Teacher, Provider, Activist
When Dr. Carolyn Westhoff, Medical Director of Columbia University’s Family Planning Clinic, went into medicine more than two decades ago, she already had an interest in reproductive health. “There wasn’t any reproductive health education in my medical school, so I created my own fourth-year elective at Planned Parenthood. My residency program didn’t have any abortion training, so I moonlighted in an abortion clinic to get experience.”
Early in her career, Dr. Westhoff faced skepticism about her choice to pursue family planning (ob/gyn). “Initially people didn’t understand why a smart person would do this,” she says. “They thought it wasn’t intellectually challenging enough. I guess I never believed that. I am still convinced that this is completely interesting and completely worthwhile, and in my local environment people are no longer telling me that my work is boring.”
It was this attitude, as well as a revelation about the scarcity of abortion training, that led to Dr. Westhoff’s work to expand the abortion program at Columbia University. “Even though I was very pro-choice, I wasn’t providing or teaching in practice. Then in the early 1990s I was asked to give a presentation about the teaching of IUDs at an international conference. Because there was no existing information, I carried out a survey of residency programs in which I also asked about abortion. I was stunned as the results came in to find out that almost no one was doing any abortion training. I realized that it wasn’t enough to be pro-choice; I had to do something about it.”
A founding member of PRCH, Dr. Westhoff is a Professor of Obstetrics and Gynecology and Public Health at Columbia University, where she runs a fellowship in Family Planning Clinical Care and Research. As Medical Director of Columbia’s Family Planning Clinic, she oversees the care given during 20,000 patient visits each year. Dr. Westhoff is also a chair of the Medical Advisory Committee of Planned Parenthood of New York City and co-chair of the American Medical Women’s Association’s Reproductive Health Initiative.
Columbia now offers information about contraception and abortion in every year of medical school, and all residents have routine abortion training in their second year of residency. “We’re hoping as we continue to develop our abortion services here we’ll have a setting where all the third-year students during their ob/gyn clerkships will automatically spend one day in an abortion unit,” Dr. Westhoff says. “We’ve really been able to incorporate a lot of training over the last few years.”
Dr. Westhoff’s program teaches all types of abortion, including manual vacuum aspiration (MVA) and mifepristone. She praises the former for its ability to make providing less formal and more accessible. “The great thing about MVA is that it can be used in a regular office setting on an occasional basis and there’s a small amount of equipment needed, so you can always have it available. MVA may be particularly useful for the once-in-a-while provider.”
This program is not without its growing pains. “The institution has been incredibly supportive, but this is just a complicated time in medicine,” she says. “It’s like doing a Rubix cube, we need to twist and twist lots of interconnected parts perfectly to get to the solution. In contrast to people in other parts of the country, I’m living in a very liberal and tolerant environment. Still, there’s a lot of retrenching and increasing bureaucracy. There are managed care barriers, financial barriers, regulatory barriers. These create extra layers of work between identifying a problem and getting to the solution.”
In light of these inevitable complications, Dr. Westhoff has become a champion of physician activism, the hallmark of the PRCH member. “You have to be driven to get something done. I’m glad when people are pro-choice, but it’s another step to go beyond that and provide the care or increase access. Activism is a different way of thinking about things. Most doctors care deeply about taking care of their patients, but sometimes you have to take a giant lateral step to get into activism.”
“Enthusiasm is so important,” Dr. Westhoff says. “I’m astonished that people are so quick to be intimidated. It’s just ridiculous. I’m taking care of my patients. I spend a lot of time trying to prevent problem pregnancies, and when that does happen I deal with it. I don’t feel an intellectual need for the argument. I know that it’s not possible to provide perfectly accessible and effective family planning to everybody all the time.”
Most of all, Dr. Westhoff stresses the dedication required to keep access to care available. “I think in the long run you can turn things around by being committed and enthusiastic. I’m a big believer in doing what’s going to work. Don’t get stuck on the biggest or hardest problem–start with a small one. Then it’s possible to make things happen. I was interested in this as a college student, and I just stayed with it. It takes a long time to have an impact. Sometimes you have to dedicate a whole lifetime to making things happen, and that’s okay.”
Physicians for Reproductive Health honored Dr. Westhoff with the William K. Rashbaum, MD, Abortion Provider Award in 2010.