Provide Abortion Care Research Articles

“With an unwanted pregnancy, we are looking for midwives in the neighbourhood to show us what to do.” Stakeholder perceptions of midwife-led woman-centred comprehensive abortion care in the province of Kinshasa, Democratic Republic of Congo: a qualitative descriptive study

ProblemMidwives are an essential yet underutilised health human resource for improving unsafe abortion outcomes and increasing abortion access and contraceptive care. BackgroundIn Democratic Republic of Congo (DRC), morbidity and mortality resulting from unsafe abortions are alarmingly high. The recent ratification of the Maputo Protocol in 2018 has made safe abortion accessible. National implementation strategies recognise midwives as providers of comprehensive abortion care (CAC), yet there is little understanding of their current role in its provision. AimTo understand the obstacles and facilitators in integrating the midwifery model of CAC in DRC's health system. MethodsA qualitative descriptive design was used to explore health system stakeholders' perceptions regarding the midwifery model of CAC in Kinshasa, DRC. Data sources included n=43 key informant interviews and n=2 FGDs. Results were member-checked with DRC Midwives’ Association (SCOSAF) members. FindingsFindings highlight midwives provided all aspects of CAC, with attention to the psycho-social well-being of their clients and acted as health service navigators in the community. Appropriate midwifery legislation, scope of practice that includes CAC, administrative support and remuneration, and better access to continuing education are facilitating health system factors for the midwifery model of CAC. Finally, SCOSAF, the Midwives’ Association, played an influential role in the implementation, positively supporting CAC integration by midwives. DiscussionUnderstanding health system levers and the involvement of Midwives’ Associations are important considerations when integrating and sustaining the midwifery model of CAC. Gender transformative approaches are appropriate given systemic gender inequities inherent in midwifery. ConclusionFurther research is needed to understand the impact of the midwifery model of CAC in DRC.

Phantom data and the potentials of radical caretaking in reproductive health.

The potentials of digital health to improve health outcomes by empowering patients with more control over their health data have transformed into threats of criminalization in the post-Roe era, threats that are creating serious, and at times deadly, harms to patients and the providers that care for them. While patients' health data are increasingly used to criminalize healthcare, data activists, legislators, and lawyers are engaged in radical caretaking strategies to protect health data, patients, and abortion care providers.

Abortion.

Induced abortion is safe, is common, and reduces pregnancy-related maternal morbidity and mortality. Internal medicine physicians are uniquely positioned to counsel patients on their pregnancy options, assess medical risks of pregnancy in the context of comorbidities, refer for abortion care when the patient desires it, or provide abortion care themselves. Clinicians can also provide anticipatory guidance about what patients should expect if they seek abortion care.

Online Medication Abortion Direct-to-Patient Fulfillment Before and After the Dobbs v Jackson Decision

