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Willing and Unable
Doctors' Constraints in Abortion Care

Author(s): Lori R. Freedman

The limited choices of pro-choice physicians in their practices

Willing and Unable explores the social world where abortion politics and mainstream medicine collide. The author interviewed physicians of obstetrics and gynecology around the United States to find out why physicians rarely integrate abortion into their medical practice. While abortion stigma, violence, and political contention provide some explanation, her findings demonstrate that willing physicians are further encumbered by a variety of barriers within their practice environments.
Structural barriers to the mainstream practice of abortion effectively institutionalize the buck-passing of abortion patients to abortion clinics. As the author notes, "Public-health-minded HMOs and physician practices could significantly change the world of abortion care if they stopped outsourcing it."
Drawing from forty in-depth interviews, the book presents a challenge to a commonly held assumption that physicians decide whether or not to provide abortion based on personal ideology. Physician narratives demonstrate how their choices around learning, doing, and even having abortions themselves disrupt the pro-choice/pro-life moral and political binary.

Biography of Author(s)

Lori R. Freedman is a sociologist at ANSIRH, a program of the Bixby Center for Global Reproductive Health at the University of California, San Francisco.


  • "This is a finely crafted and emotionally moving study which both documents and provides a persuasive explanation for the precarious nature of abortion provision in the United States today. The book will make an excellent addition to the required reading lists not only for courses in health & medicine and sex & gender, but for courses in work & organizations, social conflict, and social movements as well."
    --Lyn H. Lofland, Research Professor of Sociology, University of California, Davis
  • "A shortage of abortion providers is one of the greatest challenges facing the abortion rights movement today. In this well-researched and gracefully written book, Lori Freedman perceptively explores the reasons for this shortage, with the threat of violence being only one of several contributing factors. Willing and Unable is a must-read for anyone who wants to understand the complex status of abortion provision in contemporary American medicine"
    .--Carole Joffe, author, Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients and the Rest of Us
  • A Choice Outstanding Academic Title of 2011
  • "Lori Freedman's qualitative research is critical to understanding why only half of ob-gyns who intend to do elective abortions when starting residency actually offer them for patients once in practice. The depth and sophistication of her analyses make her findings especially profound and will shake this area of research, abortion training and provision, to its core. What she has uncovered--the complex ways stigmatization affects ob-gyns in practice--will inform many people and programs in reproductive health research, medical training, and the reproductive rights movement. With these insights, we will be better able to help ob-gyns overcome obstacles to provision in practice. We will also better understand where in medicine and medical practice we can focus our efforts of mainstreaming abortion."
    --Jody Steinauer, MD, Research Director, Kenneth J. Ryan Residency Training Program in Abortion and Family Planning, University of California, San Francisco, and Founder of Medical Students for Choice
  • "...a well written investigation of the reasons behind the shortage of abortion providers and an infomative read for anyone contemplating how to change the current system."
    --Family Medicine
  • "It should be of greatest interest to those considering obstetric careers, those involved in medical education, and advocates on either side of the abortion question."
    --World Medical & Health Policy
  • "Whether pro-choice or pro-life, readers will benefit from the authentic face that Freedman provides for this sociopolitically charged topic... Highly recommended."
  • "Freedman provides an historical context for the relationship between abortion and American medicine and details what she has termed as "the institutional buck-passing" that has marginalized abortion practice and isolated it to free-standing clinics."
  • "Book of the Week ... Why don't more OB/GYNs do abortions? Lori Freedman's new book, Willing and Unable, is the most thorough answer yet to that question."
    --Emily Bazelon, XX Factor,