Monday, December 7, 2009
Stand-alone or lump-together?
Recently I was talking with someone whom I admire very much as a professional in the field -- someone who was a provider in the past but has done many years of research, education, and advocacy since then. Nearly all of this work has been around abortion, and for reasons similar to my own: abortion is a neglected/marginalized need and until it is not, those who are willing should work for it.
Anyway, this recent conversation involved the time that my friend headed the reproductive health department of a large institution, and the birth defects department "offered" a merger between the two. My friend ended up telling them, essentially, "No, because we'd be addressing birth defects and you still wouldn't be addressing abortion." And that until that attitude changed, "combining resources" was only going to marginalize abortion further. Given the context, it was a risky but wise response.
So, here's what I am turning over and over in my mind -- something I've turned over and over in my mind for a couple of years now, and still haven't satisfactorily decided about: if holistic health care is probably better health care, but everyone else does everything but abortion care, what's the best way to structure your health services, as a provider or organization?
Focus everything on abortion care until a day comes when the need no longer so greatly outstrips availability? Or offer as many health services as possible under one roof, from primary care on down, so as to help normalize abortion care rather than section it off from health needs that are perceived as more "legitimate"? I think there are moral/ethical arguments for each.
There's also the "strategic" question of having limited resources that you might want to focus carefully, or on the other hand of trying to reach out to other providers and other patient populations in order to increase resources -- not just money and space but also, crucially, a support network.
In terms of clinical benefits to the patient, I'm again torn: it seems like specialization would promote a culture of expertise around abortion, but on the other hand integration would promote continuity of care and possibly better whole-person treatment (not sure how to quantify that!).
I know just among the authors of this blog, there are going to be differences of opinion. What do you think, fellow bloggers? And what do you think, readers? Have you worked in an abortion-and-contraception clinic, a women's health center, a sexual health clinic, a private doctor's office, a general hospital, a fertility center, a family health center? What worked, what didn't? If you went into medicine and intended to provide abortion care, are you / would you be a gynecologist or a general practitioner or...? What would your ideal abortion-providing setting be? (Assume it has to be within the medical paradigm, I guess -- but I'd love to hear counterfactual fantasies, too!)