Barriers PCPs face when providing medical abortions

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’amab 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…