Beyond Abortion: Medical Injustice Should Be Our Focus

By Jalan Washington, RH Reality Check. Posted April 14, 2008.

Originally posted at RH Reality Check.

I chose to study medicine because it provides a unique vantage point for both studying and working to solve urgent problems facing marginalized populations such as adolescents.

As a teenager growing up in Buffalo, a city which unbeknownst to me had one of the highest teen HIV and pregnancy rates in the country, knowing how to avoid pregnancy was an issue of the utmost importance. In spite of the evidenced sexual experimentation of my peers, students at my high school were offered a poorly planned "health and nutrition" class taught by our arrogant and uninterested gym teacher. Outdated texts and grisly pictures of untreated sexually transmitted infections were used to scare us into not having sex. Few adults would talk honestly and openly about sex, sexual pleasure, and protection, and coupled with the widely used "wait until you get married" mantra, this created an environment in which sex was shrouded in mystery, shame, guilt, and confusion.

This is a fate that I am working diligently to help subsequent generations avoid.

But since starting medical school, my frustrations with the lack of widespread action to address many of the educational, social, and economic determinants of health have grown tremendously. Hearing bleak statistics about Black and Latino health is a commonplace, routinely accepted, and unquestioned part of the American medical landscape. Very seldom do our discussions then proceed to the ways in which health care providers and the medical infrastructure directly contribute to these trends. Although attempts are made to incorporate cultural competency and social analysis into our first and second year curriculum, our schedules are so full of basic yet complex molecular and physiological science that questions that cannot be answered in multiple choice format become torture. Medical school, I have quickly discovered, is not for the faint of heart; analyzing medical injustice too much or empathizing too strongly becomes problematic and overwhelming when faced with 500 pages of notes to memorize.

As a pro-choice medical student, I have sought out forums and organizations that work to provide social critique, analysis, and some form of action. However, I have found myself exceedingly frustrated with the major medical sexual and reproductive rights movement. This movement should be comfortable taking a bold stance for comprehensive reproductive health options, including sexual health education and contraception, and remaining sensitive to social factors that compromise individuals' choices and rights. But the prominence of abortion in the medical provision of reproductive health care is an issue that has provided considerable discomfort for me. This focus on abortion can obscure, for example, the necessity of providing judgment-free sexual health care and education. It can allow us to forget our obligation to move beyond cultural awareness toward cultural competence and socially-aware health care professionals. The focus on technologically-centered solutions can allow us to ignore the need for worthwhile employment and living wages for all Americans that allow families to thrive and function.

Medical school, by nature, often strips out a deeper social analysis when examining the health outcomes of different communities. The pro-choice, reproductive rights movement within medical schools should always ensure that it is sensitive to patients' socioeconomic realities and is responding to the full range of individuals' reproductive health needs. It is my belief that without a spectrum of options and the determinants to support our decisions, there is no real choice.

Although I think abortion should not be given a preeminent focus in reproductive rights and health care, the dwindling and dangerously low number of health care providers that have been trained to provide abortions is alarming and requires immediate action. Abortion training is an endeavor that interested students must seek out on their own because the overwhelming majority of medical schools do not provide any formal training. The lone reproductive rights organization at my school, Medical Students for Choice, works to increase the number of medical students trained in abortion provision. Although important, I feel that this focus is limiting because abortion is such a polarizing and emotionally-charged topic. I remain one of a handful of students of color who is actively involved and I strongly believe that there would be more widespread support and involvement if other equally important issues such as contraceptive access became the focal points of action in addition to abortion.

Ultimately, my goal as a future physician is to be able to provide a broad range of affordable and accessible contraceptive options including abortion. I am dedicating my life to empowering young women and men with honest, reliable, and scientifically-based information about their bodies and their sexualities so that they can make the best decisions for themselves and their communities free of shame, guilt, and fear.

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Jalan Washington is a first year medical student at The George Washington University School of Medicine. She holds a Masters Degree in Health Promotion from the Department of Sociomedical Sciences at the Columbia University Mailman School of Public Health. She is deeply committed to issues affecting the health of marginalized populations and has worked on various projects focusing on the reproductive health of underserved adolescents of color. She became active with the Advocates for Youth (AFY) Young Women of Color Leadership Council during college and remains active as a member of the Board of Directors.

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