Personal Perspectives
Perspective on the American College of Obstetricians and Gynecologists’ Support of Access to Elective Abortion William J. Polzin,
MD
D
uring my career, the American College of Obstetricians and Gynecologists (the College), representing its members, has always been in favor of increasing access to elective abortion for women in the United States. However, it previously acknowledged and respected the fact that many of its members held an opposing view, usually based on morals grounded in religious beliefs. The College should be a representative organization. It should encourage wide consideration of facts, not ideology. Despite what the College says, its members speak with their actions. Most obstetrician–gynecologists (ob-gyns) do not perform abortions. In a survey reported by Stulberg,1 about 50% of ob-gyns who reported not performing abortions self-reported a high degree of religious motivation. This is compared with about 25% of those who reported performing abortions. Those who are motivated to not perform abortions owing to their religious convictions may find that their professional reputations are shaped by their beliefs and choices in this regard. This can, in turn, influence the education of residents and patients who seek these health care providers’ professional advice. Similarly, ob-gyns who opt to perform abortions in their practices may influence resident education and patients who seek their advice. Belief, whether religiously motivated, purely humanistic, or based on morals not grounded in religious conviction, is always expressed by the health See related editorial on page 1282.
From the Good Samaritan Hospital, Cincinnati, Ohio. Corresponding author: William J. Polzin, MD, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH 45220-2475; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0029-7844/15
VOL. 125, NO. 6, JUNE 2015
care provider. In either case, patients are never unaffected by health care providers’ beliefs. Regarding Committee Opinions 6122 and 6133 published in the November 2014 issue of Obstetrics & Gynecology, I am both surprised and disappointed at the lack of respect for the plurality in the College and the proactively dismissive tone toward dissenting opinion. Opinion 612 states that there are barriers to training in abortion care and cites legislative and institutional and social concerns. These barriers are present because they reflect the opinions, beliefs, and philosophies of those organizations duly authorized to establish same, whether they be private or public. Opinion 612 states that access to safe abortion services is a key component of women’s health care, citing only the College’s own opinion documents as reference, not scientific data. Many do not agree with the opinion expressed. Committee Opinion 613 paints all crisis pregnancy centers with the same brush, saying that they “operate to dissuade women from seeking abortion care” and “often provide inaccurate medical information.”3 Although there are publications, including some in the medical literature, that support these claims,4 there are certainly exceptions. Pregnancy centers I work with refer to medical practices with licensed and credentialed prenatal health care providers of comprehensive obstetric care, including ultrasound and counseling. The College is looked to by our profession and the lay public for information that is accurate and forthright. The College recently has highlighted the daunting clinical problem of preterm birth. It joins with the March of Dimes in designating preterm birth prevention as a key national initiative, with associated local and national fundraising efforts. Studies examining the link of abortion to preterm birth risk are varied in their results. There are publications that associate an increased risk for preterm birth with a patient’s history of elective abortion.5,6 These associations may not be strong, but they have raised
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
1285
