Here’s an example of how Arkansas legislative policy has real-life consequences: The difficulty of receiving training in and performing a legal and sometimes life-saving medical procedure — abortion.
Dr. Stephanie Ho writes in the Washington Post about the difficulties she’s encountered, first as a medical student and then in practice, in providing abortions. Dr. Ho is now primary care director for Planned Parenthood Great Plains. She’s written for us before about her work. The Post article includes details about her life in Arkansas that are worth repeating.
Where I grew up, in the River Valley of western Arkansas, nobody said the word “abortion” out loud. When I went to medical school at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, that censorious silence didn’t relent. Over four years, the most exposure we got to the topic was a half-hour guest lecture. (At that time, 17 percent of medical schools offered no formal abortion education, according to a national survey published by the American Journal of Obstetrics and Gynecology.)
Third-year residents could pursue an elective rotation, and I was determined to learn how to perform an abortion. Because I was not aware of any local providers, I enrolled in a program at Planned Parenthood of the Rocky Mountains, in Denver. The residency director said it was not an appropriate elective for a family medicine resident, and that he would have to talk about it with the other faculty physicians at Fort Smith. Then he said that the program didn’t permit residents to rotate out of state. I responded by citing the portion of the resident handbook that said we could travel for hard-to-find specialties — and pointed out that another trainee had done so the previous year in a different subspecialty. (Reached by an editor at the Post, a UAMS spokesman declined to comment, saying that the residency program has since changed directors. The medical center did not return phone requests for comment.)
Then came the end of my residency. It was commonly known among residents that if you applied to work at our training medical center and had done a decent job, you were essentially a shoo-in. In my first interview, I was forthcoming about intending to provide abortions at some point in my career. I was not offered a second interview. I decided not to attend our graduation ceremony.That implicit disapproval carried over to my residency in family medicine, which I began in 2008 at UAMS West in Fort Smith. Second-year residents gave presentations on a topic of their choice — and mine, on abortion, was the most highly attended and contentious that year. A senior faculty member vocally disagreed with my description of abortion as a common medical service, interrupting every few sentences and quoting the Bible at me. Someone dubbed me the “abortion chick,” and the nickname stuck. Whenever a patient at the clinic wanted to learn more about terminating a pregnancy, the staff would call me in to talk her through her options, even when I wasn’t scheduled on a shift. My fellow physicians didn’t feel comfortable sharing information about abortions.
There’s more: Turning away patients who’ve driven three hours for naught because of roadblocks thrown up by the legislature; tripling of Ho’s insurance rates though abortion is safer than many common procedures (wisdom-tooth extraction, Ho notes, for one); patients who won’t seek other unrelated services from a doctor who’ll provide abortion.
Ho eventually overcame a fear of speaking out and continues as one of only four doctors willing to provide abortions (and other primary health services) in a state with 1.5 million women. And she ended on a hopeful note, despite mounting obstacles:
Even so, the abortion work is hampered by a raft of medically unnecessary and insulting restrictions. Planned Parenthood clinics here currently can’t provide surgical abortions, because Arkansas requires that our facilities be outfitted comparably to a hospital surgical center. I’m legally required to hand out pamphlets filled with falsehoods about how the mifepristone pill, which ends a pregnancy, can be “reversed.” My patients sit through 48-hour waiting periods and mandatory follow-up visits, which impose costs — gas money, time off from work, overnight stays, child care — that many can barely afford. The contracted-physician requirement was only the latest imposition; the state legislature will consider passing two more bills restricting abortions when it reconvenes this month.
Reproductive rights depend, in part, on the medical community dispelling taboos. Abortion should be a topic of normal conversation, especially among medical professionals. It is, after all, a part of ordinary life — a routine medical procedure. When I first hosted a lunch for Arkansas medical students called “Meet the Provider” in 2017, I expected only a handful to attend. Instead, some 30 people came, and next time, we expect more.
The path to becoming an abortion provider can be extraordinarily frustrating in states like Arkansas, but younger doctors seem to be much more aware of inequity, stigma and other barriers to medical services. I’m hopeful that their sense of openness will ultimately mean better access for patients.