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1 chapter 1 Introduction That was probably the most disappointing thing about training residents . You know, for what? To do nothing? I mean, they obviously would refer [their abortion] patients, and they would take good care of their patients , both pre- and post-care. But, you know, it was disappointing to not have them have the guts to stand up and say, “I’m going to do it.” Dr. Davis Chasey, retired founder and director of a residency abortion clinic Dr. Chasey’s disappointment that his resident physicians of obstetrics and gynecology didn’t “have the guts” to perform abortions after graduating was harsh, yet poignant.1 Here sat a man, nearly eighty years of age, explaining how he had dedicated his career to providing abortion to women in a conservative state and how he had advocated to keep his clinic open under unsupportive conditions, at times facing hostility from colleagues, so that he could continue to train the next generation of abortion pro­ viders. And yet, very few of Dr. Chasey’s trainees performed abortions after graduating from residency. Indeed, during Dr. Chasey’s career, he saw the number of abortion providers begin a national decline in the early 1990s, most significantly in politically conservative and rural areas, making abortion less accessible for some of the most economically disadvantaged women in the United States. Dr. Chasey saw abortion training as a career calling, a way to prevent abortion-related deaths and hospitalizations such as those he had witnessed before abortion was legalized in 1973 by the Supreme Court decision in Roe v. Wade.2 Remembering experiences from his own training in the 1950s, he recounted: “When I was in 2   willing and unable [obstetrics and gynecology, ob-gyn] residency training we had a ward of about twenty beds, which was full all the time with women having ‘miscarriages .’ And we suspected that these were not all spontaneous abortions , but we had no way of proving it. If you asked a woman, she would obviously deny it. And those women had problems. They had excessive bleeding. They had infections, sometimes bad infections . . . After Roe v. Wade . . . those wards closed. There was nobody to put on them.” Before Roe, Dr. Chasey had discreetly performed abortions for his patients when asked. “They were infrequent but I did them,” he said. “And I just felt very strongly that women had this right.” In the early 1970s Dr. Chasey took a faculty position at a medical school in the Midwest where he was asked to set up the school’s first abortion service. He started it from the ground up and worked there for nearly thirty years until his retirement, after which the clinic promptly closed. Seven of the physicians I interviewed were trained by Dr. Chasey. They all spoke fondly of him; they were compelled by his story, his politics, and his genuine concern for his patients. After they learned how to perform abortions in his residency clinic, many of them continued to moonlight during residency at a remote abortion clinic. Most expressed appreciation for the skills they gained during abortion training. They frequently used the word “important” to describe abortion training. One physician said, “I was happy that I was learning how to do something that I thought was important.” Another said, “I thought it was important . . . it should be done in a safe, comfortable environment.” Still another, referring to her patients, said, “To do abortion the right way in the right setting is very important to the quality of their life.” Yet, while their feelings about the importance of abortion care did not change after residency, only one of them still included elective pregnancy terminations in her practice at the time of the interview (for abortion terminology, see Appendix A).3 This book examines how the politics of abortion have shaped its practice in the United States. In essence, I ask, What happened to Dr. Chasey’s residents after he trained them in abortion care? Was it simply “guts” that they lacked? Such a notion implies that the problem lies with the individual failings of the residents. If this were true, how could we measure the courage required to perform abortions as a newly graduated physician starting out in practice in the 1970s compared with today? Have doctors introduction   3 changed so much? Or is it the social and medical context of reproductive health care that has changed significantly? Abortion is a common and safe medical procedure technically similar to that...


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