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Research ArticleOriginal Research

Family Physicians' Barriers and Facilitators in Incorporating Medication Abortion

Na'amah Razon, Sarah Wulf, Citlali Perez, Sarah McNeil, Lisa Maldonado, Alison Byrne Fields, Kelsey Holt, Edith Fox, Ilana Silverstein and Christine Dehlendorf
The Journal of the American Board of Family Medicine May 2022, 35 (3) 579-587; DOI: https://doi.org/10.3122/jabfm.2022.03.210266
Na'amah Razon
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
MD, PhD
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Sarah Wulf
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
MPH
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Citlali Perez
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
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Sarah McNeil
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
MD
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Lisa Maldonado
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
MA, MPH
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Alison Byrne Fields
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
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Kelsey Holt
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
MA, ScD
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Edith Fox
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
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Ilana Silverstein
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
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Christine Dehlendorf
From the Department of Family and Community Medicine, University of California, Davis, Sacramento, CA (NR); Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA (SW, CP, KH, EF, IS and CD); Departments of Family Medicine and Ob/Gyn, Contra Costa Regional Medical Center, Martinez, CA (SM); Reproductive Health Access Project, New York, NY (LM); Aggregate, Seattle, WA (BF).
MD, MAS
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    Table 1.

    Participants' Characteristics and Abortion Experience (n = 48)

    n (%)
    New career family physician41 (85.4)
    Thought leader7 (14.6)
    Gender*
    Female39 (81.3)
    Male9 (18.8)
    Race†
    Asian8 (16.7)
    Black or African American4 (8.3)
    Native Hawaiian or Other Pacific Islander1 (2.1)
    White31 (64.6)
    Other4 (8.3)
    Ethnicity
    Hispanic or Latino/a/x2 (4.2)
    Non-Hispanic or Non-Latino/a/x46 (95.8)
    Age (years)
    ≤301 (2.1)
    31 to 4038 (79.2)
    41 to 504 (8.3)
    51 to 604 (8.3)
    >601 (2.1)
    Regions of the US‡
    West21 (43.8)
    South10 (20.8)
    Midwest5 (10.4)
    Northeast12 (25.0)
    State Abortion Policy Landscape§
    Hostile16 (33.3)
    Neutral3 (6.3)
    Supportive27 (56.3)
    N/A2 (4.2)
    Approximate distance between physician's clinical setting and nearest abortion clinic‖ (miles)
    <530 (62.5)
    5 to 259 (18.8)
    26 to 504 (8.3)
    >504 (8.3)
    Unknown1 (2.1)
    Abortion Training
    Aspiration and medication abortion34 (70.8)
    Only aspiration abortion2 (4.2)
    Only medication abortion1 (2.1)
    Neither aspiration or medication abortion11 (22.9)
    Abortion services provided since graduating residency
    Aspiration and medication abortion16 (33.3)
    Only aspiration abortion0
    Only medication abortion5 (10.4)
    Neither aspiration nor medication abortion27 (56.3)
    Current medication abortion provision
    Currently provides medication abortion17 (35.4)
    Does not currently provide medication abortion31 (64.6)
    Setting of current abortion provision
    Primary care5 (10.4)
    Reproductive health clinic10 (20.8)
    Primary care and reproductive health clinic2 (4.2)
    N/A (Does not provide abortion care)31 (64.6)
    • ↵* In the pre-interview survey physicians were asked the following question: “Which of the following best describes your gender?” The options include: (female, male, transgender male, transgender female, nonbinary, gender fluid, something not listed here.).

    • ↵† Participants were able to select more than one category.

    • ↵‡ U.S. Census Bureau, Census Regions and Divisions of the United States, 2013.

    • ↵§ Nash E, State Abortion Policy Landscape: From Hostile to Supportive, Guttmacher Institute, 2019. State categories were based on laws in effect as of July 1, 2020. N/A refers to areas where a state policy landscape was not available.

    • ↵‖ ANSIRH, Abortion Facility Database, University of California, San Francisco, 2019. Distance was calculated using the zip code of the clinic where the physician works and the address of the closest clinic that offers abortion care in the ANSIRH Facility Database. If a physician works at multiple sites, the zip code of the furthest clinic from an abortion clinic was used.

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The Journal of the American Board of Family Medicine: 35 (3)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 3
May/June 2022
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Family Physicians' Barriers and Facilitators in Incorporating Medication Abortion
Na'amah Razon, Sarah Wulf, Citlali Perez, Sarah McNeil, Lisa Maldonado, Alison Byrne Fields, Kelsey Holt, Edith Fox, Ilana Silverstein, Christine Dehlendorf
The Journal of the American Board of Family Medicine May 2022, 35 (3) 579-587; DOI: 10.3122/jabfm.2022.03.210266

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Family Physicians' Barriers and Facilitators in Incorporating Medication Abortion
Na'amah Razon, Sarah Wulf, Citlali Perez, Sarah McNeil, Lisa Maldonado, Alison Byrne Fields, Kelsey Holt, Edith Fox, Ilana Silverstein, Christine Dehlendorf
The Journal of the American Board of Family Medicine May 2022, 35 (3) 579-587; DOI: 10.3122/jabfm.2022.03.210266
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Keywords

  • Contraception
  • Drug-Induced Abortion
  • Family Medicine
  • Family Physicians
  • Health Policy
  • Health Services Accessibility
  • Mifepristone
  • Patient-Centered Care
  • Primary Health Care
  • Qualitative Research
  • Reproductive Health
  • Scope of Practice

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