Insights into abortion and miscarriage care is a brand new e-publication offering evidence-based, clinical advice on abortion and miscarriage care. Modeled on our popular Contraceptive Pearls, Insights are brief, evidence-based, clinical updates designed for busy primary care clinicians. Each edition of Insights contains one practical, clinical tip on abortion and miscarriage care. Insights is produced in collaboration with UCSF’s Innovating Education in Reproductive Health, a sister organization also dedicated to educating and supporting clinicians to provide comprehensive reproductive health care.
Sign up to get Insights delivered straight to your mailbox every other month and join the growing movement of clinicians dedicated to providing comprehensive reproductive health care. You can access past issues of Insights on our website.
Sometimes in implementing our programs we face misunderstandings about the work we do and the environment we work in. At a recent organizational retreat we thought about how best to debunk these myths. RHAP’s Medical Director, Linda Prine, MD, fielded the following thorny question:
“Should primary care clinicians perform abortions? Don’t they have to do a lot of procedures to get it right?”
“While it is true that highly complex medical procedures, like open-heart surgery, are better performed by people who do it over and over many times a day, day after day; outcome level data has not been demonstrated for low complexity procedures, like uterine aspiration procedures or medication abortions. In fact, several studies have been published recently that show that outcomes for medication abortion in family medicine settings are as good, or better than the high volume practices led by OB/GYNs. Additionally, a study was done comparing outcomes of uterine aspiration procedures done by advanced practice clinicians in Vermont with OB/GYNs in New Hampshire, and both groups had the same very, very low complication rates.
What really matters for providing safe abortion care is having a good relationship with our patients, and having a system in place for after-hour questions or problems. In addition, getting abortions in a continuity practice, like a family health center, contributes to de-stigmatizing and normalizing the process. When a woman’s own primary care clinician provides her with her abortion she is less likely to feel shamed. And when that clinician also provides her follow up contraception she is more likely to come back to the same clinician when she has side effects or needs refills or has questions. In every other area of medicine, we have come to realize that continuity of care and clinician/patient relationships are the key to good medical care. Why would abortion care be any different?
In my practice, we offer many procedures that are also offered by specialists: mole removals, wart treatments, ingrown toenail removals, ear lobe repairs, IUD insertions, abortions, and so on. We do give our patients the option of having these procedures done elsewhere, by specialists. They almost always choose to stay with us, and often say, ‘I know and trust you. Why would I want to go somewhere else to see someone I don’t know?’”
Here are our key findings:
- Training in abortion in family medicine residency leads to intention to provide.
- There is a dose-response relationship for training to intention to provide manual vacuum aspiration (MVA) and medication abortion. This means that the more abortion procedures family medicine residents perform the more likely they are to intend to provide abortion care.
- More complex procedures had the strongest associations between the number of procedures preformed and future intention to provide the service. This is likely because they require more practice to achieve competency.
- Exposure to different abortion procedures has a cumulative impact on the likelihood that the resident intends to provide MVA and medication abortion in the future. So, doing more abortions in general makes it more likely that a resident will provide MVA and medication abortion.
This research highlights why RHAP’s mission is so important. The lack of training for family physicians is a major barrier to making reproductive health care accessible to everyone. These findings demonstrate the need to expand training options for these primary care providers in residency and in post-residency programs such as RHAP’s Fellowships & Training Programs.
You can access the article on our website.
On February 19th the RHAP hosted a special screening of the documentary Vessel in collaboration with the New School’s Sex-E Collective and Global Studies Program. Vessel follows the work of activist Dr. Rebecca Gomperts and the organization Women on Waves as they work to expand access to safe abortion care across the globe.
Over a hundred people joined us for Thursday night’s event. The documentary’s director and producer, Diana Whitten, is a graduate of the New School. The movie premiered at the SXSW Film Festival and last year The New York Times Magazine highlighted Vessel in a feature article entitled The Dawn of the Post-Clinic Abortion. It was exciting to host a screening at the director’s alma mater and we had a great time working with students and faculty members to pull the screening together.
After the film, RHAP’s executive director, Lisa Maldonado, moderated a panel with Judith Helfand, the creative director and co-founder of Chicken & Egg Pictures, and two of RHAP’s Reproductive Health and Advocacy Fellows. Chicken & Egg Pictures helped fund Vessel and Judith answered audience questions about the film’s development. The RHAP Fellows helped explain how medication abortion care works in the United States and the laws that restrict access to mifepristone and misoprostol, the two medicines that are used during medication abortion.
It was a wonderful evening that allowed us to share a powerful film with our friends and supporters. If you are interested in attending a Vessel screening in your area please visit www.vesselthefilm.com. A big thank you to everyone who attended the screening and all the volunteers and speakers who helped make it happen!
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