Reflections from the Road: Traveling to Provide Abortions in Underserved Areas

I got up early and caught the first flight towards New Mexico. Up high above the desert, I could trace the lines of old streams merging into rivers along the valley floor now only carvings in the beautiful and stark landscape. In awe of the slow but behemoth power of water, I pondered what mark I could possibly leave here. Perhaps, helping one woman at a time to reach her goals, is enough to leave a lasting impact in a community over time.

I spent the last ten years training to be a physician, and my path unfolded in leaps and hurdles as I decided to go into family medicine, invested in human rights work, and found a place in the reproductive justice community. I had the wonderful opportunity to be trained through the TEACH and CREATE Programs at my Bay Area family medicine residency, and graduated with confidence in my abortion skills.

Choosing to Provide

My interest in abortion provision grew out of my commitment to human rights and my fundamental belief that empowered women can change the course of history. I pursued procedural training throughout my residency, and came to understand that I would have to prioritize this work if I was going to continue to provide.

Like many metropolitan areas with training programs, the Bay Area is saturated with providers and it’s hard to get shifts locally. So, I let TEACH faculty know that I was interested in traveling to provide. From there I was put in touch with the folks starting this new clinic in Southeastern New Mexico.

The Perks of Traveling to Provide

With the political climate greatly reducing the number of trained providers, the social hostilities affecting this work, and the expansion of restrictive TRAP (targeted regulation of abortion providers) laws and religious hospital systems, abortion has become a specialty service. Abortion should not be a specialty service. As trained providers, we can bring this simple and safe procedure to communities where abortion access is limited by such restrictions.

Traveling is a great way to bring your skills to an underserved area, and gives you first-hand experience with the challenges that different communities face in accessing full spectrum care. I acutely felt the stranglehold of these TRAP laws when providing in New Mexico. One woman drove 12 hours from her small town in Texas to have a medical abortion because she was past the 7-week cut-off enforced there. A second woman came from Fort Bliss in El Paso, Texas when she was unable to access care through her military providers. Hearing these stories, and being able to offer support, was more powerful than any news article I could have read on the topic.

Another advantage of traveling to provide is the ability to compartmentalize one’s work. As an outsider in the community, I didn’t fear reprobation or stigmatization in my work and personal life. I didn’t run into protesters at the local grocery store or fear them targeting my clinic. Although I still dealt with my fair share of protesters and recall looking in my rearview mirror on occasion, I felt anonymous as soon as I pulled out of the clinic driveway. This ability to drop in and out of a community can make provision less taxing emotionally and risky professionally.

The Challenges of Traveling to Provide

As a visiting provider, it is difficult to establish relationships with professionals in your practice area, should a complication arise or follow-up be needed. In some cases, the only local facilities are religiously affiliated, and it is not clear whether your patients will get access to full and appropriate options in these settings. When I recently referred a client for a formal ultrasound after a procedure, I was cautioned by staff, “Are you sure she needs to go? She might end up with a hysterectomy if they think there is any complication.” Building personal relationships with local providers has the potential to improve perceived hostilities; but traveling doesn’t allow this. Additionally, being a traveler, and the sole on-site provider, can be isolating. I keep a critical list of mentors whom I call with questions during my work days. Having this network of colleagues (in my case, dispersed from New York to California), is vitally important for this kind of work.

There is also difficulty with reimbursement. Travel time is not compensated and most of the time I was lucky to break even. To do this work, I took other part time jobs and negotiated to have the flexibility for these trips. As I pursue further career options and my home life evolves, this calculus may shift.

Conclusions

As restrictions on abortion training and provision rise, more doctors are traveling to provide. A long-term strategy to increase accessibility must be multi-faceted. Whether we invest in regional training centers, advocate and facilitate increased training in more rural residency programs, and continue to call for repeal of restrictive laws, traveling is one important but challenging part of the puzzle.

Resources

If you are interested in learning more about opportunities to travel to provide, contact www.cliniciancorps.org a national network that matches trained clinicians with health centers and clinics in need of abortion providers. Also, many of the challenges and benefits discussed here are touched on in the helpful TEACH workbook chapter, Becoming a Provider (http://teachtraining.org/trainingworkbook/10-Becoming-a-Trainer.pdf).

Nicky B.