Violence versus reproductive health care

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6979.547 (Published 04 March 1995) Cite this as: BMJ 1995;310:547
  1. Jane E Hodgson
  1. Clinical associate professor of obstetrics and gynaecology 1537 North Fisk Street, St Paul, MN 55117, USA

    In the United States organised medicine averts its gaze

    January this year marked the 22nd anniversary of the United States Supreme Court's decision in the case of Roe v Wade,1 which established women's constitutional right to abortion. Justice Blackmun's carefully written opinion in 1973 removed almost all legal restrictions on abortions during the first trimester of pregnancy.

    But this year's anniversary was a sad day for those of us dedicated to providing reproductive health care to women. In the past six months five murders, six woundings of escorts and workers, an escalation of fire bombings, harassment of patients, and death threats to doctors have closed clinics that have been legal for 22 years. Doctors are the prime targets now, and our numbers are dwindling. Although older than most practising physicians, we keep on working to keep the clinics open; medical schools and residency training programmes are failing to provide replacements.2

    According to the Allen Guttmacher Institute, a non-profit group that researches reproductive issues, 84% of counties in the United States no longer have a doctor prepared to perform abortions. In addition, only one in eight residency programmes in obstetric and gynaecology require training in abortion—half the proportion of a decade ago. The fact that 90% of abortions are being performed in freestanding clinics and only 7% are being performed in hospitals, where residency programmes are based, is an important reason for the decline in training as well as for the activism against doctors who provide abortion that is instilling fear in providers, young and old. Similar violence has not erupted in other parts of four continents where I have travelled and worked with Project Hope. Never have I witnessed elsewhere the intensity of the United States' divisions over reproductive choice.

    One of the factors usually blamed for this is the inflammatory language used by the opponents of …

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