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vii preface Today, in the early twenty-first century in the United States, health policymakers , ethicists, and advocates are actively debating the rights of health practitioners to deliver care according to their own consciences. The idea that particularly troubles Americans is that physicians could be forced to participate in abortion care (or other reproductive health care) when they do not want to. In this book I show that, given the way abortion care is marginalized in American medicine, and given that “conscience clauses” extend to health-care institutions that regulate the practices of physician employees, the problem is quite the opposite: physicians who want to provide abortions within mainstream American medicine often cannot. While such clauses ensure that individuals have the right not to provide abortion care, they ineffectively ensure that physicians have the right to provide abortion care. The inability of physicians to include abortion care in American mainstream medical practice is the main exploration of this book. Readers predominantly interested in structural obstacles to abortion practice may want to focus their attention on Chapters 2, 5, and 6. Chapter 2 looks at the history of how abortion care exited mainstream medicine and how abortion clinics came to provide 93 percent of abortions. Chapter 5 pre­ sents the multilevel barriers to abortion practice that physicians in this study faced after residency. Chapter 6 examines abortion prohibitions in Catholic-owned health-care institutions and their effects on the medical practice of physicians in the study, especially during the management of miscarriages. There is a second important focus in this book, not reflected in the title. Despite conventional wisdom, ideology and practice are not neatly viii   willing and unable aligned in the context of abortion care. Sometimes “pro-choice” physicians have complicated feelings about providing abortions. Physicians’ reasons for not providing abortions often extend beyond their fears of violence, stigma, and the professional consequences of involvement with abortion. At the same time, some physicians who oppose abortion find themselves more sympathetic to the need for abortion after they are exposed to that need during their residencies. Chapters 3 and 4 tell the moral and emotional stories of physicians’ choices around abortion care. These chapters tease apart how particular training experiences and interactions with patients shape doctors’ orientations toward abortion care in ways they did not necessarily expect. It has been some time since social scientists regarded Western medicine as an objective, depoliticized science. While physicians may share a certain set of skills and knowledge from their professional training, physician practice is subject to diverse financial and political tensions in additiontoindividualpreferences .Nevertheless,abortionpoliticsoftenextend their reach into surprising corners of the physician experience, shedding light on individual and institutional ideas about women’s sexual behavior, with real consequences for women’s reproductive lives. ...


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