• Abortion may be legal, but that doesn’t mean it’s easy to get one

    I’ve always been a fan of good survey research. Sometimes, surveys are the best way to answer simple questions. In the most recent issue of Obstetrics and Gynecology, there’s a good example of such a study:

    OBJECTIVE: To estimate prevalence and correlates of abortion provision among practicing obstetrician–gynecologists (ob-gyns) in the United States.

    METHODS: We conducted a national probability sample mail survey of 1,800 practicing ob-gyns. Key variables included whether respondents ever encountered patients seeking abortions in their practice and whether they provided abortion services. Correlates of providing abortion included physician demographic characteristics, religious affiliation, religiosity, and the religious affiliation of the facility in which a physician primarily practices.

    A survey of 1800 ob-gyns is a large sample. The response rate was 66%, which is pretty impressive for a survey of physicians. It didn’t hurt that they were offering a $20 inducement with the first survey. They also offerred an additional $30 to potential respondents with the third mailing. On a side note, that was an odd thing to do, because it actually tempts participants not to respond to early mailings. But they did fine. This was not a cheap survey to do.

    A whopping 97% of practicing ob-gyns had encountered patients seeking abortion, yet only 14% of ob-gyns perform them. That’s significantly fewer than previously thought. The study also provides some interesting data on which ob-gyns are more likely to provide abortions. Here’s a chart I made with their data:

    Male ob-gyns are less likely to provide abortions, as are middle-age ones. If you live in a rural area, you’re very unlikely to find an ob-gyn who will provide an abortion. And here’s some religious data:

    Almost no Evangelical Christian ob-gyns will provide abortions. Jewish ob-gyns are the most likely to provide abortions, even more likely than ob-gyns who report having no religion at all. This study doesn’t prove causality, so we can’t tell if any of these factors cause providers to provide abortions or not, but it’s interesting nonetheless.

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    • In much of Judaism, life is not believed to begin until 40 days after conception. Before that, an abortion would be acceptable, generally speaking. That may play into the data above.

      • Jusaism generally does not regard the date of conception, or 40 days or any such factor.
        The Jewish criterion stems form the idea that one must attack an attacker and not succumb; hence a fetus that attacks the pregnant woman, may have its life taken to protect the woman.
        A question remains, is psychological attack or emotional attack as real as a physical attack by the fetus on the life or health of the pregnant?

      • The story of the birth of John the Baptist (Luke 1:57-64, KJV) is a clear indication that a newborn was not officially made a part of the community until the eighth day after birth, which was the day of naming the baby and, for males, circumcision. Genesis 2:7 clearly states that the clay form “became a living soul” after God “breathed into his nostrils the breath of life,” which argues for ensoulment at birth, not conception.

    • These numbers seem to be higher than the number of psychiatrists that provide therapy. What percentage of surgeons provide elective surgery? Most abortions are elective, and, strictly speaking, not healthcare any more than rhinoplasty is.

      • Nope, abortions can be, and frequently are, medically necessary. Most second-term abortions performed in the US, for example, are medically indicated.

    • Yes, Richard. Because living with a large nose is the same thing as raising a child. I understand exactly what you mean about abortion being like rhinoplasty!

    • Weird that Catholic and Orthodox are lumped in together.

    • Speculating here, but I can think of a couple of points that might affect the “Jewish” number.
      1) There is a HUGE difference between the religious and irreligious Jew. A Jewish atheist is still very likely to identify as Jewish when given the option, but their behavior is likely to be more like an atheist.
      2) There is a HUGE link between Jews and liberal politics. The less religious, the more liberal. Dig into this group, and you might find some who deliberately went to medical school in order to provide abortions as a civil right.

      Also, I think that this survey is very likely to be systematically skewed, but I have little clear idea in which direction. Abortion is hugely political, and people are therefore significantly motivated to opt out or misreport.

      I find it odd that they reported such a limited number of demographics. In particular, a lack of political affiliation. Again, given the contention of the issue, it is almost meaningless to provide these sorts of breakdowns without crossing political affiliations.

    • ” Dig into this group, and you might find some who deliberately went to medical school in order to provide abortions as a civil right.”

      Seems unlikely. Of the many docs I have known and worked with, does not seem to be the case. Awfully expensive and time consuming path.

      Steve

    • This is not meant to make fun of a serious subject but…
      OB/GYNs can really be induced to fill out a survey for $20?

    • Only about 1.7% of Americans are Jewish. If a similar percentage of ob-gyns are Jewish, there would only be about 20 in the 66% who responded. I doubt we can draw any really useful generalizations about Jewish ob-gyns from that data. That’s even more true for Muslims and Hindus. Unless adherents of those religions become ob-gyns at significantly higher rates than the rest of the population for some reason, there’s probably about 7 Muslim ob-gyns in the study and about 5 Hindi ob-gyns.