Online pharmacies have emerged as stakeholders in abortion care since the US Food and Drug Administration (FDA) relaxed in-person dispensing requirements in 2020. The role of online pharmacies in dispensing abortion medications following the Dobbs v Jackson Women's Health Organization decision on June 24, 2022, is understudied. To describe medication abortion prescription fulfillment patterns for 1 online pharmacy 1 year before and after the Dobbs v Jackson decision, considering patient, prescriber, and state policy characteristics. This cross-sectional study assesses deidentified medication abortion prescription fulfilment data from 1 online pharmacy. Prescribers sent prescription requests to the online pharmacy, which dispensed abortion medications to patients by mail. The study sample included prescription requests fulfilled by the online pharmacy between June 20, 2021, and June 24, 2023, for patients aged at least 18 years who received the combined medication abortion regimen. Data were analyzed from July 2023 to July 2024. The US Supreme Court Dobbs v Jackson decision on June 24, 2022. Patient and prescriber characteristics are described, including patient age, state to which the prescription was sent, medications prescribed, and prescribing prescriber's clinic care modality (in-person only, hybrid [in-person and virtual], and virtual only). States were grouped according to the Guttmacher Institute classification of policy support for abortion (most or very supportive, somewhat supportive, and somewhat restrictive). Fulfillment trends were disaggregated by prescriber modality and state policy environment; 2 states with similar telehealth but differing coverage policies (Illinois and Colorado) were compared. The dataset included 87 942 observations. Most prescriptions were sent to individuals younger than 30 years (57.1%), with a mean (SD) age of 28.7 (6.4) years. Throughout the study period, the greatest volume of prescription requests came from states with most or very supportive policies and from prescribers at virtual-only platforms. More prescriptions were sent in the year after Dobbs v Jackson (daily mean [SD], 88.5 [47.2] prescriptions in March 2022 vs 201.5 [97.5] prescriptions in March 2023) with fulfillment spikes following the Dobbs v Jackson leak on May 2, 2022, and decision on June 24, 2022. State policy contexts mirrored the overall trends, while prescriber modality trends were unique, with a big spike in fulfillment at 12 weeks after the Dobbs v Jackson decision for hybrid clinics compared with in-person-only clinics and telehealth-only platforms, which saw their largest spikes in mean daily prescription fulfillment the week immediately after Dobbs v Jackson. Illinois and Colorado had similar fulfillment trends, with spikes immediately following the Dobbs v Jackson decision and overall higher fulfillment after Dobbs v Jackson, with a daily mean (SD) of 10.5 (7.0) prescriptions in Illinois and 8.8 (5.7) prescriptions in Colorado in March 2022 versus 26.6 (13.6) prescriptions in Illinois and 16.7 (10.1) prescriptions in Colorado in March 2023. These findings illustrate the increasingly critical role online pharmacies play in direct-to-patient abortion care provision in the US and the strong linkages between virtual-only prescribers and online pharmacies. These findings suggest that barriers to accessing online pharmacies for abortion care should be removed.

Choosing to Provide: Early Medical Abortion and Clinician Conscience in Ireland

Providers are essential to the delivery of abortion care. Yet, they often occupy an ambiguous space in political discourse around abortion. The introduction of a new abortion service in Ireland invites us to look afresh at providers. Since the Health (Regulation of Termination of Pregnancy) Act 2018 came into force, by far the most common form of abortion care has been early medical abortion (EMA). This is typically provided by General Practitioners (GPs), with approximately 10% of GPs having chosen to provide EMA. This article draws on an empirical study of providers to investigate their motivations for, and experiences of, provision and their views on colleagues who have not chosen to provide. The study shows that for many providers, the choice to provide was grounded in a moral commitment to protecting women’s rights to autonomy and health and ensuring that the harms of the past were not repeated. The article argues that notwithstanding increased normalisation of EMA in Ireland, conscience still has a role to play in abortion care provision and it is important to reflect on the various aspects of this role.

Strengthening the Provision of Abortion and Sexual and Reproductive Health Care Post-Dobbs: An Initiative of the Philadelphia Department of Public Health

The U.S. Supreme Court decision on Dobbs v. Jackson Women’s Health has had a disruptive impact on not only the patients who seek reproductive health care, abortion care providers, and abortion care–adjacent organizations, but has also sparked a need for public health departments to take on new roles to support their communities. In the wake of that 2022 decision, the Philadelphia Department of Public Health launched an ongoing initiative to increase support for the provision of abortion and sexual and reproductive health care. The authors describe the effort, which started with a landscape analysis and qualitative interview analysis to understand the needs and concerns of those comprising the abortion care delivery system in Philadelphia. The authors found that the immediate, short-term needs to support the local abortion care delivery network included funding for patients seeking abortion care, plus communication and education to counter misinformation about the legality of abortion in Pennsylvania. Through the initiative’s research efforts, the authors also found that long-term needs included care capacity–building and health systems–strengthening by removing non–evidence-based restrictions on abortion access and care. Another ongoing role for public health systems is to address and avert legislative or regulatory efforts to impose restrictions to Medicaid coverage for abortion services or other impediments that would disrupt the ability or capacity of health care providers to deliver comprehensive reproductive care. Today, public health departments are uniquely suited to address and mitigate the emerging post-Dobbs chilling effect on both patients and clinicians who may fear legal, professional, or personal consequences as they navigate options for appropriate, evidence-based reproductive health care, even in states where abortion remains legal.

