A Hard Choice

Thirty-five years after the U.S. Supreme Court legalized abortion in Roe v. Wade, any mention of abortion is rare in the first three or four years of medical school, when students must zero in on a specialty and eventually apply for residency training. Even in Maryland, where about 61 percent of voters approved a referendum guaranteeing abortion in 1992 and which has the fourth-highest abortion rate in the country, abortion is not taught in any formal lectures at the state's flagship medical school. The subject is viewed as too controversial, despite the fact that, according to the nonprofit National Center for Health Statistics, abortion remains among the most common surgical procedures for reproductive-age women. Nevertheless, many people, including some of Lesley's friends, believe abortion is the murder of an unborn child and should not be legal, much less taught to future doctors.

To learn about the procedure, students can ask to observe abortions for a day in their third year, during the rotation through obstetrics. That was something Lesley planned to do. The only other possibility for more training is offered by the national Medical Students for Choice office -- an "externship" at a local clinic where a student can observe abortions for a few weeks during the break between first and second years. (Lesley didn't apply, thinking she would spend her last free summer in Africa on a fellowship, which wound up falling through.)

Some of those who have had the externship say it was instrumental in their career decision. Audrey Lance, a medical student at George Washington University who wanted to be an obstetrician, said her summer observing abortions at Johns Hopkins Bayview Medical Center and a clinic in Annapolis was life-changing.

"Patients were so grateful," said Lance, who had only vague interest in abortion until she learned about the shortage of providers. "It just became very clear to me that this was where I was needed."

She has since moved on to an obstetrics residency. Those residencies still train the majority of doctors who do abortions, but there has been a successful effort by abortion rights advocates to recruit new kinds of providers, including family doctors, general surgeons, emergency medicine doctors and pediatricians, who get that specialized training at hospitals or abortion clinics. The nonprofit National Abortion Federation says 32 percent of its member-providers are not obstetricians.

Regardless of specialty, doctors who perform abortions sign up for a lifestyle unlike any other in medicine, a subculture replete with drawn blinds, shredders, and security guards at professional conventions. Violence against abortion providers has declined markedly since the 1980s and '90s, when several doctors were killed or injured in shootings across the country and scores of clinics were torched or bombed, according to abortion federation data.

Myron Rose, a longtime College Park abortion provider who spoke at the seminar Lesley attended, wept as he described the difficult search for new office space after his clinic was firebombed in 1984. But that, he assured Lesley and the other medical students, was "antique times."

Even so, those involved with abortion remain extremely cautious. Doctors take cover in the anonymity of large hospitals and debate whether to take their spouses' surnames and how best to protect their children. Some avoid speaking publicly about abortion.

One of Lesley's professors at the University of Maryland is nationally known in the academic world for her clinical trials on RU-486, the abortion pill that won FDA approval in 2000. But she made a deal with her husband that she would not be an activist or be quoted by the media until their toddler is in college. Her mentor's children have been harassed, she said, and she wants to insulate her own child. Not even her neighbors know the type of doctoring she does. "Maybe when I'm 60," she said.

Carole Meyers said she has never been threatened, but she described herself as hyper-vigilant about her safety. More than most people, she notices when a car slows as it drives by her house, and she isn't comfortable sitting in her living room with the shades up. She always keeps her car keys handy.

To Lesley, these lifestyle sacrifices felt distant. "Nobody's called me a baby killer yet," she said. "I don't know what I would do then."

The everyday pressure of being an abortion provider can be grating: the self-censorship, the disapproving stares of fellow doctors, the social repercussions in small communities. So perhaps it's not surprising that among doctors who said they wanted to provide abortions when they entered their residencies, only 52 percent did so once they were working, according to a recent study published in the American Journal of Obstetrics & Gynecology by Jody Steinauer, a professor at the University of California, San Francisco, and a co-founder of Medical Students for Choice. The young doctors' commitment to abortion rights, she said, may not run as deep as the doctors of Myron Rose's generation, who have vivid memories of women dying from botched, back-alley abortions before Roe v. Wade and who regularly recall the details for medical students.