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This summer, advocates for women's reproductive rights quietly expanded abortion options and training in Utah.

In July, the University of Utah joined a national program to train physicians in contraception and abortion techniques. And in August, Planned Parenthood of Utah started offering first-trimester abortions, becoming the state's fourth provider.

Supporters say the need for expanded training has been highlighted by a botched abortion in Maryland by Utah doctor Nicola Riley. Maryland's medical board suspended her license in August, accusing her of endangering patients' safety.

Riley, who also provides abortions in Utah, still has her local medical license. She declined comment through her Baltimore-based lawyer.

"There are bad people in every profession," said Karrie Galloway, CEO of Planned Parenthood Association of Utah. "That's why it is so important that we have training programs … so that medical students and post docs have the skills and the training to provide the best care possible."

Still, Galloway is nervous about publicity and said she fears protests in front of her clinic.

And she and others anticipate backlash in January during the 2011 legislative session. Many lawmakers are eager to restrict abortion, and they can exert control over the state-owned U.'s medical school and hospital.

An expanded role • Even though Utah has one of the highest birth rates and lowest abortion rates in the nation, supporters say the moves are necessary to ensure women continue to have access to safe abortions.

Hospitals provide only medically necessary terminations. Just a handful of doctors regularly provide elective abortions in the four clinics in Salt Lake County.

People have long assumed the nine Planned Parenthood clinics in Utah already provided abortions, since it is the state's most vocal advocate for keeping abortion safe and legal. Instead, they had long made referrals to abortion clinics.

Galloway said the organization also had helped manage one of Utah's abortion clinics. But another provider wasn't needed until now, she said.

"We're there because we need to be good at it. We need to be able to pick up when anyone else slows down."

Planned Parenthood also wanted to expand services offered at its Salt Lake City clinic, including birth control and screenings for sexually transmitted diseases and cancer. Demand for the low-cost care has been growing 10 percent to 15 percent a year.

In opening the new Metro Health Center, 160 S. 1000 East, Galloway took advantage of a pot of money available to add abortion services. The Consortium of Planned Parenthood Abortion Providers gave the Utah clinic an undisclosed amount.

"I'm really proud of where this whole process has brought Planned Parenthood of Utah to be able to do full comprehensive reproductive health," Galloway said.

Few providers • Some estimates put the number of physicians who regularly perform elective abortions in Utah at four. Riley is one of them, and her license is likely under review by Utah's licensing board, which will not comment. Two others are nearing retirement — including 69-year-old Madhuri Shah, who has been terminating pregnancies in Utah since the late 1970s.

She planned to retire in December, but expects to wait until next year while she seeks someone to take over her Utah Women's Clinic.

Performing about 2,000 abortions a year, the Salt Lake City clinic carries out more than 50 percent of all terminations in Utah. And it's the state's only clinic that offers second-trimester abortions, defined as up to 20 weeks from the last menstrual period. About 200 to 300 pregnancies are terminated in the 15th to 20th week of gestation each year.

Shah said only she and another Utah doctor are trained to offer second-trimester abortions.

"We need at least two providers. At least, if not more," she said. While Utah women could travel out of state for late-term elective abortions, she doesn't want to add to their burden.

"The person who is already stressed out with their situation, to go out of town, that adds to the cost and stress."

'The difficult cases' • The U.'s hospital performs abortions only when a woman's life is in danger or a fetus suffers fatal anomalies.

But the U. requires obstetrics and gynecology residents to know how to end pregnancies at any gestation since managing failed pregnancies is part of the job.

"People come in every day to the E.R. miscarrying. They need to be managed; they are hemorrhaging," said Kirtly Parker Jones, a professor and vice chair for educational affairs at the U.'s Department of Obstetrics and Gynecology.

Residents who choose to learn about and perform elective abortions work at Shah's clinic, and now at Planned Parenthood.

And this summer, the U. became part of a national pipeline training doctors in abortion, adding a Fellowship in Family Planning designed for post-residency physicians.