      • There’s a reason I give you a link to the study. They oversampled those groups in order to have enough power to do statistical tests.

        In fact, there were 158 Jewish respondents, 54 Muslim respondents, and 91 Hindu respondents.

        If it’s gated, and you can’t get through, feel free to ask. But, in general, it’s not helpful to “guess” at things that are verifiable, and then declare the study wrong based on your assumptions.

        • Yeah, the study is definitely and obviously behind a paywall at the link you provided, and yes, I did visit the link and read the entire abstract, which is all that is available to the general public. You don’t have to be an ass just because you belong to an organization where you can get it for free. My comment was made in good faith on the best information I had available. In general, it’s not helpful to “guess” that the general public has access to the same information you do, then deride them for doing the best they can with the information that is available.

          • I’m not being an “ass”, and this is the last I’ll say on it.

            I have no problem with your asking about the number of responses for groups that are likely to be under-represented. That’s a perfectly valid question. I take exception to your assuming that they didn’t think of that and then saying that you doubted the results were valid based on your assumptions.

    • I would defend the commentor who was skeptical of the Jewish and Moslem result because of small sample size. I thought the same thing. Here, it turns out that the survey did the right thing and oversampled, but it’s so common not to do that that it was reasonable to assume that the survey did it wrong. Really, the post ought to have noted the oversampling, just as it noted that the overall sample size was much better than the typical sample one hears about in medical studies.

      That said, what surprised me was that Protestant-not-evangelical was about the same as Catholic-orthodox. Generally, the protestant-not-evangelical denomination clergy are strongly pro-abortion.

      It also shocked me that as many as 14% of the ob-gys perform abortions. Guttmacher says “The number of U.S. abortion providers remained stable between 2005 (1,787) and 2008 (1,793). Eighty-seven percent of all U.S. counties lacked an abortion provider in 2008; 35% of women live in those counties.”

      • It’s fine to question. I’m not perfect, and I’m more than happy to clarify. Moreover, you may pick up an issue I’ve missed.

        What’s not as helpful, as I said, are comments where people assume problems with the study and dismiss it based on those assumptions without asking. Or checking.

    • Something’s funny about those charts. Eye-balling the male vs. female chart, it looks like 14% for male physicians and 20% for female physicians. I thought it was hard to see how that would average out to 14% for all physicians, so I looked at the abstract, and sure enough, the numbers don’t seem to match: “Female physicians were more likely to provide abortions than were male (18.6% compared with 10.6%”.

      • I looked at my chart, and the numbers are correct as found in table 1. I think there may be a slight issue in that the 14.4% overall rate is adjusted, and the numbers in Table 1 are raw.

    • The study requires a password to access.

      May I ask if they also asked whether those who did not perform abortions, (a) referred for them to doctors who did perform them, and (b) whether the doctor they referred to was within easy driving distance (say 45 minutes)?

      That would give us more information about the availability of abortion. As a matter of fact, in most states, any medical doctor can perform an abortion. You don’t need to be an OB-GYN.

      • They did not and they acknowledged that in the Discussion:

        This study did not assess whether ob-gyns who do not perform abortions routinely refer their patients seeking abortions to colleagues who do perform them. Consistent referral would facilitate access to abortions for at least some of these patients. In 2010, the Ethics Committee of the American College of Obstetricians and Gynecologists issued a Committee Opinion in which they argued that ob-gyns are obligated to refer their patients for all legal reproductive health services, including abortions. Nonetheless, that article proved controversial, and previous research has shown that substantial minorities of physicians do not believe they are obligated to refer patients for or provide information about how to obtain procedures to which the physician has a religious or moral objection. Furthermore, the fact that so few ob-gyns provide abortions may limit access to abortion, even for patients whose ob-gyns are willing to refer.

    • “Medically necessary” was a requirement under Roe for 2nd term abortions. A figure I think many people would like to see is how often that refers to “medically necessary for mental health reasons” and how often within that category it means “medically necessary in the sense that this doctor is willing to sign off on it because he would categorize any desired abortion as medically necessary”.

      As I understand it, such figures are unavailable, and pro-abortion people fight like crazy to avoid having anyone collect them. Am I right? If not, does anybody know of a webpage that tells the figure?

    • There’s more to the Jewish number than meets the eye. Ashkenazi Jews are afflicted with a number of diseases which have genetic origins (Tay-Sachs, Usher, Gaucher, Walker-Warburg, Cystic Fibrosis). These diseases are generally recessive and so usually express in a fetus when both parents carry the gene. The likelihood of both parents carrying the gene is higher if both parents are Ashkenazi Jews. Genetic tests can identify some of these diseases very early making termination of the pregnancy an option that can be considered. Jewish OB-GYNs are very sensitive to the special need that Jewish couples have for genetic counseling, testing, and potentially, termination at a higher rate than the general population. So we see that Jewish OBs tend to provide abortions at a higher rate than other groups.