Stigma, policy, training: Barriers PCPs face when providing medical abortions
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Barriers at nearly every level of health care are preventing primary care physicians in the United States from providing medically necessary abortions, according to researchers.
Legal restrictions to abortion services are growing in the U.S., decreasing access across the country, Na’amah Razon, MD, PhD, an assistant professor of family and community medicine at the University of California, Davis Health, and colleagues wrote in the Journal of the American Board of Family Medicine. The 2000 FDA approval of mifepristone for medication abortion “created the potential to integrate abortion services into primary care,” they added.
“Unfortunately, such an expansion of abortion provision in primary care has not occurred,” Razon and colleagues wrote.
PCPs are the first point of contact for many people, Razon said in a press release discussing the study, and “play a critical role in promoting better access to safe abortion options.”
The researchers conducted a qualitative study to investigate the barriers to abortion provision in primary care. They interviewed 48 family medicine physicians — representing all four regions of the U.S. — who were then categorized into three groups: physicians who did not receive training and do not provide abortions (n = 11); physicians who received training but do not provide abortions (n = 20); and physicians who received training and provide abortions (n = 17).
The physicians had diverse experiences relating to the environment in which they practice, with a third of participants working in states with “hostile abortion policies,” according to the researchers.
The main barriers that the physicians faced in providing abortion services included stigma, restrictions from both government entities and their institutions and a lack of training, Razon and colleagues reported.
For the physicians who did not receive training, the lack of training was noted as the most prominent barrier. The researchers note that there is a need to strengthen education — an “essential first step” — on abortion in primary care.
But clinical training alone is not sufficient, according to the researchers. Some early career PCPs said they felt “unprepared and too junior to take on integrating [medication abortion] into a new setting,” suggesting that there is a need for continued support.
Additionally, legal barriers can complicate efforts. One participant said that because her practice is not an ambulatory surgical center, it is “impossible to provide abortion in my family medicine clinic.”
Of the 17 physicians who said they currently provide abortions, 10 were not providing medication abortion in primary care settings. Many of them also split their time between primary care and reproductive health clinics to provide abortions. All 17 were based in the Northeast or West.
Two of the participants who provided abortions in a reproductive health clinic said they felt they were “too junior to take on the process” of getting their clinics to provide medication abortion. One participant shared that she lost her job because her primary care employer discovered she was providing abortions at another clinic and said she would “really need to establish” herself in a new position before she would try to integrate abortion care.
In addressing these barriers, the researchers reported that training, support from administration and the community and internal motivation can help PCPs integrate medication abortion into their practices.
“Our study highlights the ongoing individual, system and policy barriers family physicians face in integrating medication abortion into primary care,” Razon said in the release. “This is a critical time where family physicians can and should play a role in strengthening abortion access.”
References:
- Study shows family medicine physicians face many barriers to providing medical abortions. https://www.eurekalert.org/news-releases/952919. Published May 18, 2022. Accessed June 1, 2022.