Jul 1, 1970 - critical social issues involved in abortion. New York State Physicians and the. Social Context of Abortion. Introduction. In medical care the ...
Attitudes toward the liberalized abortion law in New York State were assessed among obstetrician-gynecologists in the state. This paper presents findings on various issues and relates them to a number of variables. In general, the New York State practitioners were found to favor the new law and to take a rather liberal view of some critical social issues involved in abortion.
New York State Physicians and the Social Context of Abortion Introduction In medical care the opinions of specialists are preeminent when they focus upon issues related to their practice. This paper examines one of these instances: the social context of abortion services as seen by New York State ob-
stetrician-gynecologists. The potential influence of obstetrician-gynecologists on the functioning of the New York State abortion statute was made explicit in the Act itself. In the legislation it was stated that abortions could only be performed by licensed physicians. Because of medical specialization this stipulation was tantamount to placing obstetrician-gynecologists in a sanctioning role vis-a-vis the new law. The recent public discussions of abortion by groups advocating various policy positions on abortion have highlighted the complexity of this social problem, however. The New York State experience has provided an opportunity to understand obstetricians' attitudes and their relationship to abortion performance. The New York State obstetricians' views partially explain the volume of abortions performed under the law's first year. This paper explores these relationships.
Background On July 1, 1970, the new liberalized abortion law became effective in New York State. The law permits a woman to have an abortion up to the 24th week of gestation, when performed by a duly licensed, consenting physician. It does not specify where the abortion should be performed (i.e., in a hospital or in a doctor's office) nor does it set up any residency requirements. Before the law came into effect, there was very little concrete information upon which to base predictions about how the law would actually function, although there was considerable speculation. For instance, it was widely thought that the demand for abortions would put great stress on available facilities. For this reason, Dr. Robert Hall,' a leader in the movement to reform the old New York State abortion law, as well as others, was strongly against permitting abortions to out-of-state residents. However, demand for abortions was met in spite of the fact that of the close to 200,000 abortions done between July 1, 1970 and July 1, 1971, more than half were done for out-of-state
residents.2 Prior to July 1, 1970 there was widespread concern regarding the attitudes of obstetricians toward the new law. 144
AJPH FEBRUARY, 1973, Vol. 63, No. 2
Sylvia Wassertheil-Smoller, Ph.D.; Raymond C. Lerner, Ph.D.; Charles B. Arnold, M.D.; and Susan L. Heimrath, B.S. Since the law would primarily be implemented by the obstetrician-gynecologists of the state, their general attitudes toward various provisions of the law, and their experience with various abortion techniques could be expected to have a bearing on the functioning of the law in New York State, and also in other states planning revisions of their own abortion laws. In order to assess physicians' opinions regarding abortion issues, a two-part survey was done of a 50% panel sample of all obstetrician-gynecologists in New York State. The physicians were interviewed first in July 1970 at the inception of the law, and again in January 1971, after six months experience with the law. (See 9 for detailed discussion of methodology). In addition to issues primarily relating to medical aspects of abortion, such as complication rate, preference for and prior experience with various abortion techniques at different gestational ages, preferred sites for abortion, professional opinion on the maximum gestation age for abortion, and so on, the survey also collected data on the social context within which abortion would take place. What were physician attitudes and opinions at the inception of the law and after six months' experience? Would many of them, influenced by religious belief, refuse to perform abortions? How did different subgroups of physicians view the adequacy of their local resources to meet the abortion demand and what was their collective stand for the desirability of the government paying for abortions for women who could not afford it? Other questions of interest included opinions on abortions for out-of-state residents, views on contraception for women post-abortion, views on the need for counseling women having abortions. It should be noted that a great deal of literature on therapeutic abortion emphasizes psychological hazards such as depression and guilt feelings, although considerable evidence to the contrary comes to us from abroad.3-5 While results regarding various other aspects of this study have been presented elsewhere6-8 this paper will concentrate on the issues noted above, relating to the social context of abortions.
Method
Results
For the first round of the survey in July, 1970 a 50% sample (every other name) was drawn from the American Medical Association tape-file of all 3,000 physicians in New York State with a primary interest in obstetrics and gynecology. A number were found ineligible due to death, retirement, or no longer interested in obstetrics, reducing the sample to 1,374. Of these 10.1 % could not be located and 6.4% refused to be interviewed. The number of physicians surveyed in the first round was 1,146 which represents 83.4% of those eligible to be interviewed by the original sample. For the second round six months later, the panel of 1,146 were again contacted. This time 996 of the original group responded to the interview. A comparison of the 996 physicians responding on the second round with the 1,146 responding on the first round showed that the demographic composition of the two groups was similar. An analysis of the 150 non-respondents in the second round with respect to the attitude toward abortion they had expressed on the first round indicated that their attitudes paralleled the initial sample group surveyed on the first round9 i.e., the loss of this group of 150 on the second round did not bias the overall results. The pre-coded questionnaire forms were edited, keypunched, and merged with the demographic data on each physician from the AMA tape-file and analyzed at the Albert Einstein College of Medicine Computer Center.
