From Israel, With Questions: Learning to do Abortion Care

From Israel, With Questions: Learning to do Abortion Care

By Gabrielle Korn

January 12, 2012

Maayan Melamed, a first-year medical student at The Medical School for International Health at Ben Gurion University of the Negev in Israel, came to Choices Women’s Medical Center in Queens for a three-week externship in Fall 2011. Melamed was born in Heifa, Israel, and grew up both in the U.S. and Israel. After graduating from college in Baltimore, she served in the Peace Corps in the Dominican Republic and then began medical studies in Israel. Gabrielle Korn interviewed Melamed about her experiences at Choices for On The Issues Magazine.

What brought you to Choices Women’s Medical Center

I know I want to work in women’s health as a doctor. In my four years at medical school, I will not be taught about abortion at all. So I wanted to strengthen my education and form a more well-rounded opinion on the subject, and I found this externship through Medical Students for Choice.

What’s the attitude of other medical students towards abortion

It’s split. Nobody’s violently against it. Some conservative students went to the first Medical Students for Choice meeting because they were interested. The spin in the meeting was — this is about abortion; even if you are pro-life or antiabortion, if somebody tries to get an abortion and it [the abortion] fails, you’re going to have to deal with the consequences. A lot people came from that angle.

How you will incorporate what you’ve learned at Choices with your medical school education

Before I came, I wasn’t totally sure exactly what my position on abortion was. I knew that I was pro-choice and I think women should be free to choose. But it’s hard sometimes to morally deal with the details. And I’ve come more to the position that it is a service, and being a service-centered person, I’ve realized that women need to have high quality of care and there aren’t many people providing it. So if I want that to happen, I have to do it myself.

There was a questionnaire for Medical Students for Choice before I started the externship. It had questions like: “Would you feel comfortable giving an abortion under the following circumstances” — not enough money, victim of rape, medical reason and then the last one was “for any reason, it’s a women’s choice.” I answered it conservatively because I wasn’t really sure.

But I’ve been deliberating over the time that I’ve been here. I do think that it is a woman’s right to choose and should be legal regardless of what her reasons are. But there are two people involved in an abortion — a provider and a patient. I think that it’s important to recognize that, and that I’m also there.

For example, we’ve had ethics classes and they emphasize that medical students are at the height of their empathy on the first day of medical school and they pretty much lose it all by the time they graduate. And I don’t want that to happen to me! I really like being empathetic and I think it’s really important in a doctor. And I’m afraid that steeling myself in terms of abortion is part of losing my empathy in some ways.

What is your feeling about how abortion is provided

On the one hand, I feel it’s the woman’s choice, so I should be willing to perform it, no matter what. And then, the other part of me thinks — this is me, too. If I’m performing this and I really don’t agree with her reasoning, what does that make me I want to acknowledge people who are anti-abortion and I understand they feel that life starts much earlier. But I don’t think that, which is why I can be here and can agree with abortions in general. If the patients feel that they need to justify having an abortion, that’s not right either. Maybe she had some other horrible reason she couldn’t talk about. Maybe she was raped. But you don’t know.

I had come in here with the thought that I don’t really like how the abortion system is set up — it doesn’t seem fair to the patient that she had to go to a special clinic where she doesn’t know any of the providers and she’s treated like “you’re just here to have an abortion, and we’re just going to get you in and out.”

It’d be nice if you had your gyno who you’ve known and you can have it be part of regular gynecological procedures. That would just be better care for patients.

What’s the process for getting an abortion in Israel

Basically, you come to the gyno thinking you’re pregnant. She confirms the pregnancy and you tell her you want to have an abortion. She refers you to a committee composed of a different gynecologist, a social worker, and then maybe a judge or social worker. You have to come and verbally explain why you need an abortion. Most of the time, they accept, and you go to another provider, your gyno or the women’s clinic for your health insurance. The committee, from what I understand, is more of a formality in a lot of cases. For example, if you’re not married, you can automatically get through.

A lot of people have criticized the Israeli health care system for having too many abortions in cases of genetic defects. They have one of the foremost genetic institutes and there’s a long story behind that — Ashkenazim are very prone to certain illnesses, Sephardic people are very prone to other illnesses. As one of my friends put it, you put a bunch of people in a shtettle for a couple hundred years, there’s going to be some genetic defects. Culturally, it’s very acceptable for people to have abortions because of genetic defects.

How do you feel about your experience at Choices

I’ve learned a lot. I’ve been able to observe so many different people with their patient interactions. When you’re a med student at the height of your empathy, you have all these ideas about what kind of provider you want to be.

I’ve come to the conclusion that when you’re a provider, everybody has a different style. And I’ve learned by the books that you have to make sure you introduce yourself — we’ve had people tell us to make physical contact with the patient within the first 10 seconds. It’s very specific. But no provider that I’ve ever met employs all of those guidelines. It’s a personal interaction and you can’t necessarily predict who you’re going to connect with and if you’re going to be a good provider.