Differences in management of early pregnancy loss in abortion hostile and supportive states
Awarded 2020
Complex Family Planning Fellowship Research
Elana Tal, MD, MS
The Washington University

We propose to conduct a cross-sectional study of general obstetrician-gynecologists (OBGYNs) who care for patients with EPL. We will recruit OBGYNs who practice at academic medical centers and invite them to complete a quantitative survey designed to assess current EPL practice along with barriers and readiness to implement those management options not currently in place. We will employ the Consolidated Framework for Implementation Research to guide our data collection and analysis to gain a more a comprehensive understanding of the implementation of medical management and office MVA for EPL.
We hypothesize that OBGYNs who practice in abortion-hostile states are less likely to offer medical management and office MVA compared to OBGYNs who practice in abortion-supportive states. Additionally, we hypothesize that OBGYNs in abortion-hostile states experience greater barriers to implementing management options that are similar to abortion care. We are not aware of prior studies evaluating the associations between state-level abortion policy and EPL care practices, nor of studies that assess implementation of EPL care with the use of a rigorous framework from the implementation science field.
We hope that data obtained from the proposed study will identify successful implementation strategies for medical management and office MVA in order to inform further implementation efforts. A potential study challenge is that OBGYNs in abortion-hostile states may be less willing to complete the survey but we propose to use multiple recruitment strategies to reach academic OBGYNs. We also hope results from this study will illuminate the possible impact of abortion restrictions on non-abortion-related reproductive healthcare.