Physician Profile
Attitudes Toward Abortion Law and Willingness to Pefform Abortions At the inception of the law in July 1970, a large majority (73%) of the obstetrician-gynecologists in New York State were in favor of the law or in favor with some qualifications.8 The qualifications primarily concerned the provision of the law which allows abortion up to the 24th week of gestation. These attitudes were generally stable over the six-month period with a very slight increase in average favorability from 73% in June 1970 to 76% January 1971. There were however, wide variations within different subgroups of physicians. The variables which most strongly affected attitude toward the abortion law were the religion of the physician and the region of the state in which he lives. Table I shows attitude toward the abortion law in January 1971, by religion and region of state. Virtually all of the Jewish physicians (98%) a vast majority of the Protestants (84%), and a surprisingly large proportion of the Catholics (39%) favored the law. Particularly favorable toward the law were physicians in New York City, (82%) and least favorable were those in Upper New York State (62%). This regional variation is especially apparent among the Catholic physicians: 50% of the New York City Catholics were in favor of comparison to 29% of the Catholic physicians in Upper New York State. But perhaps more important than their attitudes toward the law, was the physicians' stated willingness to actually perform abortions, two out of three gynecologists were willing to perform an abortion if requested. The pattern by region and religion was the same as for those in favor.
Before the results of the survey are considered let us look at the composition of this sample, which is representative of the composition of all Ob-Gyn physicians in New York State. With regard to professional activity, 69% of the physicians in the sample are in private practice, 19% are residents, fellows or interns and 8% are hospital staff. The remainder are in other categories. Approximately half of the physicians are board certified in Ob-Gyn and half have no board certification. With regard to the personal characteristics of the physicians, 34% are Jewish, 30% are Catholic, 29% are Protestant and 16% stated they were members of other religions. Only 8% of the physicians are female and 92% are male. Almost three-fourths of the physicians practice in New York City and the surrounding suburbs and only 26% practice in the rest of the state. It is important to investigate the demographic and professional characteristics of the subset of physicians who state they perform abortion. There is a shift in the religious distribution with Jews comprising 47% of this subgroup, Catholics 9%, Protestants 25% and members of other religions 17%. In New York City and its suburbs, somewhat more than half of the obstetricians who state they perform abortions are Jewish while in the rest of the state, 58% of the obstetricians who state they perform abortions are Protestant. Among Jewish physicians who state they perform abortions, two out of three are board certified in comparison to one out of three among Catholic physicians. This implies that the Catholic physicians who state they are performing abortions are more likely to be general practitioners or residents.
Opinions Regarding Adequacy of Local Resources to Meet Abortion Demand Since there was concern about the possibility of hospital facilities being inadequate to meet anticipated demand for abortion, we asked the following question: "'Do you believe the hospital and clinic resources in your county are sufficient or insufficient to handle the demand for abortion?" In July 1970 only 43% of the physicians thought local resources would be sufficient. By January 1971, 68% thought they would be sufficient. Thus the original pessimism was unwarranted. However, perhaps the more relevant issue here concerns the opinion of those physicians actually performing abortions. Of those physicians who stated they were willing to perform abortions 68% thought, in January 1971, that resources would be sufficient. There were variations in opinion by demographic characteristics of the physicians, the most important of which are shown in Table 2, which refers to the January 1971 views of those physicians who stated they were willing to perform abortions. As shown in Table 2, physicians in New York City and its suburbs were slightly less optimistic regarding adequacy of local resources than those in the balance of New York State. The city physicians undoubtedly expected that patients from out-of-state and from upstate would flock to New York City for abortions. Among board certified obstetricians resources were considered less of a problem than among those not board certified, and physicians in proprieSOCIAL CONTEXT OF ABORTION
145
Table 1Favorable1 Attitude Toward the Abortion Law and Willingness to Perform Abortions by Religion and of New York State (January 1971)
Region
TOTAL
favor law
will perform
(N)
% of N will favor law perform
(N)
% of N
(N)
% of N will favor law perform
76 71
( 26) ( 96) (100) ( 32)
100 29 78 84
81 11 75 56
64
(256)
62
50
Jewish Catholic Protestant Other
(222) (140) ( 62) ( 92)
99 50 89 86
93 30 93 82
( ( ( (
88) 61) 38) 17)
97 30 92 88
93
Total
(531)
82
74
(209)
75
Total
Upstate New York4
New York City suburbs3
New York City
11
(N)
% of N
law
will perform
(336) (297) (200) (141)
98 39 84 86
93 20 81 76
(996)2
76
66
favor
row sum
1 The favorable responses include physicians who indicated they agreed with the law and those who agreed with the law with some reservation. Similarly, those stating willingness to perform abortions also includes physicians who were willing to perform abortions with some reservation. 2
The row and column sums are different because 22 physicians did not indicate their religious
preference.
City Suburbs include Westchester, Nassau and Suffolk counties. 4 Upstate New York includes all of New York State except New York City and suburbs.
3 New York
Table 2-Physicians' Attitudes Regarding Local Medical Resources for Abortion and Attitude on Abortion for Out-of-state Residents (January 1971)
(Total N)1
sufficient
% of N who were in favor2 of abortions for out-of-state residents
(393)
64* 72 76
88 87 73*
(162) (1 o)7)
66 71 77* 59*
90* 78 77 86
(3419) (30)6)
77* 58
87 83
( 6;2) (504) ( 7r5) (6555)
69
85
71 55* 68
86
% of N who believe resources were
Variable
Region of State New York City
(166)
Suburbs Upper New York State Religion Jewish Catholic
( 96) (312)
( 59)
Protestant Other
Board certification in ob-gyn Board certified Not board certified Primary hospital affiliation Proprietary Voluntary Government Total3
80 85
performed abortions are included. 2 Includes those in favor with some qualifications.
1
Only those physicians who
3
Column totals are not all equal because recorded here.
I
some
physicians
did not
P
