Lee Charlotte M, Johns Sarah L, Stulberg Debra B, Allen Rebecca H, Janiak Elizabeth
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Boston, MA, USA.
Contraception. 2023 Jan;117:39-44. doi: 10.1016/j.contraception.2022.08.001. Epub 2022 Aug 12.
To assess barriers to and facilitators of abortion provision among abortion-trained primary care providers.
We conducted 21 qualitative in-depth interviews with 20 abortion-trained family physicians and one internal medicine physician in five New England states. We dual-coded interviews, using a consensus method to agree upon final coding schema. Through iterative dialogue, using an inductive content analysis approach, we synthesized the themes and identified patterns within each domain of inquiry.
The most commonly reported barriers were a lack of organizational support, the Hyde Amendment, which prevents the use of federal funds for most abortion care, and the mifepristone Risk Evaluation and Mitigation Strategy, a federal regulation which prohibits routine mifepristone pharmacy dispensing. The logistical barriers created by these policies require cooperation from additional stakeholders, creating more opportunities for abortion stigma and moral opposition to arise. Other salient barriers included inter-specialty tension (particularly with obstetrician-gynecologists), perceived need for pre-abortion ultrasound, absence of a clinician support network, and lack of knowledge of existing resources for establishing abortion care in primary care.
Increased abortion provision in primary care is one of many necessary responses to the human rights crisis produced by the Dobbs decision. Eliminating the Hyde Amendment and ending federal regulations restricting pharmacy dispensing of mifepristone are key interventions to address barriers to primary care abortion provision. Building interspecialty partnerships between family medicine and OB/GYN and spreading awareness of the evidence-based ultrasound-as-needed protocol and other educational resources are also likely to increase primary care abortion access.
By exploring barriers to and facilitators of primary care abortion provision, this study outlines a targeted approach to support increased access to abortions. In states with legal abortion post-Roe, it is important that motivated and trained primary care providers can offer abortions, rather than referring patients to overburdened specialty clinics.
评估接受过堕胎培训的初级保健提供者在提供堕胎服务方面的障碍和促进因素。
我们对新英格兰五个州的20名接受过堕胎培训的家庭医生和1名内科医生进行了21次定性深入访谈。我们对访谈进行了双重编码，采用共识方法确定最终编码方案。通过反复对话，采用归纳式内容分析法，我们在每个调查领域内综合了主题并识别出模式。
最常报告的障碍包括缺乏组织支持、《海德修正案》（该修正案禁止使用联邦资金进行大多数堕胎护理）以及米非司酮风险评估和缓解策略（一项联邦法规，禁止米非司酮在药房常规配药）。这些政策造成的后勤障碍需要其他利益相关者的合作，从而产生了更多堕胎污名化和道德反对出现的机会。其他显著障碍包括专科间的紧张关系（特别是与妇产科医生之间）、认为堕胎前需要进行超声检查、缺乏临床医生支持网络以及对在初级保健中建立堕胎护理的现有资源缺乏了解。
增加初级保健中的堕胎服务是对多布斯裁决引发的人权危机的众多必要应对措施之一。消除《海德修正案》并终止限制米非司酮药房配药的联邦法规是解决初级保健堕胎服务障碍的关键干预措施。在家庭医学和妇产科之间建立跨专科伙伴关系，并传播基于证据的按需超声检查方案及其他教育资源的意识，也可能会增加初级保健中堕胎服务的可及性。
通过探索初级保健堕胎服务的障碍和促进因素，本研究概述了一种有针对性的方法来支持增加堕胎服务的可及性。在罗诉韦德案后堕胎合法的州，有积极性且受过培训的初级保健提供者能够提供堕胎服务，而不是将患者转诊至负担过重的专科诊所，这一点很重要。
