Willing and Unable: Doctors' Constraints in Abortion Care [Paperback]

Lori R. Freedman (Author)

Book Description

Publication Date: August 9, 2010 | ISBN-10: 0826517153 | ISBN-13: 978-0826517159 | Edition: 1

Willing and Unable explores the social world where abortion politics and mainstream medicine collide. The author interviewed physicians of obstetrics and gynecology around the United States to find out why physicians rarely integrate abortion into their medical practice. While abortion stigma, violence, and political contention provide some explanation, her findings demonstrate that willing physicians are further encumbered by a variety of barriers within their practice environments.
Structural barriers to the mainstream practice of abortion effectively institutionalize the buck-passing of abortion patients to abortion clinics. As the author notes, "Public-health-minded HMOs and physician practices could significantly change the world of abortion care if they stopped outsourcing it."
Drawing from forty in-depth interviews, the book presents a challenge to a commonly held assumption that physicians decide whether or not to provide abortion based on personal ideology. Physician narratives demonstrate how their choices around learning, doing, and even having abortions themselves disrupt the pro-choice/pro-life moral and political binary.

Editorial Reviews

Review

"...a well written investigation of the reasons behind the shortage of abortion providers and an infomative read for anyone contemplating how to change the current system."
--Family Medicine

A Choice Outstanding Academic Title of 2011

"Freedman provides an historical context for the relationship between abortion and American medicine and details what she has termed as "the institutional buck-passing" that has marginalized abortion practice and isolated it to free-standing clinics."
--Conscience

"Book of the Week ... Why don't more OB/GYNs do abortions? Lori Freedman's new book, Willing and Unable, is the most thorough answer yet to that question."
--Emily Bazelon, XX Factor, Slate.com

"Whether pro-choice or pro-life, readers will benefit from the authentic face that Freedman provides for this sociopolitically charged topic... Highly recommended."
--CHOICE

"This is a finely crafted and emotionally moving study which both documents and provides a persuasive explanation for the precarious nature of abortion provision in the United States today. The book will make an excellent addition to the required reading lists not only for courses in health & medicine and sex & gender, but for courses in work & organizations, social conflict, and social movements as well."
--Lyn H. Lofland, Research Professor of Sociology, University of California, Davis

"It should be of greatest interest to those considering obstetric careers, those involved in medical education, and advocates on either side of the abortion question."
--World Medical & Health Policy

"A shortage of abortion providers is one of the greatest challenges facing the abortion rights movement today. In this well-researched and gracefully written book, Lori Freedman perceptively explores the reasons for this shortage, with the threat of violence being only one of several contributing factors. Willing and Unable is a must-read for anyone who wants to understand the complex status of abortion provision in contemporary American medicine"
.--Carole Joffe, author, Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients and the Rest of Us

"Lori Freedman's qualitative research is critical to understanding why only half of ob-gyns who intend to do elective abortions when starting residency actually offer them for patients once in practice. The depth and sophistication of her analyses make her findings especially profound and will shake this area of research, abortion training and provision, to its core. What she has uncovered--the complex ways stigmatization affects ob-gyns in practice--will inform many people and programs in reproductive health research, medical training, and the reproductive rights movement. With these insights, we will be better able to help ob-gyns overcome obstacles to provision in practice. We will also better understand where in medicine and medical practice we can focus our efforts of mainstreaming abortion."
--Jody Steinauer, MD, Research Director, Kenneth J. Ryan Residency Training Program in Abortion and Family Planning, University of California, San Francisco, and Founder of Medical Students for Choice

From the Inside Flap

The limited choices of pro-choice physicians in their practices

See all Editorial Reviews

Product Details

• Paperback: 200 pages
• Publisher: Vanderbilt University Press; 1 edition (August 9, 2010)
• Language: English
• ISBN-10: 0826517153
• ISBN-13: 978-0826517159
• Product Dimensions: 6 x 0.6 x 9 inches
• Shipping Weight: 10.4 ounces (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #1,050,200 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

5.0 out of 5 stars From the mouths of docs December 26, 2012

By PHgeek

Format:Paperback

I read the article that was based on Chapter 6 in the Journal of Public Health, "When There's a Heartbeat," which led me to Ms. Freedman's book. In my job, I collect data on and provide support for families who have experienced an infant or fetal death, so I am no stranger to the medical imperative for some abortions or the challenges of obtaining one when needed, especially in a Catholic healthcare system. Interviews with family members are a large part of the data collection process I use, so I appreciate the power of the doctors' stories in Willing and Unable. I also appreciate that Ms. Freedman went into her research with a bias that she is honest about and that listening to the experiences of the doctors enlightened her to alter her hypothesis. Hopefully, readers will be similarly enlightened. Anyone who is passionate about the human right to access reproductive health services can very easily place blame: on politicians, consumers, healthcare administrators, the providers themselves -- but this doesn't always lead to constructive solutions to the problem. Because Ms. Freedman is sensitive to the realities the doctors face, she ends the book with some concrete and practical suggestions that advocates can use. Although the book is based on interviews meant to answer specific questions around access, it is appropriate for readers from across the political spectrum. Willing and Unable explains the complex circumstances around medically indicated abortions in lay terms, which is all but missing from the political debate for that very reason: it's too hard to explain to the general public in a sound bite. Willing and Unable gently pulls the often heated discussion around abortion in the direction of science and medicine, a good place for it to be.

5.0 out of 5 stars Fascinating Book! November 13, 2012

By Drew

Format:Paperback

This book advances both medical sociology and the sociology of reproductive health by examining the constrained choices of doctors who have been trained to provide abortions but face numerous barriers to doing so. It richly examines how they deal with stigma, professional sanctions, practice rules against abortion provision, and declining autonomy in the era of managed care. This is the first work to take on this subject in depth. It is a brilliant account of the many ways in which antiabortion activism and "medicine as a business" combine to restrict abortion access. It combines gripping interview data with clever analysis and an engaging writing style.