Greenberg Megan, Herbitter Cara, Gawinski Barbara A, Fletcher Jason, Gold Marji
Montefiore Medical Center, Bronx, NY 10467, USA.
Fam Med. 2012 Jul-Aug;44(7):493-500.
Despite abortion being one of the most common procedures undergone by women of reproductive age in the United States, the number of abortion providers has been declining for the last 20 years. We sought to assess the long-term impact of the Reproductive Health Program (RHP), a national elective abortion training program for primary care abortion providers that operated from 1999-2005.
We conducted a mixed-methods cross-sectional study of 220 former RHP trainees. Participants were interviewed over the phone and asked a series of questions about their training at RHP, their current practice, abortion provision since RHP, and enablers and barriers to abortion provision.
More than half of respondents (58.8%) have provided any abortions since RHP; more have provided medical abortions (56.5%) than surgical abortions (47.1%). Of respondents who have provided abortions, most have performed more than 50 surgical (87.5%) or medical (77.1%) abortions since RHP and had provided an abortion in the last 3 months (67.5%, 70.8%). More than 90% of abortion providers reported having liability insurance that covers abortion, colleague support, ease of obtaining medications and/or equipment, reimbursement, and administrative and/or staff support at the site where they provide abortions. Relative to providers, the greatest barriers reported by non-providers were lack of skills, concerns about liability, and difficulty obtaining supplies.
Our findings suggest that the RHP model of elective training can yield a substantial percentage of abortion providers. We also describe enablers and barriers to provision once trainees are in practice, highlighting the importance of continued support after training is completed.
尽管堕胎是美国育龄女性最常进行的手术之一，但在过去20年里，堕胎服务提供者的数量一直在下降。我们试图评估生殖健康项目（RHP）的长期影响，该项目是一项面向基层堕胎服务提供者的全国性选择性堕胎培训项目，于1999年至2005年实施。
我们对220名RHP前学员进行了一项混合方法的横断面研究。通过电话采访参与者，询问了一系列关于他们在RHP的培训情况、目前的执业情况、自参加RHP以来的堕胎服务提供情况以及堕胎服务提供的促进因素和障碍。
超过一半的受访者（58.8%）自参加RHP以来提供过堕胎服务；提供药物流产的受访者（56.5%）多于提供手术流产的受访者（47.1%）。在提供过堕胎服务的受访者中，大多数自参加RHP以来进行了超过50例手术流产（87.5%）或药物流产（77.1%），并且在过去3个月内提供过堕胎服务（手术流产为67.5%，药物流产为70.8%）。超过90%的堕胎服务提供者报告称，他们拥有涵盖堕胎的责任保险、同事支持、药物和/或设备获取便利、报销以及在其提供堕胎服务的场所获得行政和/或工作人员支持。与服务提供者相比，非服务提供者报告的最大障碍是缺乏技能、对责任的担忧以及获取用品困难。
我们的研究结果表明，RHP的选择性培训模式可以培养出相当比例的堕胎服务提供者。我们还描述了学员在执业后提供堕胎服务的促进因素和障碍，强调了培训完成后持续支持的重要性。
