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Abortion might as well be illegal in this country given the intensely restrictive laws and regulations placed on the procedure depending on the state. From ridiculous waiting periods enforced for women, to mandatory counseling, and laws that dictate the exact size of clinic hallways, anti-abortion advocates can make it a living hell for women who just want to obtain one. And sometimes, those advocates can make it a living hell for women who just want to learn how to perform one.

Stephanie Ho, the director of primary care for Planned Parenthood Great Plains, wrote an op-ed for The Washington Post which tracks how difficult it was for her to even seek out becoming an abortion provider as a medical student. She writes about how growing up in Arkansas, people barely even said the word abortion, which was an attitude that didn’t change much even as she entered medical studies.

That implicit disapproval carried over to my residency in family medicine, which I began in 2008 at UAMS West in Fort Smith. Second-year residents gave presentations on a topic of their choice — and mine, on abortion, was the most highly attended and contentious that year. A senior faculty member vocally disagreed with my description of abortion as a common medical service, interrupting every few sentences and quoting the Bible at me. Someone dubbed me the “abortion chick,” and the nickname stuck.

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When it was time for Ho to choose a rotation, she had to enroll in a Planned Parenthood program in Denver because of a lack of local providers just so she could learn how to perform an abortion. The director of her residency program tried to tell her it couldn’t happen, but eventually relented when she pointed out program rules for “hard-to-find specialties.” But the disapproval from her supervisors didn’t end there.

It was commonly known among residents that if you applied to work at our training medical center and had done a decent job, you were essentially a shoo-in. In my first interview, I was forthcoming about intending to provide abortions at some point in my career. I was not offered a second interview. I decided not to attend our graduation ceremony.

Ho eventually opened and closed her own practice before moving onto Planned Parenthood, but she writes that she’s only one of four physicians in Arkansas regularly providing abortions there. And that’s not surprising given the mountain of restrictions the state piles onto abortion clinics.

Planned Parenthood clinics currently can’t provide surgical abortions, because Arkansas requires that our facilities be outfitted comparably to a hospital surgical center. I’m legally required to hand out pamphlets filled with falsehoods about how the mifepristone pill, which ends a pregnancy, can be “reversed.” My patients sit through 48-hour waiting periods and mandatory follow-up visits, which impose costs — gas money, time off from work, overnight stays, child care — that many can barely afford.

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Reading Ho’s op-ed, where she is confronted with anti-abortion bias at every step of her training and schooling, and then subjected to harsh and expensive TRAP laws as a provider, it’s easy to see why so many doctors would, or are perhaps forced to, pursue different specialties. The list of states in America which only have one abortion clinic is growing and as of 2014, 90 percent of U.S. counties had no clinics providing abortions. But TRAP laws are just one part of the growing provider shortage; in a study of 190 residencies done in 2018, 64 percent of directors reported that that abortion training was routine, 31 percent reported it optional, and 5 percent reported that it wasn’t even available.