By Julie Ostrowski
Monday, February 25, 2002
Medical residents in New York City hospitals may soon be learning the latest abortion techniques under a plan Mayor Mike Bloomberg hopes will make up for the loss of the country's retiring abortion providers.
NEW YORK (WOMENSENEWS)--New York City Mayor Michael R. Bloomberg is looking to adopt a plan that would consolidate the city's patchwork of abortion training into one curriculum for residents at its hospitals, a move that would make the latest procedures more widely accessible and compensate for the retirement of the nation's abortion providers, who are finishing their professional duties in numbers greater than replacements are filling them.
Abortion training is currently an elective course for residents in the city's hospitals, not a requirement. Under Bloomberg's plan, medical residents who object to abortion could still opt out of the training on moral grounds. Those who don't would learn newer procedures that proponents say will move abortion from the operating room to a "procedure room," increasing the number of abortions that can be performed per day and decreasing delays for women who want abortions.
The plan could have a significant impact nationally, as one in seven residents in the United States is trained in a New York City hospital, according to the National Abortion and Reproductive Rights Action League of New York, which first posed the plan to Bloomberg when he was campaigning for mayor last year. Bloomberg included the plan in his campaign platform and NARAL-NY discussed it on Feb. 14 with obstetrician-gynecologists from the New York City Health and Hospitals Corporation, which runs 11 acute-care hospitals and 9 diagnostic and treatment centers serving city residents, many of whom are uninsured or rely on Medicaid.
Dario Centorcelli, a spokesman for the Health and Hospitals Corporation, said the group is "totally supportive" of Bloomberg's plan--an important endorsement. While Bloomberg does not need legislative approval to make policy changes to the city's hospital system, he does need the hospital system's backing and cooperation.
Asked to comment on Bloomberg's intentions, spokesman Jerry Russo would say only that "the mayor keeps his promises."
NARAL-NY Executive Director Kelli Conlin will meet next month with Deputy Mayor of Policy Dennis Walcott to discuss the plan in greater detail. Conlin said that "there's been a fairly good response and it has been positive that Bloomberg came out for it so forcefully."
NARAL-NY reports that abortion complications accounted for 23 percent of all pregnancy-related admissions to municipal hospitals in New York City before the procedure was legalized. Thus, as physicians in training assigned to the hospital's gynecology wards, they quickly became aware of the need for safe abortion services, the group contends. Right after legalization, in 1973, over 81 percent of all abortions were performed in hospitals, but by 1992, less than 7 percent of all hospitals offered abortion services. Since 1992, there has been an 18 percent decline in hospital abortion providers.
Indeed, the generation of doctors who witnessed the toll illegal abortion exacted on women and hospitals is retiring without anyone to replace them--about 85 abortion providers nationwide leaving the practice each year, according to NARAL-NY. With half of the nation's approximately 2,000 abortion providers age 50 or older, it's vital to make abortions more accessible in hospitals now, Conlin said.
"It's a ticking clock," she said. "Most doctors want this training. It can become the model to provide residency training for the whole nation."
The proposed plan would update an arcane method of abortion that is still used at some city hospitals that relies on the injection of a saline solution into the abdomen of the woman to induce contractions. Instead, they would use more modern procedures, such as the administering the drug mifepristone (formerly known as RU486), which can be taken from the time a woman knows she is pregnant up to seven weeks after the beginning of her last menstrual period and other less painful processes such as vacuum aspiration.
Lori Hougens, a spokeswoman for the New York State Right to Life Committee, said her group is against the abortion-training plan. "This is not normal health care and not something that should be institutionalized as a normal medical procedure," Hougens said. She said that equating abortion with other health care is a "huge moral, ethical, outrageous problem."
Bloomberg's plan also calls for an end to assigning Medicaid-eligible women to managed-care plans that do not provide abortion and other reproductive health care. Hougens is also opposed to this change as well, saying such a move would discriminate against plans administered by Roman Catholic insurance companies. The New York State Comptoller Carl McCall has recently issued a report calling for an end to the state's practice of randomly assigning Medicaid patients to health care providers, leaving many women from their teens to their 50s in plans that do not provide for reproductive health care, including contraception, tubal ligation and abortion.
"There are certain things that HMOs don't need to provide. They do not need to cover abortions," Hougens said.
What remains unclear is how much the change in how physicians are trained would cost the city. Proponents, however, are convinced of the revenue-enhancing benefits. Christina Page, director of the residency-training initiative for NARAL-NY, says that by reducing delays for women seeking abortions, city hospitals will retain more of them as clients and gain reimbursement through Medicaid, rather than lose the women to private clinics.
Page said currently that hospitals "lose a lot of patients because of delays," adding that sometimes a woman will wait three or four weeks before she can obtain the procedure. Such waits sometimes delay the abortion to the point that the procedure become "costly for the institution and unsound," Conlin said.
Abortion is the most common surgical procedure performed in the United States, after cesarean section. Approximately 1.3 million women have an abortion each year and 43 percent of women will have an abortion in their lifetimes, the group says.
Julie Ostrowski is a freelance writer based in New York.
Office of the Mayor
Mayor Michael R. Bloomberg:
National Abortion and Reproductive Rights Action League of New York:
New York State Right-to-Life Committee:
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