Jill Clements was 37 and living in downtown Wichita when she found herself unexpectedly pregnant for the second time in her life. Her first abortion, three years earlier in 2010, had been a disaster: Alone and broke, Clements had driven 250 miles through a blizzard to get to a Planned Parenthood. Not wanting to relive the experience, she reached out to her primary-care doctor with the hope he could refer her to a local ob-gyn to terminate her pregnancy, then only six weeks along.

Wichita was—and still is—politically conservative. In 2009, an anti-abortion extremist assassinated one of Wichita’s most prominent abortion doctors, Dr. George Tiller while he attended church just a few blocks from Clements’ apartment. Still, she was hopeful that she’d be able to find someone competent and close to home to perform her procedure. Her primary care doctor referred her to an ob-gyn nearby—but only after saying “maybe this baby is God’s plan for your life,” according to Clements.

At the OB appointment, things took a turn for the worse. After performing an ultrasound and a pelvic exam, the doctor left the room and returned with a nurse who presented her with a stack of pamphlets. “We understand you are considering adoption,” he said.

At first, Clements was too stunned to speak. “I hadn’t breathed a word about adoption to anyone, and that wasn’t at all what I was considering,” Clements says. “But they were acting like it was the only option I had.”

Clements left the office quickly and started researching, eventually finding a female doctor who she hoped would understand. But when she showed up for her appointment a few days later, she was again disappointed. “She sympathized with me and she listened, but then she shook her head and told me she couldn’t help,” Clements says. The doctor also wouldn’t refer her to another doctor in the area who would perform the abortion, she adds. “Looking back, I think she was scared. It had only been a few years since Dr. Tiller’s murder, and I can’t imagine that it wasn’t on her mind,” Clements says. “She seemed like she wanted to help me, but in the end, she didn’t.” Sobbing, Clements left her office and went home.

A Common Problem

Across the country, patients like Clements request abortion services from their ob-gyns and are routinely denied. In a recent survey from the journal Obstetrics & Gynecology, researchers found that although the majority of ob-gyns have encountered patients seeking an abortion, only 24 percent of them actually perform the procedure themselves.

A major contributing factor: they aren’t being trained. One 2013 survey found that out of 161 physician residency programs across the United States, only half provided abortion training as part of their standard curriculum. (Some programs have “opt-in” abortion training.)

In some cases, doctors are outright barred from learning or performing the procedure. A 2016 report from the ACLU found that 1 in 6 U.S. hospital beds fall under the rule of directives from Catholic hospitals, which “prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments, and abortion, even when a woman’s life or health is jeopardized by a pregnancy.” In some states, more than 40 percent of hospitals have to abide by these rules.

That’s part of a deeper issue: Abortion care is often viewed as separate from mainstream medicine, a view that’s been percolating since abortion was legalized in 1973, says says Lori Freedman, Ph.D., a researcher studying reproductive health care access at the University of California San Francisco and author of Willing and Unable: Doctors’ Constraints in Abortion Care.

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