Doctors’ voices generate support for abortion care: Results from a nationally representative survey

ObjectiveWe tested abortion messaging to develop evidence-based communication recommendations for doctors who provide abortion care. Study DesignWe conducted an on-line survey in a nationally representative sample of 1,215 people, using NORC’s Amerispeak® Panel. We surveyed participants before and after viewing two brief videos featuring doctors who provide abortion care speaking about their work. Doctors’ comments were grounded in strategic communications and applied psychology research and emphasized caregiving roles, avoided political-sounding punditry, and acknowledged abortion’s complexities. We assessed participants’ characterizations of doctors who provide abortion care, how these characterizations impact support for abortion restrictions and overall views on abortion legality. We analyzed pre-post data using descriptive statistics, t-tests and multivariable regression. ResultsPost-messaging more participants endorsed positive descriptors of doctors who provide abortion care (p<0.001,t=8.99); fewer endorsed negative descriptors (p<0.001,t=10.32). Increased post-messaging endorsement of positive descriptors predicted declines in support for abortion restrictions (AOR = 1.69,p<0.01); decreased endorsement of negative descriptors did not. After messaging, 37% of respondents said their views of doctors who provide abortion care made them less likely to support abortion restrictions, compared to 14% before (p<0.001,t=-6.9). After messaging there was more overall support for legal, accessible abortion and less for abortion being mostly illegal (46%→48% and 24%→22%,p<0.001;t=-4.11). ConclusionsWhen doctors who provide abortion care use messaging recommendations that include speaking about abortion’s complexities and avoiding political-sounding punditry, they generate more support for legal abortion and less for restrictions. ImplicationsThe voices of doctors who provide abortion care shape abortion public opinion. When doctors speak from caregiving perspectives, avoid punditry, and acknowledge abortion’s complexities they generate more support for legal abortion and less for restrictions. However, audiences may not be aware a priori that ideas of doctors shape their views.

Providers' experiences with abortion care: A scoping review.

Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains controversial. The objective of this scoping review was to explore and map existing literature on the experiences of those who provide abortion care. This exploratory review followed the Levac et al. guidelines and was reported in accordance with the PRISMA-ScR checklist. CINAHL, Cochrane, EMBASE, PsycInfo, PubMed, and Web of Science were used to identify peer-reviewed, original research articles published on providers' experience of abortion. We identified 106 relevant studies, which include a total sample of 4,250 providers from 28 countries and six continents. Most of the studies were qualitative (n = 83), though quantitative (n = 15) and mixed methods (n = 8) studies were also included. We identified two overarching themes: (1) Providers' experiences with abortion stigma and (2) Providers' reflections on their abortion work. Our findings suggest that providers from around the world experience challenges within society and their communities and workplaces which reinforce the stigmatization and marginalization of abortion and pose questions about the morality of this work. Most, however, are proud of their work, believe abortion care to be socially important and necessary, and remain committed to the provision of care. The findings of this review provide a comprehensive overview on the known experiences of providing abortion care. It is a key point of reference for international providers, researchers, and advocates to further this area of research or discussion in their own territories. The findings of this review will inform future work on how to support providers against stigmatization and will offer providers the chance to reflect on their own experiences.

Trail Magic

In this narrative medicine essay, an obstetrician-gynecologist describes a day in her life of crossing state lines to provide abortion care for people from all over the Southeast US in the post-Dobbs era.

The importance of abortion training for obstetrician-gynecologists: A comparison of the United States, Sweden, and Ghana.

