"Now that I have pills at home, I feel less trapped": Advance provision of abortion pills in Poland.

Medical Abortion

Method choice is an important component of quality abortion care and qualitative research suggests that abortion stigma can influence provider preference and provision of abortion methods. This study is the first to explore the relationships between abortion providers' method preferences, their provision of medication or instrumentation abortion or both methods, and abortion stigma. We conducted secondary analysis of a survey of United Kingdom (UK) abortion providers (N = 172) to describe and compare providers' self-reported method preferences and provision. We used multinomial logistic regression to assess the association between method preference and provider experiences of abortion stigma (measured using a revised Abortion Provider Stigma Scale (APSS)), adjusting for relevant provider and facility characteristics. Almost half (52%) of providers reported that they only provided medication abortion care, while 5% only provided instrumentation abortion care and 43% provided both methods. Most (62%) preferred to provide both methods while 32% preferred to provide only medication abortion and 6% only instrumentation abortion. There was no significant difference in revised APSS scores by provider method preference or provision. Most surveyed UK abortion providers prefer to offer both methods, but over half only provide medication abortion. This may reflect patients' preferences for medication abortion, and health system and legal constraints on instrumentation abortion. Addressing these systemic constraints on method provision could expand patient choice. Providers' method preference was not significantly associated with provider stigma but future research should consider the influence of structural stigma on method provision at the health system level.

Background90% of United States’ counties do not have a single clinic offering abortion care, and barriers to care disproportionately affect low-income families. Novel models of abortion care delivery, including provision of medication abortion in pharmacies, with pharmacists prescribing medication, have the potential to expand access to abortion care. Pharmacists are well-positioned to independently provide abortion care and are highly accessible to patients, however medication abortion provision by pharmacists is not currently legal or available in the United States. To assess the potential acceptability of pharmacist provision of medication abortion and to identify anticipated barriers and facilitators to this model of care, we explored pharmacists’ attitudes towards providing medication abortion, inclusive of patient selection, counseling, and medication prescribing.MethodsFrom May to October 2021, we conducted 20 semi-structured qualitative interviews with pharmacists across the United States, guided by the domains of the Consolidated Framework for Implementation Science Research.ResultsMajor themes included there is a need for pharmacist provision of medication abortion and pharmacists perceive provision of medication abortion to be potentially acceptable if anticipated barriers are addressed. Anticipated barriers identified included personal, religious, and political beliefs of pharmacists and lack of space and systems to support the model. Ensuring adequate staffing with pharmacists willing to participate, private space, time for counseling, safe follow-up, training, and reimbursement mechanisms were perceived strategies to facilitate successful implementation.ConclusionsPharmacist identified implementation strategies are needed to reduce anticipated barriers to pharmacist provision of medication abortion.

Young People's Support for and Personal Interest in an Advance Provision Model for Medication Abortion

Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization.

Provision of medication and procedural abortion among Massachusetts obstetrician-gynecologists

To examine practice nurse knowledge, attitudes, and practices about medication abortion in Australia. Cross-sectional survey. A national online survey was conducted from July to December 2021. Nurses working in general practice were recruited using convenience sampling. Data collected included demographics, knowledge, attitudes, and practices in abortion care. Analyses used included descriptive statistics and Poisson regression. From 489 responses, knowledge about medication abortion, its provision, and efficacy was low. Although many respondents felt it was acceptable to assist in medication abortion, few indicated involvement. Those with advanced qualifications had greater perceived knowledge of abortion counselling. Respondent involvement in medication abortion was more likely if they had worked in general practice for a long time, their primary place of work was outside of general practice, or had advanced nursing qualifications. Given their role in the community, there is an opportunity to better utilise practice nurses for abortion care. Incorporation of abortion into the nursing curriculum and routine practice, including supportive funding mechanisms for care, is needed. Low knowledge and a lack of practice nurses providing abortion services adversely impact patient access. Practice nurse provision of medication abortion has not yet been optimised. While practice nurses reported acceptability to provide abortion care, this could be enhanced with funding, education, and service normalisation. These results will inform policy makers, educators, patients, general practices, and nurses to support patient access to abortion care. Incorporating abortion care into nursing curriculum and practice will support women's access to these services. CHERRIES guideline. Professional groups, family planning organisations, industry, and government grant partners supported the study's recruitment. ACTRN12622000655741.

