Education, training, laws all barriers to medication abortions in family medicine

Education, training, administrative support and state laws all prevent family medicine physicians from providing medication abortions (MAB), according to a new study.

Researchers interviewed U.S. family doctors about their experiences navigating barriers to providing MAB in primary care.

“Our study highlights the ongoing individual, system and policy barriers family physicians face in integrating medication abortion into primary care,” lead author Na’amah Razon, MD, PhD, assistant professor of family and community medicine at UC Davis Health said in a press release. “This is a critical time where family physicians can and should play a role in strengthening abortion access.”

The study, “Family Physicians’ Barriers and Facilitators in Incorporating Medication Abortion,” was published May 18 in the Journal of the American Board of Family Medicine.

“We found that training, administrative and community support, and internal motivation to overcome barriers help family physicians integrate MAB in primary care services,” the study said. “Federal and state laws, absences 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.”

The researchers said they proposed a framework to develop communications strategies to help motivate family physicians to provide MAB and address the individual and system barriers that family physicians face.

Federal rules

The study, based on interviews conducted January to October 2019, did not refer specifically to the U.S. Supreme Court draft ruling that would overturn the 1973 landmark decision in Roe v Wade and the 1992 Supreme Court decision on abortion rights, known as Planned Parenthood of Southeastern Pa. v. Casey. The Supreme Court has confirmed the authenticity of the draft but said it did not represent a final decision in the case.

In 2000, the U.S. Food and Drug Administration (FDA) approved mifepristone for MAB. The researchers said studies have shown MAB to be safe and effective, but potential access to the drug through primary care, has not happened.

“This approval created the potential to integrate abortion services into primary care, which abortion advocates hoped would normalize abortion services and broaden access,” the study said. “Unfortunately, such an expansion of abortion provision in primary care has not occurred.”

The researchers interviewed 41 early career family physicians, who completed their residencies within the last 10 years, and seven family physician leaders with experience integrating abortion into family medicine or motivating other family physicians to expand their scope.

The doctors were classified into three groups:

• 11 physicians did not receive training and do not provide abortions.
• 20 physicians received training but do not provide abortions.
• 17 physicians who received training and provided abortions.

Physicians who received training on MAB, but did not provide abortions, cited as barriers such as the FDA’s “stringent” criteria for mifepristone prescriptions, and the federal law known as the Hyde Amendment, which prohibits federal funding from being used for abortion.

As a result, 95% of U.S. abortions took place within dedicated clinics, as of 2017, according to the study. Among physicians who provided abortions, 60% practiced in reproductive health clinics.

Although MAB has been slow to move into primary care practices, the American College of Physicians, the American Medical Association and the American College of Obstetricians and Gynecologists have opposed Supreme Court action to overturn Roe v Wade. They argue doing so would undermine patient rights and the doctor-patient relationship.