Since 2020, World Health Organization guidelines state that universal access to abortion care is critical for individual and community health, and for the realization of human rights. Yet the right to access safe abortion care is severely restricted in many countries. This article outlines institutional and educational systems in the USA, Sweden, and Ghana, which all require obstetrics and gynecology (ob-gyn) training to include abortion care but vary in implementation. It argues that regardless of the political environment, the specialty should protect abortion training worldwide. In Sweden and Ghana, ob-gyn residents are required to participate in abortion training, while in the USA they are permitted to opt out. In Sweden, practicing ob-gyn specialists are required to provide abortion care, whereas in Ghana and the USA, this care is optional, leading to geographic disparities in abortion care access in these two countries. In the USA, the Supreme Court's Dobbs ruling jeopardizes programs' abilities to meet the training mandate, a requirement that was insufficiently implemented even before the ruling. It is critical that all clinicians are well-equipped to provide accurate information to their patients and provide pre- and post-abortion care. For this reason, we recommend that abortion is included in all undergraduate medical education programs in accordance with the recommendations of FIGO (the International Federation of Gynecology & Obstetrics). To meet WHO guidelines that require ob-gyn specialists to provide abortion care in an emergency, we urge FIGO to create a guideline about expectations for abortion training integration in obstetrics and gynecology.

"I Went Into This Field to Empower Other People, and I Feel Like I Failed": Residents Experience Moral Distress Post-Dobbs.

Background The 2022 Supreme Court ruling in Dobbs v Jackson Women's Health Organization nullified the constitutional right to abortion, which led to effective bans in at least 14 US states and placed obstetrics and gynecology (OB/GYN) residents in dilemmas where they may have to withhold care, potentially causing moral distress-a health care workforce phenomenon less understood among resident physicians. Objective To identify and explore moral distress experienced by OB/GYN residents due to care restrictions post-Dobbs. Methods In 2023, we invited OB/GYN residents, identified by their program directors, training in states with restricted abortion access, to participate in one-on-one, semi-structured interviews via Zoom about their experiences caring for patients post-Dobbs. We used thematic analysis to analyze interview data. Results Twenty-one residents described their experiences of moral distress due to restrictions. We report on 3 themes in their accounts related to moral distress (and 4 subthemes): (1) challenges to their physician identity (inability to do the job, internalized distress, and reconsidering career choices); (2) participating in care that exacerbates inequities (and erodes patient trust); and (3) determination to advocate for and provide abortion care in the future. Conclusions OB/GYN residents grappled with moral distress and identified challenges from abortion restrictions.

Defying the odds: Facilitating integration of abortion care into clinical practice in the United States

ObjectivesWe sought to describe the experiences of physicians who successfully incorporated abortion care into their practices in the United States. We explored facilitators of and barriers to abortion provision. Study designIn this qualitative study, we conducted semistructured interviews with a national sample of obstetrician–gynecologists and family medicine physicians providing abortion care. Interviews addressed facilitators of and barriers to abortion provision, lessons learned and recommendations for future providers. We analyzed data using a content analysis approach. ResultsWe interviewed 14 obstetrician–gynecologists and 11 family medicine physicians providing abortion care as part of their practices. We identified four categories of facilitators and barriers: personal, community, training, and workplace factors. Major facilitators included supportive leadership and professional mentorship. Major barriers included antagonistic colleagues and leadership. Lessons learned included proactively assessing leadership support, identifying institutional allies, actively minimizing workplace conflict and being perceived as a team player. Recommended resources to increase abortion provision included clinical support, mentorship, funding, negotiation coaching, and access to clinical policies. ConclusionsInstitutional leadership support emerged as a critical facilitator for initiating and continuing to offer abortion care. Efforts to expand abortion access should include investments in supportive leadership, both in academic and community practices. ImplicationsMaximizing abortion access is essential to counteract the legislative and political restrictions imposed on abortion care. Institutional support is a critical facilitator of abortion provision, and efforts to expand abortion access should include investments in supportive leadership and health care administration.

