Intention to Provide Abortion Upon Completing Family Medicine Residency and Subsequent Abortion Provision: A 5-year follow-up survey

Srinivasulu S, Maldonado L, Prine L, and Rubin SE.

Contraception May 2019


OBJECTIVE: Among family physicians who graduated from residencies with abortion training, we explore the association between intention to provide abortion at the end of residency and abortion provision five years post-residency.

STUDY DESIGN: We invited 2009-2012 graduates from U.S. family medicine residency programs with a required opt-out abortion training rotation or elective abortion training opportunities, and who had completed a baseline end-of-residency survey (N=477), to take our follow-up survey five years post-residency (2014-2017). We used logistic regression to examine the association between intention to provide abortion post-residency and abortion provision five years later.

RESULTS: One hundred and seventy-two of 477 (36.1%) family physicians responded to our survey. More responders compared to non-responders had intended to provide uterine aspiration and medication abortion at baseline (p<.01) and attended residency in states considered hostile and middle ground toward abortion rights (p=.03). Of the 155 eligible respondents for analysis, 27.1% offered some type of abortion care in their practice. Of those that provided abortion, 100% provided medication abortion and 71.4% uterine aspiration. Most respondents that provided uterine aspiration abortion did so in abortion/family planning clinics or in sites that already established routine abortion care. Those who had intended to provide any abortion care at baseline had 4.03 times the odds of providing any abortion care five years later [95% CI: 1.72, 9.47]. Administrative and systems-level barriers to integrate abortion were mentioned most frequently compared to personal beliefs or safety factors to explain why respondents did not provide abortion.

CONCLUSIONS: We found an association between intention to provide abortion after residency and providing abortion in practice, five years later. However, only 27.1% of respondents provided some abortion care. Factors beyond intention to provide care appear to inhibit or facilitate family physicians’ abilities to practice abortion in primary care.

IMPLICATIONS: Supporting family physicians who express intention to provide abortion after residency with additional training and technical assistance may contribute toward expanding access and availability of abortion care.

By Silpa Srinivasulu, MPH; Lisa Maldonado, MA, MPH; Linda Prine, MD; and Susan E. Rubin, MD, MPH

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