CHAPTER 9 TEACHING POINTS: BECOMING A PROVIDER

In which setting(s) do you visualize your future participation in reproductive health or abortion care? Do you imagine joining a team that already offers services? Or do you picture starting services on a new site? Do you see yourself adding services in a setting where access is currently limited?
- There are multiple settings in which reproductive health and abortion services may be offered: clinics (community, non-profit, for profit, independent, residency program continuity sites), private doctor’s offices, hospitals, and telehealth organizations.
- You could work on expanding services in your current clinical setting to include the full range of contraceptive options, outpatient miscarriage management, medication and/or aspiration abortion.
- There are many ways to get involved: moonlight at a local clinic, join a practice already providing, get involved in teaching other providers, integrate services into your new practice, or provide services through telehealth.

How will you connect with other providers in or beyond your region?
- Ask faculty mentors to help introduce you to providers in your new area.
- Look online for providers or ask for contacts on one of the listservs.
- Contact one of the organizations listed to help make an introduction, or to become a member.
- Get on mailing lists of state and local pro-choice groups to get involved in local efforts in your community.
- Attend a regional or national conference.
- Utilize community organizations and networks to identify local mentors with shared identities and backgrounds

How do you frame this discussion with potential employers? How would you ascertain if your potential employer is open to offering abortion services?
- Role-playing a discussion with a potential employer may give you maximal benefit from this exercise, in order to consider your comfort with various approaches and possible responses. Specific questions to ask are discussed in the Strategies for Interviewing section.
- Also note that employment discussions and decisions may be especially fraught in the current legal landscape following the Supreme Court Dobbs decision. With the constantly evolving landscape it may be hard to know if abortion care can be ensured as part of a new position.

Consider the importance of community in fostering hope and resilience. Reflect on what knowledge you can share with your patients or your community to empower them.
Community building and knowledge sharing are essential tools to combat the isolation and despair we may feel. By working together, we can create transformative systems of care that benefit everyone. Reflect on:
- Ways to build connections between your area of practice and the community around you.
- How can you foster partnerships with community members or organizations to create safer, more equitable systems of care?
- Reflect on how dreaming and collaborating with others can help combat the fear, anxiety, or despair providers may feel in today’s climate.

To help you prepare, create a list of questions that you can imagine asking in an interview. What information would you want to obtain? How will you address parts of the interview process that will be more challenging for you?

- Get advice from mentors and faculty to obtain different perspectives.
- You will want to understand the scope of your duties and responsibilities.
- Understand the chain of command (Sarfaty 2007, Herbert 2012).
- Role-playing with a trusted mentor or peer may help you prepare.
- Utilize the Abortion Clinic Toolkit for generating interview questions.

^{(Adapted from The Providers Share Workshop, Debbink 2012)}

For most people talking about their work hardly registers as a decision. For abortion providers, doing so always involves assessments (sometimes unconscious) of risks and benefits, for oneself as well as family members. Is there a relationship (e.g. in-laws, colleague) in which you are conflicted about disclosing your abortion work? If so, what are the potential risks and benefits of disclosing or non-disclosing (to the relationship or your community).

For abortion providers, there are additional layers of discrimination given the politicization and polarization of reproductive healthcare (León 2018).
If, when, and how you decide to disclose that you provide abortions is a deeply personal issue that this exercise will help you consider.
Engaging in this discussion with other abortion providers can help foster interpersonal connections, and serve as an effective stigma management tool (Harris 2011).
Reaching out to others in the field can help provide a supportive environment.
Your ideas on this can and will likely change with time and circumstances.

Relationship

Time or Age

Contextual Details/ Consideration

Disclosure

Non-Disclosure

Decision*

Potential Risks

Potential Benefits

Potential Risks

Potential Benefits

EXAMPLE

Adult Extended Family

Now

My in-laws do not know about my abortion work.

They are religiously conservative and anti-choice. I have 2 young children. We are close and rely on their assistance with childcare.

Loss of relationship would be a loss to kids, and loss of family support. Could undermine my work. Risks consequences in their community.

Possibility they accept. Relief from worry about silence, “accidental out- ing”. Extended family could celebrate my successes.

Uncontrolled accidental outing, Persistent strain on re- lations. Not sure I can disclose to kids –moves to a family secret.

Preservation of innocent relationships and tenuous peace in family. Continued ued reliance on them for childcare.

*

D ND

*D = I mostly discuss openly, but sometimes choose not to. ND = I never discuss; the risks are too great

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