Insights: Practice Change: Key Considerations for Providing Medication Abortion in Primary Care

Written by Rory Tito, MPH

Integrating a new service into your practice is no small undertaking, and medication abortion is no exception.

You will need a multi-disciplinary team of people dedicated to the implementation of this service. Think of the various roles involved directly in the provision of care, as well as the roles on the back-end: accounting, billing, scheduling, IT, etc. It is important to understand and address the concerns of people at all levels of the health center. You will need to ensure that staff are well-trained and feel comfortable providing this care.

Due to the Hyde Amendment, if your organization receives federal funding, like Federally Qualified Health Centers (FQHC) or Title X sites, you will need to establish cost allocation systems that keep federal funds separate from the direct or indirect provision of abortion care. FQHCs must also consider federal property interest. If you utilized federal funds to construct or renovate buildings where you want to provide abortion care, you likely cannot provide abortion in those specific buildings.

Most FQHC clinicians are covered under malpractice insurance provided by the Federal Tort Claims Act, which does not include coverage for abortion. For clinicians associated with a hospital or large academic practice, you may already have abortion in your malpractice policy. It will be important to determine your need for additional coverage, and work with administrative leaders to obtain that coverage.

Unfortunately, adding these services to your practice can increase safety and security concerns. You will need to work with your Security team to review protocols and decide if you are going to advertise these services publicly.

Many patients may prefer to get this care with their primary care clinician who they know and trust. FQHCs and other community providers are well-positioned to serve communities who often face barriers to care, especially when navigating the health care system outside of their medical home. Because of this, and/or a lack of abortion providers in certain areas, referrals can cause delays, which can result in more costly or complex care. You can administer a patient attitude survey to get a better understanding of how your patients feel.

When we treat abortion like any other health care service, and when it can be accessed like any other health care service, it can reduce stigma and enhance reproductive autonomy for all. While it can seem daunting, the desire for change often starts with one person and can have a ripple effect of increased abortion access, empowered patients, and healthier communities.

RHAP Resources:

Medication Abortion in Early Pregnancy

Triaging Medication Abortion Related Calls Video

How to Order Mifepristone

Toolkit for Integrating Medication Abortion in Primary Care

Values Clarification Workshop

Staff Attitude Survey

Patient Attitude Survey


Carvajal D. Primary Care Providers can help safeguard abortion. Scientific American. Published June 24, 2022. Accessed April 7, 2023.

Yanow S. It is time to integrate abortion into primary care. American Journal of Public Health.  2013;103(1):14-16. doi:10.2105/ajph.2012.301119

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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This bi-monthly clinical e-newsletter highlights evidenced-based best practices in abortion and miscarriage care

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