Malcolm Henry
Even with Roe v. Wade still the law of the land, primary care doctors in the United States have difficulty prescribing U.S. federally approved abortion pills, a new study finds.
Getting in the way is a complex combination of state and federal regulations, insufficient training and institutional hurdles, researchers found when they surveyed dozens of doctors.
“As family physicians provide comprehensive medical care to individuals throughout their life course — including supporting their reproductive choices — they are prime individuals to provide medication abortion,” explained study lead author Dr. Na’amah Razon.
“We found a range of barriers that prevented family physicians from integrating medication abortion into their primary care practices,” said Razon, an assistant professor in the Department of Family and Community Medicine at the University of California, Davis.
It’s a landscape that will likely only gets worse, said Razon, whether or not Roe v. Wade is actually overturned, although a leaked draft from the U.S. Supreme Court indicates it will be.
“Given the recent movement toward restricting abortions in the United States, family physicians could face increasing barriers in providing medication abortion,” she noted.
The two-pill regimen consists of mifepristone and misoprostol. Planned Parenthood notes this noninvasive method is safe and 94%-96% effective. And the Guttmacher Institute says that the medicinal approach now accounts for more than half of all abortions in the United States.
Until December 2021, the U.S. Food and Drug Administration only allowed mifepristone to be administered in-person at a clinic, a hospital or under the direct supervision of a certified medical provider. Retail pharmacy pickup and mail orders were not allowed. The December FDA ruling did away with the in-person requirement, allowing telehealth consultation, though all the doctors in the current study were interviewed before that decision came down.
For the study, 48 U.S. primary care doctors were interviewed in 2019 and classified into one of three groups: those who did not provide abortions and had not been trained to do so (11 doctors); those who didn’t provide abortions, despite having received training (20 doctors), and those who had been trained and did provide abortion services (17 doctors).
Roughly two-thirds were not providing abortions at the time they were surveyed.
Those in the untrained/non-provider group said their lack of training was the main reason for not offering abortion care.
Such doctors variously said their lack of abortion care skills left them “uncomfortable,” unfamiliar with the medications involved, and/or unconvinced that abortion services truly falls within the realm of family medicine. They were also the most likely to point to their state’s anti-abortion political climate, a lack of community support, and a poor understanding of local hospital regulations as discouraging factors.
By contrast, those who didn’t provide abortion services despite their training generally said they understood all too well the wide range of primary care, clinic and hospital restrictions in place in their region.
This group also cited the federal Hyde Amendment as a red-tape barrier to providing care in their own practice and elsewhere. That law prevents any federal funds from being used for abortion.
In addition, the group highlighted the FDA’s REMS (Risk Evaluation and Mitigation Strategy) as another impediment. REMS is a drug safety protocol applied to certain medications. Since 2011, the FDA has applied REMS to mifepristone to restrict how, where and when it can be prescribed and obtained.
Among primary care doctors who were trained and currently providing abortion care, 60% said they didn’t offer abortion pill prescriptions as part of their family practice, but only at specialized reproductive health clinics.
Researchers also found that practitioners who offered abortion pill prescriptions in their primary care setting were located in either the Northeast or West; none resided in states with highly restrictive abortion laws in place.
Some also noted that the institutions and/or hospital ob-gyn departments with which they worked prohibited abortion services of any kind.
Several said that in order to make abortion pills available at a family practice or a specialized clinic it was necessary to have a “champion” on board willing to jump through the regulatory hoops involved.
Elisa Wells is co-founder and co-director of Plan C, an organization dedicated to ensuring unrestricted and non-stigmatized access to abortion pills. She expressed frustration with the status quo.
“The science about the absolute safety of medication abortion doesn’t support these added barriers to access,” Wells said. “Many primary care providers we have talked to are not in practices that allow them to do abortion, so that’s a huge hurdle,” even among those who are trained and willing.
Wells, who was not involved in the study, said that ensuring widespread abortion pill access will mean convincing the FDA to remove all REMS restrictions for mifepristone.
“Mifepristone is an extremely safe medication,” she noted, “and any licensed provider should be able to write a prescription for a patient who qualifies for it, and the patient should be able to fill that prescription at any pharmacy.”
