in isolated stand alone clinics. Population surveys already support the right of women to access abortion and late-abortion. Teaching, in schools and elsewhere, should include discussion about the necessity of service provision and respect for those who commit their professional lives to offering these services.

It is hoped that one day doctors will feel proud to proclaim: “I am an abortionist”.