Most U.S. Obstetrician-Gynecologists in Private Practice Do Not Provide Abortions and Many Also Fail to Provide Referrals

Only 7% of U.S. obstetrician-gynecologists who work in private practice settings provided abortions in 2013 or 2014, according to a new analysis by Guttmacher researchers Sheila Desai, Rachel Jones and Kate Castle. Among those who did not provide abortions, 54% reported that they did provide referrals to a facility or practice where a patient could obtain an abortion. However, more than one-third (35%) said that they would not provide a referral for a patient seeking an abortion.

"As the number of U.S. abortion providers declines, obstetrician-gynecologists in private practice must do all they can to help their patients obtain care," says Rachel Jones. "While it may not be feasible or realistic for all obstetrician-gynecologists to provide abortions, they have a professional and ethical obligation to provide referrals for this care."

The authors analyzed data from a national survey of 1,961 obstetrician-gynecologists and found that abortion provision among respondents varied by geographic region. A greater proportion of respondents in the Northeast (14%) and the West (11%) provided abortion care than those in the Midwest (4%) and the South (3%). Moreover, the proportion of obstetrician-gynecologists who did not provide referrals for abortion services was significantly higher in the South (42%) than in the Northeast and West (27% in each region).

The most common reasons that obstetrician-gynecologists gave for not offering abortion referrals included provision of indirect referrals (to another information source, rather than directly to a provider), an office policy against abortion referrals, a moral or ethical objection to abortion, and a lack of patients seeking abortions. Desai and colleagues further note that obstetrician-gynecologists practicing in regions with only a few abortion facilities may not provide referrals because they do not know of any abortion providers in their area.

Among obstetrician-gynecologists who provided abortions, 42% offered only surgical abortions and a smaller proportion, 25%, offered only medication abortions. The researchers had expected that medication abortion would be more common because it is noninvasive and requires fewer resources than surgical abortions. However, it is possible that U.S. Food and Drug Administration restrictions on stocking and administering medication abortion pills and certification requirements for providers discourage some physicians in private practice from offering this option.

The authors recommend further education and training for obstetrician-gynecologists and office staff in private practice. It is important that healthcare professionals are equipped with the information and resources they need to provide clinical referrals for abortion, particularly in areas without many abortion providers, including the South and Midwest.

"Obstetrician-gynecologists in private practice may be unable to provide abortion care to their patients for a variety of reasons," says Heather Boonstra, Guttmacher policy expert. "In these cases, they have a professional obligation to counsel patients on their pregnancy options and to provide referrals if necessary."

"Estimating Abortion Provision and Abortion Referrals Among United States Obstetrician-Gynecologists in Private Practice," by Sheila Desai, Rachel Jones and Kate Castle, is currently available online and will appear in a forthcoming issue of Contraception.