enough concern to be included in mainstream obstetric textbooks used in resident education. Many thoughtful reviews look at the publications that show varied results.7 I would not describe a discussion of this concern, especially in the context of preterm birth, which is such an important issue, as “other misinformation.”3,8 It is a discussion that should be advanced and rigorously studied beyond the observational studies used to argue for and against association. This could happen more quickly, especially if aided by the College’s being more inclusive in its thinking rather than dismissive as it is in Committee Opinion 613. The point of all this is simply to say that the College should help further the health care environment and culture for all women faced with unwanted pregnancies. The College can start by acknowledging its members have serious disagreement on this issue. The College can recognize that most care is given to women who do not favor unlimited access to abortion9 and that care is given by a majority of obstetricians who do not provide abortion.1 The College could help pregnancy centers that are filling gaps in many underserved and at-risk communities give better information, especially around the controversial associations of abortion with future risk, instead of proposing ways to limit or eliminate the centers’ effectiveness.3,8 Elective abortion is not, primarily, a medical issue. It is a cultural issue that is divisive owing to a polarized disagreement over the rights of the fetus. I believe that all human life is sacred, from conception to natural death, and therefore it is my duty as a physician to promote, protect, and advance that
1286
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Perspective on Abortion Access
life’s well-being. I recognize that many disagree. But the College should acknowledge that this is the belief of many patients and health care providers. It makes the singular opinion of the College, without acknowledging the plurality on this important issue, sound contentious and uncompromising. I encourage the College to accept the disagreement and work to create best practices and policies for all women’s health care and the health care providers who deliver the care. REFERENCES 1. Stulberg DB, Dude AM, Dahlquist I, Curlin FA. Abortion provision among practicing obstetrician-gynecologists. Obstet Gynecol 2011;118:609–14. 2. Abortion training and education. Committee Opinion No. 612. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:1055–9. 3. Increasing access to abortion. Committee Opinion No. 613. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:1060–5. 4. Bryant AG, Narasimhan S, Bryant-Comstock K, Levi EE. Crisis pregnancy center websites: information, misinformation and disinformation. Contraception 2014;90:601–5. 5. Hardy G, Benjamin A, Abenhaim HA. Effect of induced abortions on early preterm births and adverse perinatal outcomes. J Obstet Gynaecol Can 2013;35:138–43. 6. Swingle HM, Colaizy TT, Zimmerman MB, Morriss FH Jr. Abortion and the risk of subsequent preterm birth: a systematic review with meta-analyses. J Reprod Med 2009;54:95–108. 7. Thorp JM, Hartannn KE, Shadigian E. Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obstet Gynecol Surv 2003:58:67–79. 8. Rosen JD. The public health risks of crisis pregnancy centers. Perspect Sex Reprod Health 2012;44:201–5. 9. Gallup. Generational differences on abortion narrow. Available at: http://www.gallup.com/poll/126581/generational-differencesabortion-narrow.aspx. Retrieved April 9, 2015.
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Perspective on the American College of Obstetricians and Gynecologists’ Support of Access to Elective Abortion William J. Polzin,
MD
D
uring my career, the American College of Obstetricians and Gynecologists (the College), representing its members, has always been in favor of increasing access to elective abortion for women in the United States. However, it previously acknowledged and respected the fact that many of its members held an opposing view, usually based on morals grounded in religious beliefs. The College should be a representative organization. It should encourage wide consideration of facts, not ideology. Despite what the College says, its members speak with their actions. Most obstetrician–gynecologists (ob-gyns) do not perform abortions. In a survey reported by Stulberg,1 about 50% of ob-gyns who reported not performing abortions self-reported a high degree of religious motivation. This is compared with about 25% of those who reported performing abortions. Those who are motivated to not perform abortions owing to their religious convictions may find that their professional reputations are shaped by their beliefs and choices in this regard. This can, in turn, influence the education of residents and patients who seek these health care providers’ professional advice. Similarly, ob-gyns who opt to perform abortions in their practices may influence resident education and patients who seek their advice. Belief, whether religiously motivated, purely humanistic, or based on morals not grounded in religious conviction, is always expressed by the health See related editorial on page 1282.
