Provision of reproductive health services among adolescent medicine providers
Awarded 2009
Small Research Grants
Mandy Coles, MD, MPH
University of Rochester

Purpose: Adolescents are at high risk for unintended pregnancy and abortion. Medication abortion accounts for 21% of early abortions in the US, and is well-tolerated and efficacious among adolescents. The purpose of this study is to understand if providers caring for adolescents have accurate knowledge to counsel on medication abortion. Methods: Using an online questionnaire, we surveyed US Society for Adolescent Health and Medicine providers on medication abortion knowledge, counseling, and provision. Clinicians were also asked to assess their own knowledge of medication abortion. Using chi-square analyses and ANOVA statistics, we examined respondents’ knowledge by counseling and provision, demographics, and self-assessed knowledge. Results: This survey had a 54% response rate (n=430). Most respondents were white, non-Hispanic, pediatrics-trained, Adolescent Medicine subspecialty-trained, and worked in urban settings; 44% did not counsel teens on medication abortion. One-third of respondents incorrectly believed medication abortion is not very safe, 40% misidentified that it is < 95% effective, and 32% did not select the correct maximum recommended gestational age (7-9 weeks). Forty-three percent of clinicians could not identify the most common side effects, and 79% could not identify that all serious complications are rare. Knowledge scores were higher for those who provide medication abortion, and steadily decreased from those who counsel to those who do not counsel (p<0.001). Individual self- assessment of medication abortion knowledge accounted for only a small fraction of variation in actual knowledge (r2=0.08). Conclusions: It is critical that clinicians caring for adolescents counsel pregnant teens on all their options, including medication abortion. However, many providers underestimated the effectiveness of medication abortion, and had incorrect knowledge about side effects and complications. Service provision was the only factor reliably associated with accurate information. As self-assessment was a poor predictor of accurate knowledge, there is a need to better educate all Adolescent Medicine providers on medication abortion.