What will it take? Expanding medication abortion access with family physicians
Awarded 2019
Complex Family Planning Fellowship Research
Sumathi Narayana, MD
Albert Einstein College of Medicine

Much research exists to support the provision of medication abortion in primary care settings. Studies have demonstrated that medication abortions provided by family physicians is safe, effective, and acceptable. In addition, integration of abortion care into routine family practice allows patients to avoid potential harm caused by security measures, protesters and the social stigma associated with getting care in a known abortion clinic. Family physicians often practice in remote and low resource settings which have limited access to abortion care. However, few offer medication abortions to their patients, despite the fact that this service draws upon skills that are already elements of family medicine practice. The REMS for mifepristone has been identified as a significant barrier to expanding the provision of medication abortion. We hypothesize that, in addition to the REMS, several other salient factors may preclude implementation of services, such as: providers’ confidence in their ability to provide this care; liability insurance coverage; perceived stigma of being an abortion provider; concern about the impact on their families; and the local political climate and culture of a particular practice region.
The primary objectives of this study are to explore family physicians’ attitudes and identify perceived barriers to and facilitators of medication abortion integration into their practices. In order to better understand the complexities surrounding the lack of medication abortion provision among primary care providers, we propose conducting a mixed methods study. Phase One will include semi-structured interviews with family physicians, focusing on those who are practicing in non-academic, rural, and/or low resource settings in diverse geographic areas with limited access to abortion. Phase Two will use the information generated from the qualitative phase to develop and administer a survey instrument for a descriptive component.
 Anticipated outcomes of this study include the development of educational strategies and policy recommendations that directly address the barriers, needs, and challenges identified by family physicians in high need areas. More broadly, we hope to contribute to ongoing research in medication abortion expansion and the normalization of abortion as a routine component of quality health care through its integration in primary care settings.