Early View

Barriers to and Enablers of Abortion Provision for Family Physicians Trained in Abortion During Residency

CONTEXT

Although some family medicine residency programs include routine opt‐out training in early abortion, little is known about abortion provision by trainees after residency graduation. A better understanding of the barriers to and enablers of abortion provision by trained family physicians could improve residency training and shape other interventions to increase abortion provision and access.

METHODS

Twenty‐eight U.S. family physicians who had received abortion training during residency were interviewed in 2017, between two and seven years after residency graduation. The doctors, identified using databases of abortion‐trained physicians maintained by residency programs, were recruited by e‐mail. In phone interviews, they described their postresidency abortion provision experiences. All interviews were transcribed, coded and analyzed using Dedoose, and a social‐ecological framework was employed to guide investigation and analysis.

RESULTS

Although many of the physicians were motivated to provide abortion care, only a minority did so. Barriers to and enablers of abortion provision were found on all levels of the social‐ecological model—legal, institutional, social and individual—and included state‐specific laws and restrictions on federal funding; religious affiliation or policies prohibiting abortion within particular health systems; mentorship, colleagues’ support and the stigma of being an abortion provider; and geographic location, time management and individuals’ prioritization of abortion provision.

CONCLUSIONS

Clinical training alone may not be sufficient for family medicine physicians to overcome the barriers to postresidency abortion provision. To increase abortion provision and access, organizations and advocates should work to strengthen enablers of provision, such as strong mentorship and support networks.

Authors' Affiliations

Aleza K. Summit is research and evaluation manager, Ian Lague is curriculum and program manager, and at the time the article was written, Miranda Dettmann was getLARC program manager—all in the Reproductive Health Education in Family Medicine (RHEDI) program, Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY. Marji Gold is professor, Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.

Disclaimer
The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.

Perspectives on Sexual and Reproductive Health