The findings were published in the May-June issue of the Journal of the American Board of Family Medicine.
More information
There’s more on abortion medication at Plan C.
SOURCES: Na’amah Razon, MD, PhD, assistant professor, Department of Family and Community Medicine, University of California, Davis, Sacramento; Elisa Wells, MPH, co-founder and co-director, Plan C; Journal of the American Board of Family Medicine, May-June 2022
I am not really wonderful with English but I come up this rattling easygoing to read .
Hi would you mind letting me know which web host you’re utilizing? I’ve loaded your blog in 3 different internet browsers and I must say this blog loads a lot quicker then most. Can you suggest a good web hosting provider at a honest price? Kudos, I appreciate it!
This blog has undergone some amazing research. I found it very useful.
I as well conceive thence, perfectly pent post! .
I really appreciate this post. I?¦ve been looking all over for this! Thank goodness I found it on Bing. You’ve made my day! Thanks again
Hi there, thank you for the great value that you have provided about unwanted pregnancy to us.
You can certainly see your expertise within the paintings you write. The sector hopes for even more passionate writers such as you who aren’t afraid to say how they believe. At all times follow your heart.
Hello there, I found your blog via Google while looking for a related topic, your site came up, it looks great. I’ve bookmarked it in my google bookmarks.
As I website possessor I believe the content matter here is rattling wonderful , appreciate it for your hard work. You should keep it up forever! Good Luck.
You have brought up a very wonderful points, appreciate it for the post.
Some truly terrific work on behalf of the owner of this site, absolutely great written content.
It?¦s in reality a great and useful piece of information. I am glad that you simply shared this useful info with us. Please stay us informed like this. Thank you for sharing.
Hmm is anyone else encountering problems with the pictures on this blog loading? I’m trying to find out if its a problem on my end or if it’s the blog. Any responses would be greatly appreciated.
Greetings! Very helpful advice on this article! It is the little changes that make the biggest changes. Thanks a lot for sharing!
I think this website has got some rattling wonderful information for everyone :D. “Experience is not what happens to you it’s what you do with what happens to you.” by Aldous Huxley.
Hello, you used to write wonderful, but the last several posts have been kinda boringK I miss your great writings. Past several posts are just a little bit out of track! come on!
I have been browsing on-line more than 3 hours nowadays, but I never found any interesting article like yours. It?¦s pretty price enough for me. Personally, if all web owners and bloggers made excellent content as you probably did, the web will probably be a lot more helpful than ever before.
That is very attention-grabbing, You are an excessively skilled blogger. I have joined your rss feed and look forward to in quest of extra of your excellent post. Additionally, I’ve shared your site in my social networks!
I have been reading out some of your stories and i can state pretty nice stuff. I will definitely bookmark your blog.
Hello. Great job. I did not expect this. This is a excellent story. Thanks!
Thank you for the sensible critique. Me & my neighbor were just preparing to do some research on this. We got a grab a book from our area library but I think I learned more from this post. I am very glad to see such magnificent info being shared freely out there.
hello there and thank you for your info – I have definitely picked up something new from right here. I did however expertise some technical points using this web site, since I experienced to reload the web site many times previous to I could get it to load properly. I had been wondering if your web hosting is OK? Not that I’m complaining, but slow loading instances times will very frequently affect your placement in google and can damage your high quality score if advertising and marketing with Adwords. Anyway I am adding this RSS to my e-mail and can look out for much more of your respective
What i do not understood is in fact how you’re not really a lot more well-liked than you might be right now. You are very intelligent. You recognize therefore significantly in relation to this subject, made me for my part believe it from numerous numerous angles. Its like women and men are not interested except it?¦s something to accomplish with Woman gaga! Your individual stuffs nice. All the time handle it up!
980340 416149Good post. I learn something a lot more challenging on different blogs everyday. It will always be stimulating to read content from other writers and practice just a little something from their store. Id prefer to use some with the content on my weblog whether you dont mind. Natually Ill give you a link on your internet weblog. Thanks for sharing. 608665
714716 339936Some really interesting information , nicely written and loosely user genial . 604269