Effect of Dobbs v. Jackson Women's Health on Obstetrics and Gynecology Residency Applicants [ID 2683390

INTRODUCTION: Abortion restrictions affect not only provision of abortion care but also experience for trainees. Data from the 2023 match showed a decrease in obstetrics and gynecology residency applications in restrictive states. Our national survey of medical students applying to obstetrics and gynecology residency sought to assess the effects of the Dobbs decision on their application process. METHODS: Medical students who applied to obstetrics and gynecology residency for the 2023 match were surveyed via an electronic questionnaire. Convenience sampling was used. Institutional review board waiver was granted. RESULTS: One hundred seventy-eight students, from 39 different states, completed the survey. The average age was 27.8 years, and the majority identified as women (89%) and White (80.9%). The majority (72.7%) of respondents reported that the Dobbs decision influenced which residency programs they applied to, and of those, 96.9% report that they applied to programs in states with fewer abortion restrictions. Similarly, 66.5% reported that the decision influenced their rank list, and of those, 98.3% report they ranked programs in states that are less restrictive on abortion services higher. CONCLUSION: Access to abortion training was identified as important to a majority of survey respondents. Students reported applying to states with less abortion restrictions and that access to abortion training influenced their rank list. Prior studies have surveyed third- and fourth-year students about predicted effects of the Dobbs decision on residency applications. This is the first to assess perspectives among students who completed the residency application process.

낙태죄 비범죄화 이후

Access to safe abortion is a key aspect of sexual and reproductive rights. However, even after the decriminalization of abortion in 2021, abortion care has not been normalized in South Korea. This study analyzes the current state of medical assistance and access to abortion after decriminalization, with a focus on abortion due to sexual violence, keeping in mind that abortion, even before decriminalization, was not punished and it was included in the government’s medical expenses subsidy. In-depth interviews with sexual violence victim support workers and healthcare providers revealed that while decriminalization has improved access to care and information, many interviewees did not see any significant changes in medical support for abortion for sexual violence victims. Both support organizations and providers often felt that “abortion has not been legal yet” and as a result, they felt that they were under pressure to make sure that a pregnancy was the result of sexual violence in order to justify providing assistance to victims. As a result they tend to impose strict requirements on victims for providing medical assistance for them. In some cases, support organizations required a complaint of sexual violence, DNA matching of the perpetrator and the fetus, a case conference decision by an external advisor, or parental consent for adolescent victims as prerequisites for medical assistance, which made it impossible for victims to receive assistance. In addition, the Ministry of Gender Equality and Family’s guidelines discourage supporting organizations to apply for assistance as the guidelines stress the possibility of being accused of false accusation and redeeming of support money. It was also pointed out that the guidelines do not specify whether to support medical expenses for pregnancies resulting from prostitution, so the possibility of support is ambiguous. The most difficult thing with regard to supporting abortion was to find a medical professional who would provide medical care ad abortion to victims. Despite being a victim of sexual violence, women were frequently rejected by healthcare providers and were not officially provided with information on which hospitals could provide abortion care. The experiences of being rejected by medical professionals or support organizations in itself caused worse stigma and pain of abortion for victims. Even at hardly found hospitals, it was often the case that hospitals refuse abortion operation expenses be covered by medical insurance and charged high fees while abortions were mostly performed surgically. Parental consent was required for all processes of investigation and medical assistance, leading adolescent victims to abandon their requests for assistance because they were unable to inform their guardians about their problems. There were also challenges in ensuring the right to self-determination for victims with developmental disabilities. Secondary victimization has been found occurred during the medical assistance, investigation, and victim assistance processes. Post-abortion support for contraception was limited, and counseling and follow-up support were scarce. Since the decriminalization of abortion, amendments to the abortion law were submitted to the National Assembly which maintain the punishment of abortion but limiting them based on respective of reasons. The Ministry of Women and Family Affairs’ policy regarding abortion is that it will only fund abortions in some cases of sexual violence. However, the results of the in-depth interviews show that no support for abortion is possible while criminalizing or stigmatizing it in principle. Given the above-mentioned interview results, this study recommends the measures to ensure the right to abortion for sexual violence victims.

