Abortion Providers on Decline in Rural Areas

EVEN with few new state laws on the books, the anti-abortion movement is winning on a different front: The number of abortion facilities is on the decline. In rural America, where abortion availability has always been limited, the drop has been especially pronounced in recent years, according to the Alan Guttmacher Institute (AGI), a special affiliate of Planned Parenthood of America.

Between 1985 and 1988, the number of providers in rural areas dropped by 19 percent; since 1977, when that figure hit its peak, there has been a 51 percent decline. In urban areas, the number of abortion facilities has declined by 6 percent since it peaked in 1982.

Despite this trend, the number of reported abortions performed in America has remained roughly at 1.6 million a year since 1980. But, says AGI's Stanley Henshaw, the farther a woman must travel to have an abortion, the greater the economic toll. She is also more likely to have the abortion later in pregnancy, when the risk of complications is higher.

In effect, the rural poor are losing their access to abortion - a class distinction reminiscent of the days before the Supreme Court decision in the Roe v. Wade case legalized abortion nationwide.

Barbara Radford, head of the National Abortion Federation, which represents abortion facilities, says a key factor in the drop in providers is the difficulty in finding qualified physicians. For that, she cites a variety of reasons:

Harassment. Of those physicians willing to perform abortions in the first place, some quit because they tire of facing pickets calling them ``baby-killers.'' Some cite threats to themselves and their children. Of those who were operating in hospitals, some quit under pressure from colleagues or because the hospital itself decided to stop providing abortions.

The ``graying'' of the field. It's been 17 years since Roe, and physicians with firsthand memories of patients who suffered injury or death because of illegal abortions are retiring or approaching retirement. For many of these physicians, it was these pre-Roe medical-school experiences that got them started in the abortion practice.

Decline in abortion training. Fewer than a fourth of the nation's 282 obstetric/gynocology residency programs require abortion training, according to a 1987 study by AGI. Twenty-eight percent do not provide it at all. For the remaining half, training is optional. But according to Ms. Radford, since that study more and more programs have made training optional. ``And after residency,'' she says, ``the chances of training are not great.''

Working conditions. In clinics, where most abortions are performed, doctors' salaries can be comparatively low. The clinic setting also eliminates the doctor-patient relationship, since patients are counseled by a counselor. Abortion clinics can also have a hard time getting malpractice insurance, and many doctors are unwilling to work for clinics that cannot supplement their own insurance.

Overall, only 29 percent of the members of the American College of Obstetricians and Gynecologists actually perform abortions. In a 1985 ACOG study, 84 percent of the college's members said abortion was acceptable in certain circumstances and 13 percent said it was never acceptable. Of the 84 percent, three-quarters said the woman's personal choice was sufficient reason for a first-trimester abortion. And of the 13 percent, 55 percent said they were willing to refer patients to other doctors.

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