In spite of the legality of abortion in Canada, many women continue to lack access to abortion services. This is in a large part due to the declining number of abortion providers. Abortion is one of the only medical procedures with a “conscience clause” that allows medical providers to refuse to participate in the care of a patient. Physicians can refuse to perform or refer for an abortion for a variety of reasons and hospitals can refuse that their facility be used for the provision of abortion services. The number of abortion providers has decreased significantly in the last few years. Many providers have retired and many of the doctors who are currently performing abortions are over 50 years old. It is therefore expected that the number of providers will continue to decline. Younger doctors are not always trained in abortion techniques. In fact, not all obstetrician and gynecology residency programs will train residents in abortion procedures. As a consequence, students graduating from medical school have little or no abortion education. The preliminary results of a study conducted by Medical Students for Choice in the US and in Canada found that nearly 40% of the schools surveyed do not teach any aspect of abortion in the pre-clinical years. The same study found that on average, more class time is dedicated to the study of Viagra than to abortion procedures, pregnancy options counseling, and abortion law and policy combined. (MSFC 2003) According to Medical Students for Choice, medical schools in Canada spend an average of less than 1 hour teaching about abortion throughout a four-year curriculum. Of the 10 Canadian medical schools, 3 dedicate fewer than 20 minutes of teaching time to all aspects of abortion. First-trimester surgical abortion techniques are discussed in only half of Canada’s medical schools. This is disconcerting because if new doctors are not trained on the issue of abortion, they will most likely choose not to provide the service. The shortage expands further than physicians. Many nursing programs do not adequately prepare students to care for women having abortions. This contributes to a shortage of nurses who are willing and trained to assist abortion providers. Catholic hospital mergers have also contributed to the lack of training opportunities and to the decreasing number of facilities offering abortion services. (Gallagher) The decrease in hospitals that offer abortion services negatively affects the education of medical students and residents, who receive the majority of their training in hospital settings. (Koyama & Williams) Violence, intimidation and the harassment of abortion providers are also reasons why physicians refuse to start or decide to stop performing abortions. In Canada, three abortion providers have been wounded by gunshots. These attacks in British Columbia, Manitoba and Ontario have all happened since 1994 and have all occurred close to Remembrance Day. This is because the anti-choice movement uses Remembrance Day as a day to “remember the unborn”. After Dr. Hugh Short was shot in Ancaster, Ontario, many abortion providers in the Hamilton area stopped performing abortions. Aside from shootings, there have been many other anti-choice terrorist attacks. In 1992, the Morgentaler’s Clinic in Toronto was firebombed. In 1996, the Edmonton Morgentaler Clinic was the victim of an acid attack. In 1998, a New York abortion provider was shot dead by a man known to Canadian police as the “Remembrance Day sniper". It took until 2002, for perpetrator James Kopp to be arrested. In 2003, James Kopp was convicted of second-degree murder in a state court and received the maximum sentence of twenty-five years to life in prison. The details of his case continue to be reviewed and to this day, Kopp maintains that he was not in the wrong for killing anyone. He continues to try to appeal the court decision that gave him a life sentence. Other cases of violence and harassment targeted at abortion providers continue to happen regularly in Canada and in the US. On top of persuading doctors to stop performing abortions, it also scares medical students from taking training in abortion techniques. Medical Students for Choice also highlights “commitment” as one reason explaining the shortage of providers. According to MSFC, “many of today’s providers are pioneers whose commitment to safe, legal abortion was shaped by having witnessed the effects of botched illegal or self-induced abortions. Younger physicians have not been exposed to the horrors of unsafe abortion.” (MSFC, factsheet). Young doctors don't know what it was like when abortion was illegal. Also, they don't always want to perform a medical procedure that doesn't carry as much prestige or financial reward as some of the other medical specialties. In Canada, abortions must be performed by a doctor and in many hospitals, by an obstetrician or gynecologist. Some groups are starting to explore the possibility of having other health professionals such as midwives and nurse practitioners perform early term abortions. In fact, even the American College of Obstetricians and Gynecologists is recommending that non-physicians be trained to perform abortions. (Gianelli) References: CARAL report, Protecting Abortion Rights in Canada http://www.canadiansforchoice.ca/PDF/caralreport.pdf Diane Gianelli, "ACOG backs training nonphysicians for abortions" American Medical News, Vol. 37, Iss 4, 24 January 1994, p 3, 26. Gallagher J. Religious freedom, reproductive healthcare, and hospital mergers. Journal of American Medical Women's Association 52(2): 65-68; 1997 Medical Students for Choice. Curriculum Mapping Project at the Leadership Training Program. Chicago, IL: MSFC, 2003. Medical Students for Choice factsheet. http://www.ms4c.org/ca_factsheet.pdf Abortion in Medical School Curricula http://www.medicine.mcgill.ca/MJM/issues/v08n02/crossroads/82157.pdf