From the Good Samaritan Hospital, Cincinnati, Ohio. Corresponding author: William J. Polzin, MD, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH 45220-2475; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0029-7844/15
VOL. 125, NO. 6, JUNE 2015
care provider. In either case, patients are never unaffected by health care providers’ beliefs. Regarding Committee Opinions 6122 and 6133 published in the November 2014 issue of Obstetrics & Gynecology, I am both surprised and disappointed at the lack of respect for the plurality in the College and the proactively dismissive tone toward dissenting opinion. Opinion 612 states that there are barriers to training in abortion care and cites legislative and institutional and social concerns. These barriers are present because they reflect the opinions, beliefs, and philosophies of those organizations duly authorized to establish same, whether they be private or public. Opinion 612 states that access to safe abortion services is a key component of women’s health care, citing only the College’s own opinion documents as reference, not scientific data. Many do not agree with the opinion expressed. Committee Opinion 613 paints all crisis pregnancy centers with the same brush, saying that they “operate to dissuade women from seeking abortion care” and “often provide inaccurate medical information.”3 Although there are publications, including some in the medical literature, that support these claims,4 there are certainly exceptions. Pregnancy centers I work with refer to medical practices with licensed and credentialed prenatal health care providers of comprehensive obstetric care, including ultrasound and counseling. The College is looked to by our profession and the lay public for information that is accurate and forthright. The College recently has highlighted the daunting clinical problem of preterm birth. It joins with the March of Dimes in designating preterm birth prevention as a key national initiative, with associated local and national fundraising efforts. Studies examining the link of abortion to preterm birth risk are varied in their results. There are publications that associate an increased risk for preterm birth with a patient’s history of elective abortion.5,6 These associations may not be strong, but they have raised
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
1285
enough concern to be included in mainstream obstetric textbooks used in resident education. Many thoughtful reviews look at the publications that show varied results.7 I would not describe a discussion of this concern, especially in the context of preterm birth, which is such an important issue, as “other misinformation.”3,8 It is a discussion that should be advanced and rigorously studied beyond the observational studies used to argue for and against association. This could happen more quickly, especially if aided by the College’s being more inclusive in its thinking rather than dismissive as it is in Committee Opinion 613. The point of all this is simply to say that the College should help further the health care environment and culture for all women faced with unwanted pregnancies. The College can start by acknowledging its members have serious disagreement on this issue. The College can recognize that most care is given to women who do not favor unlimited access to abortion9 and that care is given by a majority of obstetricians who do not provide abortion.1 The College could help pregnancy centers that are filling gaps in many underserved and at-risk communities give better information, especially around the controversial associations of abortion with future risk, instead of proposing ways to limit or eliminate the centers’ effectiveness.3,8 Elective abortion is not, primarily, a medical issue. It is a cultural issue that is divisive owing to a polarized disagreement over the rights of the fetus. I believe that all human life is sacred, from conception to natural death, and therefore it is my duty as a physician to promote, protect, and advance that
1286
Polzin
Perspective on Abortion Access
life’s well-being. I recognize that many disagree. But the College should acknowledge that this is the belief of many patients and health care providers. It makes the singular opinion of the College, without acknowledging the plurality on this important issue, sound contentious and uncompromising. I encourage the College to accept the disagreement and work to create best practices and policies for all women’s health care and the health care providers who deliver the care. REFERENCES 1. Stulberg DB, Dude AM, Dahlquist I, Curlin FA. Abortion provision among practicing obstetrician-gynecologists. Obstet Gynecol 2011;118:609–14. 2. Abortion training and education. Committee Opinion No. 612. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:1055–9. 3. Increasing access to abortion. Committee Opinion No. 613. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:1060–5. 4. Bryant AG, Narasimhan S, Bryant-Comstock K, Levi EE. Crisis pregnancy center websites: information, misinformation and disinformation. Contraception 2014;90:601–5. 5. Hardy G, Benjamin A, Abenhaim HA. Effect of induced abortions on early preterm births and adverse perinatal outcomes. J Obstet Gynaecol Can 2013;35:138–43. 6. Swingle HM, Colaizy TT, Zimmerman MB, Morriss FH Jr. Abortion and the risk of subsequent preterm birth: a systematic review with meta-analyses. J Reprod Med 2009;54:95–108. 7. Thorp JM, Hartannn KE, Shadigian E. Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obstet Gynecol Surv 2003:58:67–79. 8. Rosen JD. The public health risks of crisis pregnancy centers. Perspect Sex Reprod Health 2012;44:201–5. 9. Gallup. Generational differences on abortion narrow. Available at: http://www.gallup.com/poll/126581/generational-differencesabortion-narrow.aspx. Retrieved April 9, 2015.
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
