Determinants of success: characterizing the facilitators of integrated abortion provision
Awarded 2017
Complex Family Planning Fellowship Research
Lily Bayat, MD, MPH
The University of New Mexico

Background: Despite barriers to abortion provision, some physicians have successfully incorporated abortion care into their practices. Research identifying facilitators of abortion integration is limited.  Characterizing factors associated with successful integration may inform interventions to increase abortion provision at the individual provider level.
To identify OB/GYN and Family Medicine physicians who have successfully integrated abortion care into their practices and to describe their experiences with abortion provision.
To explore the range of facilitators of and barriers to integrating abortion care into clinical practice.
To inform approaches to assist other physicians in the integration of abortion care into clinical practice.
Methods: We conducted semi-structured interviews with 25 OB/GYN and Family Medicine physicians who provide abortion care as part of their clinical practice.  Interviews addressed four domains: facilitators of and barriers to abortion provision, lessons learned in integrating abortion care, and suggestions for coaching future providers.  Axial coding was used to identify emergent themes; data were synthesized using directed content analysis using inductive and deductive techniques.
Results: We conducted 14 interviews with OB/GYNs and 11 with Family Medicine physicians: 60% had initiated abortion services themselves.  Facilitators of and barriers to abortion provision included the following categories: personal/individual factors, community/environmental factors, educational/training factors, and professional/workplace factors.  Major facilitators included supportive medical and administrative leadership and professional mentorship by another abortion provider.  Major barriers included unsupportive staff/colleagues and antagonistic medical and administrative leadership.  Lessons learned focused on proactive assessment of administration support for abortion care prior to starting employment, identifying allies within institutional leadership, and actively working to minimize workplace conflict and to be perceived as a team player.  Coaching resources for future providers included clinical support, professional mentorship networks and administrative support.  Valuable administrative support included grant funding for resources and equipment to initiate abortion services, assistance with up-front negotiation to ensure institutional agreement with abortion provision, and access to shared policies/documents.  Overall, institutional medical or administrative leadership support was integral to being able to initiate abortion services. 
Conclusions: Efforts to expand abortion integration into practice should include empowering administrative leaders to support their physicians to offer abortion care.