Experiences with and unmet needs for medication abortion support: A qualitative study with US abortion support providers.

Quality abortion care must be person-centered. Although academic literature has focused on full-spectrum and abortion doulas supporting instrumentation abortion (also referred to as procedural abortion)clients, clients undergoing medication abortion remain understudied and may have unique needs. We aimed to understand United States (US) abortion support providers' perceptions of medication abortion clients' support needs by exploring which needs they address, which needs remain unmet, and how remote support provision might help address client needs. Between April and October 2018, we conducted 60- to 90-min semi-structured, in-depth interviews by telephone with medication abortion support providers. The interviews focused on their experiences providing support to medication abortion clients in the US. We used a deductive thematic analysis approach. We interviewed 16 abortion support providers affiliated with nine US-based organizations. Six participants provided in-person support to medication abortion clients, five provided remote support, and five provided both remote and in-person support. Both in-person and remote providers described offering support that addressed clients' informational, emotional, physical, spiritual, and logistical needs. Through participant narratives, we identified interwoven benefits and challenges to remote support care provision. Participants highlighted that most medication abortion clients did not have a support provider. Participants revealed that abortion support providers, including remote support providers, can be a critical component of high-quality abortion care provision. More work is needed to ensure all abortion clients have access to support services as the abortion landscape in the US continues to evolve.

“That is when I understood everything”: Ideological trajectories of pro-choice female doctors in Mexico

ObjectivesThere is little global evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of self-identified pro-choice female Mexican doctors and the factors that made them become pro-choice. Study DesignIn this qualitative study we conducted semi-structured interviews with members of the Mexican Network of Female Pro-choice Physicians (Red de Médicas por el Derecho a Decidir - México). Participants came from 8 diverse states in Mexico. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training). ResultsWe included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from “pro-life” to “pro-choice”. Participants described an absence of abortion training in medical schools or stigmatizing training, and the use of alternative training sources. ConclusionIn the absence of training on abortion during the medical education, a combination of intersecting personal as well as work-related experience may turn doctors in to pro-choice abortion clinicians and/or advocates. Training on abortion care in medical education and stigma reduction in Mexican society is essential. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors in who have never received training on abortion care, such as promoting interactions between doctors and non-medical abortion providers, education on inequalities and violence against women, moving beyond a public health to a human rights and gender perspective, and exposure to routine safe abortion care. ImplicationsMexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Assessment of relevance and actual implementation of person-centeredness in healthcare and social support services for women with unintended pregnancy in Germany (CarePreg): results of expert workshops

IntroductionPerson-centeredness is a key principle in the German healthcare system. However, access to high-quality care for women with unintended pregnancy is limited due to social stigma and legal restrictions. There is little research on the adoption of person-centeredness in care for women with unintended pregnancy. The aim of this study was to analyze relevance and actual implementation of dimensions of person-centeredness in psycho-social and medical abortion care from the view of abortion care providers.MethodsCounselors and gynecologist working in psycho-social or medical abortion care participated in one of two digital workshops. Discussions were semi-structured based on the 16 dimensions of an integrative model of person-centeredness, audio-recorded and transcribed verbatim. During qualitative content analysis, deductive categories based on the integrative model of person-centeredness were applied and inductive categories were developed. Additionally, participants rated relevance and actual implementation of the dimensions in an online survey.ResultsThe 18 workshop participants most intensively discussed the dimensions “access to care”, “person-centered characteristics of healthcare providers” and “personally tailored information”. Four additional categories on a macro level (“stigmatization of women with unintended pregnancy”, “stigmatization of healthcare providers”, “political and legal aspects” and “corona pandemic”) were identified. Most dimensions were rated as highly relevant but implementation status was described as rather low.ConclusionsIn Germany, high quality person-centered care for women with unintended pregnancy is insufficiently implemented through limited access to information, a lack of abortion care providers, and stigmatization. There is a need for changes in health care structures to enable nationwide person-centered care for women with unintended pregnancy. Those changes include a more easy access to evidence-based information and person-centered abortion care, more education on abortion care for healthcare providers, integration of topics of abortion care in medical schools and promotion of de-stigmatizing actions to enable abortions as part of the general healthcare.

