The Challenges of Modern Abortion Care

In years since Roe v. Ward abortion care has evolved in response to changes affecting healthcare more broadly (Halfmann 2012). Features of this newer model of healthcare provision, which is heavily influenced by managed care, include a strict division of job duties, practices that maximize efficiency and revenue, and organizational cultures that prioritize doctors’ authority and expertise but also strive to meet the demands of insurance and state reimbursement structures. Scholarly and public attention have most often focused on the doctors who perform abortions. Yet one of the key changes wrought by the reorganization of medical care more generally has been the growing role of medical assistants in the provision of abortion. Medical assistants are increasingly being incorporated into healthcare as they provide less expensive labor than doctors and nurses.These workers, I find, do not have the prior commitment to reproductive rights that doctors and nurses have. Based on 18 months of ethnographic observation at a busy abortion clinic in Southern California, my dissertation addresses how institutional changes have shaped abortion work today and address the following questions: How is abortion both similar to and different from typical healthcare? What are the implications for lower-status workers? I find the modern arrangement of abortion does little to recognize the diverse needs of low status workers nor does it account for the extra emotional work these workers do as they contend with the moral complexities of abortion. I argue that clinics’ efforts to treat abortion as similar to other healthcare procedures ends up downplaying the undeniably politicized aspect of abortion. If we act as if abortion is like any other healthcare service without considering how abortion work is quite different from other forms of healthcare, then abortion work loses an important connection to the politics of abortion. It is a connection, I conclude, that may be particularly important for lower status workers as they make sense of their roles in abortion care