Medication abortion (MAB) provision by family physicians has the potential to expand abortion access. However, there are documented individual and structural barriers to provision. This study investigates how family physicians in the United States (US) navigate the barriers impeding abortion provision in primary care. We conducted a qualitative study on the experiences of US family physicians with MAB in primary care. We recruited participants at national conferences and via professional networks. This analysis focuses on the experiences of the subset of participants who expressed interest in providing MAB. Forty-eight participants met inclusion criteria, with representation from all 4 regions of the US. Participants had diverse experiences related to abortion provision, training, and the environment in which they practice, with a third of participants working in states with hostile abortion policies. We categorized participants into 3 groups: (1) doctors who did not receive training and do not provide abortions (n = 11), (2) doctors who received training but do not provide abortions (n = 20), and (3) doctors who received training and currently provide abortions (n = 17). We found that training, administrative and community support, and internal motivation to overcome barriers help family physicians integrate MAB in primary care practices. Federal and state laws, absence of training, stigma around abortion provision, inaccurate or limited knowledge of institutional barriers, and administrative resistance all contributed to doctors excluding abortion provision from their scope of practice. Improving medication abortion provision by family physicians requires addressing the individual and system barriers family physicians encounter so they receive the education, training, and support to successfully integrate abortion care into clinical practice.

Expanding the Pool of Abortion Providers: Nurse–Midwives, Nurse Practitioners, and Physician Assistants

ObjectiveTo demonstrate the feasibility and safety of training midlevel healthcare providers (midwives and family nurses) to provide medical abortion and postabortion contraception in underserved areas in Kyrgyzstan. Study designThis was an implementation study at four referral facilities and 28 Felsher Obstetric Points in two districts to train their midwives and family nurses to deliver safe and effective abortion care with co-packaged mifepristone–misoprostol and provide contraceptives postabortion. The outcome of abortion — complete abortion, incomplete abortion or o-going pregnancy — was the primary end point measured. An international consultant trained 18 midwives and 14 family nurses (with midwifery diplomas) to provide medical abortion care. Supervising gynecologists based in the referral centers and study investigators based in Bishkek provided monthly monitoring of services and collection of patient management forms. A voluntary self-administered questionnaire at the follow-up visit documented women's acceptability of medical abortion services. All study data were cross-checked and entered into an online data management system for descriptive analysis. ResultsBetween August 2014 and September 2015, midwives provided medical abortion to 554 women with a complete abortion rate of 97.8%, of whom 62% chose to use misoprostol at home. No women were lost to follow-up. Nearly all women (99.5%) chose a contraceptive method postabortion; 61% of women receiving services completed the acceptability form, of whom more than 99% indicated a high level of satisfaction with the service and would recommend it to a friend. ConclusionThis study demonstrates that trained Kyrgyz midwives and nurses can provide medical abortion safely and effectively. This locally generated evidence can be used by the Kyrgyz Ministry of Health to reduce unintended pregnancy and expand safe abortion care to women in underserved periurban and rural settings. ImplicationsSuccess in scaling up midwife/nurse provision of medical abortion in Kyrgyzstan will require registration of mifepristone–misoprostol, regulations permanently allowing midwife/nurse provision, strengthened procurement and distribution systems to prevent stockouts of supplies, preservice training of midwives/nurses and their involvement in district level supervision, monitoring and reporting, and support from supervisors.

