Like many physicians, Dr. Claire Barnett looks forward to national conferences with her colleagues. These days, she can't help but notice the sea of gray heads at the annual gatherings.
"It's really staggering," she said. "Most of them are elderly men."
Barnett's specialty is abortion. At the age of 41, the Seattle doctor is among the younger practitioners of a trade that incites passions like few others, and which abortion-rights advocates fear might be in danger of dying out.
Today, supporters celebrate and opponents decry the 30th anniversary of the Roe v. Wade decision. But as the political battle over abortion drags into its fourth decade with little sign of change, there have been significant changes in the practice itself.
And a generation of women for whom abortion has always been legal increasingly find themselves with fewer options than their mothers had — partly because the ranks of doctors who pioneered abortion are dwindling and few seem eager to take their places.
"It's getting harder and harder for women to have easy access to abortion," said Gwen Chaplin, president of Planned Parenthood of Central Washington.
Fewer doctors perform abortions in Washington today than in the early, post-Roe years. Young physicians are reluctant to take on something saddled with so much social and moral baggage, from picketers and notorious "wanted" posters, to sidelong glances from neighbors, to threats of violence.
Much of the decline in the numbers of abortion doctors can be credited to anti-abortion activists and their tireless vigils and protests, said Dan Kennedy, chief executive officer of Human Life of Washington, which opposes abortion. Even more persuasive, he believes, has been the anti-abortion movement's fundamental argument that abortion takes the life of a human being and is at odds with the practice of medicine.
"I think it's a cultural awakening," Kennedy said. "Fewer and fewer physicians are willing to be stained by the practice of abortion."
Abortion-rights supporters agree that the national climate is far more hostile to abortion doctors today than it was three decades ago.
"A lot of people were willing to be providers right after Roe v. Wade," said Barnett, medical director of Aradia Women's Health Center. "Then slowly, the anti-choice movement has intimidated people and made it so difficult."
The impact is far-reaching. While the abortion battle rages in Congress, the courts and state legislatures, the drain of doctors willing to perform the procedure may be quietly limiting it as much — or more — than many of the legal restrictions being debated across the country.
Fewer abortion facilities
No agency or organization tracks the number of doctors performing abortions, but other statistics clearly show the trend:
In 1977, there were 104 clinics, hospitals and doctors' offices across Washington where women could get an abortion. By 2001, the number had dropped to about 60 — mainly in the Puget Sound region. Nearly 70 percent of Washington counties have no abortion providers. Nationally, the figure is 87 percent of counties, according to a study released last week by the Alan Guttmacher Institute, a national reproductive-health research organization.
There are many reasons for the decline in facilities, including the fact that state and national abortion rates have been falling gradually the past 20 years. But abortion remains one of the most common surgical procedures, with an estimated one-third of American women undergoing one during their lifetime, the Guttmacher Institute estimates.
While Seattle has an abundance of abortion providers, the numbers are tiny in other parts of the state, Chaplin said.
The sole abortion providers in Moses Lake and Wenatchee retired recently, meaning women there must make long drives if they choose to end a pregnancy. The Yakima area once had three abortion providers, but the number has dwindled to one.
Abortion providers are so scarce in many neighboring states that women from Wyoming, Alaska, Montana and Idaho routinely fly to Seattle for abortions.
Battle over medical schools
Abortion-rights groups have launched several campaigns to expand abortion training in medical schools and recruit new abortion providers. Abortion foes have been fighting the efforts, particularly in medical schools.
"There's a real battle going on," Kennedy said. "But no matter what you do in terms of training, most physicians will not perform abortions."
The Pacific Northwest is the second place in the country targeted by the Massachusetts-based Abortion Access Project, said Deborah VanDerhei, the group's local coordinator. Using a model first tested in New England, the group last year began offering training in Washington, Oregon and Alaska for family-practice doctors who want to add abortion to their professional skills.
In places like Oregon and Montana, where it's legal, the group is also encouraging more nurse practitioners, nurse midwives and physician assistants to provide abortions. "That's one of the ways they were able to increase access in New England," VanDerhei said.
The group is exploring possible amendments or changes to Washington laws, which specify that abortions must be performed by physicians. It might be possible, for example, to modify the rules so other trained medical practitioners could dispense the recently-approved abortion pill, she said.
Another organization, Medical Students for Choice, has succeeded the past few years in persuading more medical schools to add abortion training to their curricula.
In 1995, only 12 percent of obstetric-and-gynecology residency programs nationally included routine abortion training. A 1998 survey by the National Abortion Federation found the percentage had climbed to 46.
A recent follow-up survey found that the average abortion-education program at New England medical schools consists of a 30-minute lecture, VanDerhei said. "Although more schools are offering abortion information in their curricula, what they're offering is clearly not adequate."
No laws require medical schools to provide abortion education or penalize them for either choice. At those that do, classroom training can be either mandatory or elective. Medical students can observe abortions but aren't allowed to perform them — or any other medical procedure.
The hands-on training, always strictly voluntary, comes during residency, when newly-minted physicians are learning their specialties. In 1996, the Accreditation Council for Graduate Medical Education ruled that all accredited residency programs for Ob-Gyns must provide lectures about abortion and possible complications. Congress immediately passed a law that made the requirement optional.
At the University of Washington, all medical students get a brief lecture on abortion as part of a segment on reproductive health. Those who want to learn more can sign up for electives that range from more detailed coursework to internships at local clinics. Ob-Gyn residents are required to learn the basics of abortion, but aren't required to perform them.
Participation varies. Only a tiny fraction of all medical students take abortion-related medical school electives, said Dr. Louis Vontver, the UW professor emeritus who oversees obstetric-and-gynecology education. About 80 percent of Ob-Gyn residents opt in, he said.
The president of the Catholic Physicians' Guild of Washington State isn't surprised that more and more doctors are shunning the field of abortion.
"It's such a profound deviation from what medicine and the healing nature of medicine is all about," said Dr. Jan Hemstad, a Seattle-area anesthesiologist.
Hemstad is so strongly opposed to abortion that he once walked out of a clinic where he was asked to anesthetize an abortion patient — incurring the ire of his business partners.
"To me, it's anathema," he said. "There really is no justification for it."
Abortion supporters often invoke complacency as one explanation for the trend.
Most medical students were born after Roe v. Wade and have grown up expecting ready access to abortion, said 28-year-old Tess Moore, coordinator of the UW branch of Medical Students for Choice.
"People assume that somebody else will be there to provide those services."
Most young people also can't imagine the experiences of early abortion doctors, many of whom were motivated by seeing the results of botched, backstreet abortions, she said.
"Our group is going to try to show some films and pictures (this week) to remind people what it was like before abortion was legal."
Concerns about violence, protestors and disapproval can't be easily dispelled, said Barnett, the Seattle doctor.
"Security is something I have to think about all the time," she said. "I tell my family and friends: Never leave an unlabeled package by my house."
Doctors who perform abortions are generally people who believe so strongly in the cause that it justifies the risks, she said.
"Once you start working in the field and taking care of women, it's such a satisfying job and so important, it has a way of hooking you in."
But even doctors who would like to perform abortions often find that practical considerations prevent them, she said. Partners may disapprove, or religiously-affiliated organizations my forbid it.
Moore would eventually like to practice medicine in a low-income clinic where she could also offer abortions to women who want them. It could be tough, she said, because most low-income clinics receive federal funding, which carries a ban on abortion.
"Honestly, I think it will be bit of a challenge for me to realize my dream."
Sandi Doughton: 206-464-2491 or firstname.lastname@example.org.