The XX Factor

Book of the Week: Willing and Unable

Why don’t more OB/GYNs do abortions? Lori Freedman’s new book, Willing and Unable , is the most thorough answer yet to that question. Freedman is a researcher at the Bixby Center for Global Reproductive Health at U.C.-San Francisco. In 2006, she interviewed 30 OB/GYNs across the country who’d gone to residency programs that offer abortion training unless a resident asks to opt out. The doctors were in their mid-30s to early-40s-they are the next generation. Freedman found that 18 of the OB/GYNs wanted to provide abortions, but only three were actually doing it. Here’s my write-up of quotes from Freedman’s research explaining some of the reasons why, from a piece I wrote recently for the New York Times Magazine :

One doctor from a midsize city in the Midwest described her job interview at a group practice: “The one partner who’s very senior in the group and very pro-life, basically his only job is to sit with you and just tell you … ‘If you join this group, you will not be performing abortion procedures. And if that’s a problem for you, then you will work elsewhere. O.K.?’ ” Another doctor from the suburbs of a big Western city said that she refers her patients to Planned Parenthood. “Actually, in my first couple of months in practice, the people that are in my office here told me, ‘Don’t even bother,’ ” she said of wanting to perform abortions.

According to the Guttmacher Institute, 93 percent of abortions in the United States today are performed in standalone clinics, 5 percent in hospitals, and only 2 percent in doctors’ offices. From the point of view of making abortion part of doctors’ regular practice, those numbers are bleak. But is Guttmacher inadvertently undercounting? In response to my NYT piece, one doctor wrote me to say he was sure the answer is yes:

First of all, we don’t reply to questions about abortion from anyone , whether they identify themselves as being from a reputable outfit like Guttmacher or from anywhere else. They would not get any numbers from our 11-doctor ob/gyn office. Next, I would estimate that at least 35 percent, but probably more, of abortions done in our area are done quietly in doctors’ offices.

The virtue of Freedman’s method is that she got past the cold call and the front door, so that she can paint a full picture of the constraints doctors who aren’t like this one face.