“All hands on deck”: a qualitative study of safeguarding and the transition to telemedical abortion care in England and Wales

The COVID-19 pandemic raised significant challenges for in-person healthcare provision, leading healthcare providers to embrace digital health like never before. Whilst changes were made as part of a public health response, many have now become permanent fixtures of the healthcare landscape, significantly altering the way care is provided not only for patients, but also for the healthcare professionals that provide care. In abortion care in England and Wales, previously stringent regulations on in-person care provision were relaxed to permit the use of telemedicine and self-administration of medications at home. These changes have since been made permanent. However, there remains opposition to remote abortion care pathways on the basis of safeguarding. Opponents argue that it is not feasible to effectively safeguard patients accessing abortion care remotely. We conducted a qualitative study using semi-structured interviews with abortion care providers in England and Wales. Participants were asked about their views and experiences of the transition to remote care provision, with a particular focus on how they adapted their safeguarding practice. In this article, we present three themes that highlight the changing roles of healthcare professionals in abortion care: (1) a challenging backdrop and resulting apprehension, (2) adaptive practices, and (3) the continued importance of professional curiosity. Across all three themes, participants reflected significantly on how changes were made and what they experienced in the period of transition to telemedicine. In particular, they discussed the changing nature of their professional roles amidst digitalisation. Our findings provide a basis for reflection on the increasing introduction of digital approaches to healthcare provision, highlighting points for caution and emphasising the need to involve professionals in the transition process to ensure vital buy-in. Through this, we articulate two novel understandings of digitalisation: (1) the impact of speed-associated pressures on professional adaptation during digitalisation, and (2) off-proforma safeguarding through telemedicine as a form of invisible non-routine work.

Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences.

In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.

The association between abortion training and obstetrics and gynecology resident competence and intention to provide abortion care before Dobbs

ObjectiveTo assess the role of abortion training in fourth-year obstetrics and gynecology (OBGYN) residents’ abortion care competence and practice intentions before the Dobbs decision. Study designThis is a planned secondary analysis of survey data of fourth-year U.S. OBGYN residents. Abortion training was defined as ‘routine’ if automatically included in schedules, ‘‘optional’’ if not scheduled but available, and ‘‘not available’’. Self-assessed competence was defined as feeling prepared to independently provide care. Participants were asked about their competence and post-residency intentions to provide specific aspects of pregnancy loss and induced abortion care. ResultsOf 1241 fourth-year residents, 885 (71%) completed the questions of interest. For each skill, more residents with routine training reported competence compared to those with less comprehensive training. More residents with routine training reported intentions to include abortion care in practice (422, 79%) compared to residents with optional (171, 66%) or no training (51, 55%), p < 0.001). Residents with routine training were nearly six times more likely to intend to provide medication abortion post-residency compared to residents without training; more residents in all groups reported intentions to provide care for pregnancy loss compared to abortion. ConclusionsPre-Dobbs, residents with routine abortion training had greater self-assessed competence in abortion care than those with optional or no training and were more likely to intend to provide this after residency. Given the evolving impacts of the 2022 reversal of Roe v Wade, residency training programs must work to ensure routine access to legally permissible abortion training as routine training is associated with intention to provide fundamental, reproductive healthcare. ImplicationsRoutine training in abortion care during OBGYN residency is associated with higher competence and intention to provide post-residency – availability of this training Is severely compromised in restricted states post-Dobbs.