Opposition to abortion within the health care community—rather than fear of public harassment —is a major factor preventing new physicians from becoming abortion providers, according to “Obstacles to the Integration of Abortion into Obstetrics and Gynecology Practice,” by Lori Freedman et al., of the University of California, San Francisco.

The authors conducted in-depth interviews with 30 obstetrician-gynecologists who had graduated 5–10 years earlier from residency programs that included abortion training. They found that although 18 had planned to offer elective abortions after their residency, only three were actually doing so. The majority reported that they were unable to provide abortions because of the formal and informal policies restricting abortion provision imposed by their private group practices, employers and hospitals. While some of these restrictions had been made explicit when the physicians interviewed for a job, others had become apparent only after the doctors had joined a practice or institution. A few physicians had attempted to moonlight as abortion providers while working in settings that prohibited abortion provision, but found that they were prohibited from offering abortion services outside the practice as well. Respondents indicated that the strain abortion provision might put on their relationships with superiors and coworkers was also a deterrent.

The findings, the authors assert, run counter to the prevailing assumption that physicians avoid abortion provision out of fear of violence or harassment. The authors observe that new physicians often lack the professional support and autonomy necessary to perform abortions, but that training programs may be able to help prepare them to continue providing abortions as they make the transition from residency programs to practice. They suggest that training new physicians in contract negotiation and leadership skills related to conflict management, as well as linking them with colleagues and community members who support abortion provision, could be beneficial.

The article is currently available online and will appear in the September 2010 issue of Perspectives on Sexual and Reproductive Health.