As one of 21 universities — including Harvard Medical School and Johns Hopkins University — chosen by the University of California San Francisco's Bixby Center for Global Reproductive Health, the U. will select a fellow each year to train in family planning and abortion clinical skills and research.

UCSF doctors helped mobilize the medical community in the 1960s to make abortion legal. Its research has contributed to the use of medications and surgical techniques to end pregnancies and the use of over-the-counter emergency contraception.

Jones, co-director of Utah's fellowship, says the U. sought the "prestigious" fellowship to improve women's care.

"Every woman will have a time in her life when she doesn't want to make a baby," she said. For women who choose elective abortion, "it is their right to do so. Doing it in a way that is safe for the mother and future pregnancies is something those of us nationally feel is important."

Declining to name the fellow, Jones said the woman will provide elective abortions but will get most of her abortion-related experience at the U. and Intermountain Medical Center by ending high-risk pregnancies.

"We're interested in making sure our family planning fellows develop the expertise to be those people in their communities who do the difficult cases, the cases where they don't have a choice but to end the pregnancy," she said. "How it's done makes a difference."

Aiming for prevention • Still, Jones said the U.'s primary interest is in contraception research.

As part of the fellowship, the U. created a contraception clinic for "high-risk" women — those with serious conditions, such as congenital heart defects and uterine anomalies, that can lead to death during a pregnancy.

These women don't want to get pregnant by accident, Jones said, making easily available but easily misused birth control pills and condoms a bad choice.

Instead, the U. clinic offers long-acting but reversible contraception — such as rods that release a hormone to suppress ovulation and last three years, or intrauterine devices that affect sperm movement and alter the lining of the uterus and work for up to 12 years.

"They need a method they don't have to think about," Jones said.

No state money funds the fellowship, Jones said. Instead, she said, the Bixby Center provides the U. with $100,000 a year to pay for the fellow's research, travel, education and salary at the medical school. Jones said the U.'s inaugural fellow will be doing research to develop better spermicides.

"The political … part of the fellowship, which people want to write about, is the abortion provision," Jones said. "That's only part of what it's about." Doc accused of botching an abortion

Now • Utah doctor Nicola Riley, accused of botching an abortion in Maryland, was flying to the East Coast every other week to perform abortions — and develop a work history — to gain custody of her children. Read more about Riley online. > —

Utah abortion doctor loses Maryland license

Utah doctor Nicola Riley, accused of botching an abortion in Maryland, was flying to the East Coast every other week to perform abortions — and develop a work history — to gain custody of her children. Read more about Riley at —

Two notable Utahns in family planning

Notable Utahns in the national reproductive choice field include the following:

• Physician Kirtly Parker Jones, a University of Utah professor of obstetrics and gynecology who works on issues including contraception, advanced reproductive technology and menopause, was recently awarded the Alan F. Guttmacher Lectureship by the Association of Reproductive Health Professionals.

• Physician David Turok, also a U. ob-gyn professor, is scheduled to be a featured speaker at the Medical Students for Choice Conference in Chicago this December. Turok recently analyzed Utah's abortion and birth rates and use of emergency contraception. He linked the explosion in the use of emergency contraception to a 3 percent reduction in the birth rate and 6 percent drop in the abortion rate between 2000 and 2006. The student organization's goal is to "create the next generation of abortion providers and pro-choice physicians," according to its executive director, Lois Backus. The group held its annual meeting in Salt Lake City last year, attracting 344 participants with lectures on contraception counseling and hands-on abortion training. "Although it's a conservative community and a conservative state, it is a fairly good environment for learning [about] family planning," Backus said. —

Utah abortion providers

There are four clinics that provide elective abortions in Utah. All are located in Salt Lake County. Only the Salt Lake City Utah Women's Clinic provides abortions up to 20 weeks gestation. The other clinics — Planned Parenthood's Metro Health Center in Salt Lake City, Mountain View Women's in Holladay and Wasatch Women's in Millcreek — offer up to 14 weeks. Hospitals rarely offer abortions and only when they are medically necessary.