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Induced Abortion Provision Among a National Sample of Obstetrician–Gynecologists

Grossman, Daniel, MD; Grindlay, Kate, MSPH; Altshuler, Anna L., MD, MPH; Schulkin, Jay, PhD

doi: 10.1097/AOG.0000000000003110
Contents: Abortion: Original Research
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OBJECTIVE: To estimate the proportion of obstetrician–gynecologists (ob-gyns) who provided induced abortion in the prior year, disaggregated by surgical and medication methods, and document barriers to provision of medication abortion.

METHODS: In 2016–2017, we conducted a cross-sectional survey of a national sample of American College of Obstetricians and Gynecologists Fellows and Junior Fellows who were part of the Collaborative Ambulatory Research Network. We sent the survey by email, and mailed nonresponders paper surveys. We performed descriptive statistics, χ2 tests, and logistic regression analyses.

RESULTS: Sixty-seven percent (655/980) of Collaborative Ambulatory Research Network members responded. Ninety-nine percent reported seeing patients of reproductive age, and 72% reported having a patient in the prior year who needed or wanted an abortion. Among those seeing patients of reproductive age, 23.8% (95% CI 20.5%–27.4%) reported performing an induced abortion in the prior year; 10.4% provided surgical and medication abortion, 9.4% surgical only, and 4.0% medication only. In multivariable analysis, physicians practicing in the Midwest (adjusted odds ratio [AOR] 0.31, 95% CI 0.16–0.60) or South (AOR 0.22, 95% CI 0.11–0.42) had lower odds of provision compared with those practicing in the Northeast, whereas those practicing in an urban inner city (AOR 2.71, 95% CI 1.31–5.60) or urban non–inner-city area (AOR 2.89, 95% CI 1.48–5.64 vs midsize towns, rural areas, or military settings) had higher odds of provision. The most common reasons for not providing medication abortion were personal beliefs (34%) and practice restrictions (19%). Among those not providing medication abortion, 28% said they would if they could write a prescription for mifepristone.

CONCLUSION: Compared with the previous national survey in 2008–2009, abortion provision may be increasing among practicing ob-gyns, although important geographic disparities persist. Few provide medication abortion, but uptake might increase if mifepristone could be prescribed.

One quarter of obstetrician–gynecologists provide induced abortion, with variation by geography and community type, but medication abortion provision might increase if physicians could prescribe the medications.

Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California; Ibis Reproductive Health, Cambridge, Massachusetts; California Pacific Medical Center, San Francisco, California; the University of Washington, Seattle, Washington; and the American College of Obstetricians and Gynecologists, Washington, DC.

Corresponding author: Daniel Grossman, MD, ANSIRH, 1330 Broadway, Suite 1100, Oakland, CA 94612; email: Daniel.Grossman@UCSF.edu.

Supported by the Society of Family Planning Research Fund (SFPRF). The views and opinions expressed are those of the authors and do not necessarily represent the views and opinions of SFPRF. Additional support was provided by the Maternal and Child Health Bureau (Title V, Social Security Act, Health Resources and Services Administration, and Department of Health and Human Services), Grant UA6MC19010. The funding sources had no role in the study design; the collection, analysis, and interpretation of the data; nor the preparation, writing, or submission of this manuscript.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the North American Forum on Family Planning, October 14–16, 2017, Atlanta, Georgia.

The authors thank Neko M. Castleberry and Lauren M. Stark for their assistance with data collection and cleaning.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B277.

Received September 08, 2018

Received in revised form November 18, 2018

Accepted November 29, 2018

© 2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.