Family Physicians' Barriers and Facilitators in Incorporating Medication Abortion

Journal of the American Board of Family Medicine: JABFM

article

Na¹  Sarah Wulf²  Citlali Perez²  Sarah McNeil³  Lisa Maldonado⁴  Alison Byrne Fields⁵  Kelsey Holt²  Edith Fox²  Ilana Silverstein²  Christine Dehlendorf² 

[1]Department of Family and Community Medicine, University of California

[2]Person Centered Reproductive Health Program, Department of Family and Community Medicine, University of California

[3]Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center

[4]Reproductive Health Access Project

[5]Aggregate

关键词: Contraception;    Drug-Induced Abortion;    Family Medicine;    Family Physicians;    Health Policy;    Health Services Accessibility;    Mifepristone;    Patient-Centered Care;    Primary Health Care;    Qualitative Research;    Reproductive Health;    Scope of Practice;   

DOI  :  10.3122/jabfm.2022.03.210266

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: Medication abortion (MAB) provision by family physicians has the potential to expand abortion access. However, there are documented individual and structural barriers to provision. This study investigates how family physicians in the United States (US) navigate the barriers impeding abortion provision in primary care.Methods: We conducted a qualitative study on the experiences of US family physicians with MAB in primary care. We recruited participants at national conferences and via professional networks. This analysis focuses on the experiences of the subset of participants who expressed interest in providing MAB.Results: Forty-eight participants met inclusion criteria, with representation from all 4 regions of the US. Participants had diverse experiences related to abortion provision, training, and the environment in which they practice, with a third of participants working in states with hostile abortion policies. We categorized participants into 3 groups: (1) doctors who did not receive training and do not provide abortions (n = 11), (2) doctors who received training but do not provide abortions (n = 20), and (3) doctors who received training and currently provide abortions (n = 17). We found that training, administrative and community support, and internal motivation to overcome barriers help family physicians integrate MAB in primary care practices. Federal and state laws, absence of training, stigma around abortion provision, inaccurate or limited knowledge of institutional barriers, and administrative resistance all contributed to doctors excluding abortion provision from their scope of practice.Conclusion: Improving medication abortion provision by family physicians requires addressing the individual and system barriers family physicians encounter so they receive the education, training, and support to successfully integrate abortion care into clinical practice.

【 授权许可】

CC BY