Why Are Fellow OB-GYNs Making My Job as an Abortion Provider Even More Difficult?

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Culture & Conversation Abortion

Why Are Fellow OB-GYNs Making My Job as an Abortion Provider Even More Difficult?

Dr. Iman Alsaden

With Roe v. Wade under attack, American Board of Obstetrics and Gynecology's new certification for abortion providers will have devastating results.

As an OB-GYN providing the full spectrum of reproductive health care in the Mid-South, I am constantly navigating medically unnecessary restrictions on abortion care aimed at making it difficult for me to provide—and therefore difficult for patients to access—basic health care.

Whether having to recite state-mandated scripts with misinformation aimed at scaring patients away from accessing safe abortion care in Kansas, or being forced by Oklahoma to make patients wait 72 hours before receiving their abortion care, I find it infuriating to navigate the slew of dangerous restrictions implemented by anti-abortion legislators who are not trained physicians.

So I was taken aback to discover yet another layer of gatekeeping—this time not by anti-abortion legislators, but by my abortion-providing OB-GYN colleagues.

Yes, you read that right.

Roe has collapsed and Texas is in chaos.

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The American Board of Obstetrics and Gynecology (ABOG), which provides board certification for OB-GYNs like me, recently introduced a Complex Family Planning (CFP) subspecialty. Through creating an additional level of board certification for OB-GYNs specializing in abortion care in the United States, ABOG risks further restricting abortion access for patients by pushing family medicine providers out of restrictive states, not addressing the abortion provider shortage in many areas of the country, and placing an additional financial burden on physicians who do want to provide the care their communities so desperately need. The new subspecialty certification could result in more abortion provider deserts. It’s a devastating move to make during the most threatening time to the legal framework of abortion we’ve ever experienced.

While the board’s public support of efforts to increase access to abortion care has been crucial in educating legislators about just how safe abortion care is, its actions in this case fall short of its stated commitments to communities needing abortion care.

Here’s a closer look at how this will inevitably restrict access.

Many states that have historically been fiercely anti-abortion, such as Arkansas—another state where I provide care—have already used ABOG’s standard board certification process for OB-GYNs to actively restrict abortion access. You can only perform procedural or medication abortions in Arkansas if you are a board-certified or board-eligible OB-GYN, even though other health-care providers, like family medicine physicians and advanced practice clinicians, are fully qualified and capable of providing this care—just look at the success of abortion provision by those specialties in states like California and Maine. When Arkansas passed this law in 2019, it drastically reduced the number of abortion providers legally able to serve the needs of their communities to just a handful for an entire state. This is not OK.

ABOG board certification has already been weaponized against the reproductive health, rights, and justice movements, leading to a devastating decrease in access for Arkansas. There are only two abortion clinics—and only one performing procedural abortions—in the state as of this writing, both located in Little Rock. This makes abortion care inaccessible to thousands throughout the state who are seeking essential health care. By pushing this new certification forward, there’s a very real chance of abortion access being further burdened if states begin requiring abortion providers to be OB-GYNs certified in the CFP subspecialty.

If the board wants to actually serve the needs of communities across the country, their leadership and members should focus their efforts on pushing back against the countless threats on both state and national levels to abortion access.

It’s also critical to consider how geographical distribution of abortion providers will be impacted. All of the institutions with training programs for OB-GYNs wanting to specialize in abortion care, specifically this new ABOG subspecialty, are in large metropolitan areas with large patient volumes to support trainees and are under generally progressive governments that do not threaten institutions and students the way we’ve seen in conservative states. The local impact of training many of these providers is often moot when it comes to providing access in the abortion deserts around the country. There is usually no need for additional abortion providers in areas with training programs; there is usually a saturation of abortion providers, not enough shifts for all the people that want to do them, and not enough jobs for all the people that want them.

So who is performing abortions in rural areas with minimal access? Who are the doctors actively working to improve access to abortion in a meaningful way?