Intention to provide abortion upon completing family medicine residency and subsequent abortion provision: a 5-year follow-up survey

Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19

“We’ve got rights and yet we don’t have access”: Exploring patient experiences accessing medication abortion in Australia

ObjectivesTo synthesise primary research findings about factors that affect medical abortion provision by general practitioners, nurses, midwives, and pharmacists in Australia.Study designMixed methods systematic review of peer‐reviewed primary publications of qualitative, quantitative, and mixed methods studies of the provision of medical abortion in Australian primary care, 1 January 2013 – 18 January 2025.Data sourcesMEDLINE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature).Data synthesisTwenty‐three publications satisfied our inclusion criteria. We undertook a thematic synthesis of the qualitative study findings to identify barriers and facilitators of medical abortion provision, and assessed the confidence of each review finding using the GRADE‐CERQual approach; we also compared the qualitative synthesis with quantitative study findings. We developed ten review findings grouped under three themes: moral, legal, and regulatory influences on abortion care (three review findings; very low to moderate confidence); the absence of a systems‐based approach to abortion provision (six review findings; moderate to high confidence); and early medical abortion belongs in primary care (one review finding; high confidence). Barriers to providing medical abortion include the absence of a supportive service delivery strategy, insufficient Medicare remuneration, geographic isolation, limited access to training, and colleagues who conscientiously object to abortion. Facilitators of its provision include clinician support networks and personal motivation to improve access to reproductive health care.ConclusionsA range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse‐led models of care, and the integration of abortion care into primary care.

Since Dobbs v Jackson Women's Health Organization (Dobbs) removed federal abortion protections, people's views about alternative models of abortion care may have been impacted, yet research on this topic is limited. To examine changes in national support for and personal interest in advance provision (AP) and over-the-counter (OTC) access to medication abortion. Two nationally representative cross-sectional online surveys were administered to a market research firm's panel members who were assigned female at birth (AFAB) and aged 15 to 49 years from December 2021 to January 2022 (before Dobbs) and June to July 2023 (after Dobbs). Data were analyzed from February 2023 to June 2024. Completion of survey before and after Dobbs. Changes from before to after Dobbs in 4 primary outcome measures were examined: support for and personal interest in AP and OTC access to medication abortion. A total of 6982 AFAB people before Dobbs and 3561 after Dobbs completed at least 1 of 4 primary outcome measures. From before to after Dobbs, 2666 (weighted 31.3%) and 1258 (weighted 30.1%) were aged 30 to 39 years, 1395 (21.4%) and 708 (21.5%) reported their race and ethnicity as Hispanic/Latinx, 594 (13.7%) and 304 (13.6%) as Black non-Hispanic/Latinx, and 4504 (54.6%) and 2270 (54.2%) as White non-Hispanic/Latinx. There was a significant increase from before to after Dobbs in national support for AP (48.9% before; 95% CI, 47.1% to 50.6%; 55.1% after; 95% CI, 52.8% to 57.3%) and OTC access (49.4% before; 95% CI, 47.6% to 51.1%; 55.2% after; 95% CI, 52.9% to 57.5%) and an increase in personal interest in AP (23.6% before; 95% CI, 22.2% to 25.1%; 26.4% after; 95% CI, 24.3% to 28.4%) and OTC access (36.0% before; 95% CI, 34.3% to 37.6%; 42.5% after; 95% CI, 40.2% to 44.7%). Among people living in states with abortion bans, larger increases in personal interest in AP (5.3 percentage points [pp]; 95% CI, 0.5 to 10.3 pp) and OTC access (9.4 pp; 95% CI, 3.9 to 14.9 pp) were observed than among people in states without bans (1.4 pp; 95% CI, -1.7 to 4.6 pp and 5.4 pp; 95% CI, 2.0 to 8.9 pp, respectively). In this serial cross-sectional analysis of people aged 15 to 49 years before Dobbs and 1 year after Dobbs, findings suggested that national support for expanded access to medication abortion has grown. Alternative models of care, such as AP and OTC, have the potential to offer a promising approach to abortion care, particularly for people living in abortion-restricted states.