Dr. Eleanor Bimla Schwarz is the Distinguished Professor for Women’s Health for the Society of General Internal Medicine Annual Meeting 2023. Dr. Schwarz is Chief for the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Professor in Residence at the University of California, San Francisco. She is also an Associate Editor for Women’s Health for NEJM Journal Watch, serves on SGIM Council, and is council’s liaison to the Women and Medicine Commission.

Discovering a Passion for Women’s Health

Dr. Schwarz completed her undergraduate and master’s degrees at the University of California, Berkeley. As the oldest of five children, she found that college life freed up time for a variety of volunteer activities. Before the days of Uber or Lyft, she joined the Access Practical Support Network which offered free babysitting and rides to individuals seeking health care. To her surprise, essentially all those seeking practical support were seeking abortion services. Through these experiences, Dr. Schwarz came to recognize that people seeking abortions were often “living very complicated lives, and doing the best that they could.” These experiences inspired her Masters’ thesis titled “Clinic-controlled Factors Affecting Experiences with Abortion,” as the clinics she visited varied in multiple ways. For example, recognizing that most women who seek abortion services are parents, some had toys in the corner of their waiting rooms while others had a sign chillingly stating “children are only allowed in clinic if they are here for a procedure.”

During medical school at the University of California, San Francisco, Dr. Schwarz had a few other memorable experiences. In the emergency department, she met a young woman who had attempted to terminate a pregnancy by inserting a metal coat hanger into her cervix. This experience, at a time when abortion was legal, covered by Medicaid in California, and theoretically widely available in San Francisco, was a powerful illustration of just how harmful stigma can be. Dr. Schwarz resolved that “my patients should never have to feel they must manage such a difficult situation on their own.” This has led her to be proactive in sharing a willingness to help patients get the care they need, and to embrace a non-judgmental approach to empowering patients and supporting them regardless of the choices they make.

Dr. Schwarz completed residency training in primary care internal medicine at UCSF. Deciding during internship that “motherhood was on my bucket list,” Dr. Schwarz gave birth to her first child as a second-year resident. After residency, she joined the UCSF faculty as a part-time clinician educator and then decided to complete a fellowship in Women’s Health Services Research at the San Francisco VA. She then spent close to a decade with a wonderful group of colleagues at the University of Pittsburgh. In 2014, she returned to California to serve as the Medical Director of the Department of Health Care Services’ Office of Family Planning and a professor at University of California, Davis. At UC Davis, Dr. Schwarz led the Quality, Safety, and Comparative Effectiveness Research Training in Primary Care fellowship until 2021, when she returned to UCSF as the chief of general internal medicine at San Francisco General Hospital. A well-respected mentor, Dr. Schwarz continues to foster the growth of the next generation of clinicians and scholars.

Current Projects Improving Women’s Health and Primary Care

Recently, with PCORI funding, Dr. Schwarz and colleagues looked at alternatives to permanent contraception, in particular comparing outcomes between intrauterine devices (IUDs) and tubal ligation among patients with Medicaid in California. They found that IUDs were as effective as tubal ligations at preventing pregnancy and caused less pelvic pain and other side effects. She and her team are currently creating resources to disseminate this important information with funding from AHRQ. “This real-world data is really important for clinical decision-making,” she said. “Tubal ligation should no longer be viewed as the gold standard for pregnancy prevention. Options that preserve a patient’s reproductive autonomy—such as IUDs, which patients can remove themselves – are important when our goal is reproductive justice.”

Future Challenges Facing General Internal Medicine and Women’s Health

Following the Dobbs v. Jackson Women’s Health Organization decision there has been more widespread discussion of abortion. Although 25% of U.S. women have had an abortion by age 45,1 and abortion services are particularly important for women with chronic conditions that increase the risks of pregnancy, national discussions of maternal mortality rarely highlight the relevance of abortion care to general internal medicine. Twenty years ago, Dr. Schwarz found that many general internists were willing to provide medications for abortion,but few had received the training they needed. Unfortunately, this continues to be the case in many residency programs, although there is now free training available.5 In states that have restricted abortion services, it is important that patients know that abortion pills can be safely obtained by mail (e.g., PlanCPills.org ).3,4 As Dr. Schwarz notes, “deconstructing stigma doesn’t require a prescription, it means we are talking to our patients.”

As the Distinguished Professor for Women’s Health for the SGIM 2023 Annual Meeting, Dr. Schwarz gave a Keynote Lecture titled, “Stigma, Sanity, and Maternal Mortality,” on Friday, May 12, 2023, from 12-1PM MT.

References

  1. Jones RK, Jerman J. Population group abortion rates and lifetime incidence of abortion: United States, 2008-2014. Am J Public Health. 2017;107(12):1904-1909.
  2. Schwarz EB, Luetkemeyer A, Foster DG, et al. Willing and able? Provision of medication for abortion by future internists. Women’s Health Issues. 2005 Jan-Feb;15(1):39-44.
  3. Plan C. How to get abortion pills online by mail. https://www.plancpills.org/guide-how-to-get-abortion-pills#faq-overview. Accessed on May 15, 2023.
  4. Casas RS, Horvath SK, Schwarz EB, et al. Managing undesired pregnancy after Dobbs. J Gen Intern Med. 37, 4272–4275 (2022).
  5. https://abortionpillcme.teachtraining.org/. Accessed May 15, 2023.

Issue

Topic

Annual Meeting, Leadership, Administration, & Career Planning, SGIM, Women's Health

Author Descriptions

Dr. Chisty (achisty@pennstatehealth.psu.edu) is an associate professor of medicine at Penn State Health Milton S. Hershey Medical Center/Penn State College of Medicine. Dr. McNamara (megan.mcnamara@va.gov) is a professor of medicine at Case Western Reserve University School of Medicine. Dr. Kwolek (dwkowlek@gmail.com) is an assistant professor of medicine at the Massachusetts General Hospital. All co-authors are members of the SGIM Women and Medicine Commission.

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