The answer is mostly general OB-GYNs and family medicine doctors without any special certification in CFP. Most of the providers actively working to combat a lack of access to abortion care in the 89 percent of U.S. counties that do not have an abortion clinic will by and large be excluded from this new certification.

Will all of the newly certified subspecialists in CFP living in progressive, urban U.S. cities come to help the independent clinics and Planned Parenthoods in states that enacted abortion restrictions? Will this lead to the end of the few abortion providers doing the work in states like Oklahoma and Arkansas? Will CFP subspecialists begin traveling to the places that have one family medicine abortion provider who may not be allowed to work anymore? If they aren’t doing this now, in this “unprecedented situation,” as Dr. George Wendel, executive director of ABOG, stated in a September webinar introducing the CFP subspecialty certification, why would they do it in the future?

Many OB-GYNs, like myself, complete residency feeling trained and ready to begin providing the full spectrum of reproductive health care, including abortion care, without completing an additional two years of training on top of the many already completed. I decided to become a provider of abortion care because the patients I care for need it, plain and simple. I’m not here to accrue more badges of recognition, add another line on my resume, or gatekeep other compassionate health-care providers from joining me in what is the most fulfilling piece of health care I provide.

Dr. Wendel mentioned in the CFP introduction webinar that “maternal-fetal medicine didn’t destroy obstetrics,’” meaning that the advent of maternal-fetal medicine as a subspecialty did not decrease the need or make obsolete the practice of general obstetrics. This ignores one glaring fact: Federal and state governments are not trying to legislate general obstetrics out of existence in the same way they are comprehensive reproductive health care. And while we are on the topic: I don’t believe anyone was ever murdered simply for being a provider of obstetrics.

Speaking of costs of being an abortion provider, there is the financial cost of becoming a doctor in general. Many of us have enormous student loans to repay; due to the enormous cost of medical education, some OB-GYNs feel they cannot afford to do a fellowship. And due to receiving adequate training in residency, some OB-GYNs feel they do not need to do a fellowship.

Qualification elitism is rooted in white supremacy. Wanting to be recognized for professional accomplishments in a manner that could further restrict abortion access for millions of people, largely in communities with low incomes and communities of color, is a classist, racist action. While our patients’ constitutional rights are under fire, access to the very care the subspecialists are claiming to be certified in is shriveling. ABOG’s recognized specialties should be designed to increase quality of care and make it available to more patients. The opposite is true for abortion-seeking patients who may very well lose their expert-level (but non-OB-GYN) providers.

ABOG should recognize that this certification is not at all rooted in the reproductive justice framework that our field should be pushing forward based on inequality of access. It is not enough that abortions are legal; they need to be accessible in all ways, and that is why this could be such a huge blow to our patients. Who will help the patients who are the most vulnerable to laws that target abortion providers in their states?

The CFP committee within ABOG is made up of OB-GYNs located in large Democratic-majority cities. All of the members are academically affiliated. This is concerning when many of the clinics serving patients in areas of great need are independent clinics, which are often the only option for providers that want to provide abortion care. Perhaps someone from an independent clinic should have been invited to be on this committee. Perhaps a general OB-GYN who has devoted their life to abortion care? Perhaps a family medicine doctor? I suspect those people were not included for a reason—because our feedback rooted in lived experiences of providing abortion care would contradict the invention of such a subspecialty.

I plan to apply for the CFP subspecialty certification, despite all of the reasons why it’s dangerous and unnecessary, because I feel forced to in order to continue my job and meet the needs of the communities where I live and provide care.

If ABOG wants to actually serve the needs of communities across the country, their leadership and members should focus their efforts on pushing back against the countless threats on both state and national levels to abortion access instead of encouraging harmful gatekeeping of abortion care.

We need more abortion providers, period. Instead of writing and designing another hoop that we are all forced to jump through for the academic dog and pony show (those who are lucky enough to even be invited to the show, that is), these OB-GYN specialists should instead consider giving their time and skills to the clinics desperately trying to meet the needs of patients in states working to strip communities of their bodily autonomy and fundamental human rights.