Abortion Providers Research Articles

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.

The woman is the active agent: General practitioners and the agentive displacement of abortion in Ireland.

After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next-to-no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors' desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico-legal frameworks within the topic of assisted dying, I build on Anita Hannig's idea of "agentive displacement" to frame the productive impact of abortion pills on this transition.

Demand for abortion training and technical assistance in primary care: Unmet need and programmatic interventions

ObjectiveQuantify primary care provider requests for abortion training and technical assistance (TA) and availability of programs to support abortion provision. Study designWe reviewed requests for training and TA from four programs focused on capacity building for abortion care. Collectively, these programs serve every region of the United States. ResultsBetween January 1, 2021 – September 30, 2022, the programs received 207 requests for training and/or TA from individuals and organizations in 30 states. Approximately 60% of requests went unfulfilled due to programs’ capacity constraints. ConclusionsUnmet demand for training and TA to integrate abortion into primary care is significant. Increasing the availability of training and TA could increase the abortion workforce and improve access to care.

Abortion Provision and Delays to Care in a Clinic Network in Washington State After Dobbs

The Supreme Court decision Dobbs v Jackson Women's Health Organization (Dobbs) overturned federal protections to abortion care and altered the reproductive health care landscape. Thus far, aggregated state-level data reveal increases in the number of abortions in states where abortion is still legal, but there is limited information on delays to care and changes in the characteristics of people accessing abortion in these states after Dobbs. To examine changes in abortion provision and delays to care after Dobbs. Retrospective cohort study of all abortions performed at an independent, high-volume reproductive health care clinic network in Washington state from January 1, 2017, to July 31, 2023. Using an interrupted time series, the study assessed changes in abortion care after Dobbs. Abortion care obtained after (June 24, 2022, to July 31, 2023) vs before (January 1, 2017, to June 23, 2022) Dobbs. Primary outcomes included weekly number of abortions and out-of-state patients and weekly average of gestational duration (days) and time to appointment (days). Among the 18 379 abortions during the study period, most were procedural (13 192 abortions [72%]) and funded by public insurance (11 412 abortions [62%]). The mean (SD) age of individuals receiving abortion care was 28.5 (6.44) years. Following Dobbs, the number of procedural abortions per week increased by 6.35 (95% CI, 2.83-9.86), but then trended back toward pre-Dobbs levels. The number of out-of-state patients per week increased by 2 (95% CI, 1.1-3.6) and trends remained stable. The average gestational duration per week increased by 6.9 (95% CI, 3.6-10.2) days following Dobbs, primarily due to increased gestations of procedural abortions. The average gestational duration among out-of-state patients did not change following Dobbs, but it did increase by 6 days for in-state patients (5.9; 95% CI, 3.2-8.6 days). There were no significant changes in time to appointment. These findings provide a detailed picture of changes in abortion provision and delays to care after Dobbs in a state bordering a total ban state. In this study, more people traveled from out of state to receive care and in-state patients sought care a week later in gestation. These findings can inform interventions and policies to improve access for all seeking abortion care.

Unequal Spatial Consequences of Abortion Restrictions in Texas, 2021-2023.

Objectives. To demonstrate the spatially uneven effects of abortion restriction laws in Texas. Methods. We used network analysis to determine the change in distance to the nearest surgical abortion provider for 5253 Texas neighborhoods after the passing of Texas Senate Bill 8 (SB8; 2021) and the US Supreme Court's Dobbs v Jackson Women's Health Organization (2022) decision. We identified associations between key measures of neighborhood socioeconomic context and change in distance to providers using multivariable linear regression models. Results. After the Dobbs decision, Texas residents experienced an average change in distance to the nearest provider of 457 miles (SD = 179). Neighborhoods of concentrated disadvantage experienced the greatest increase in distance to abortion providers after SB8's passing, and neighborhoods with high levels of income inequality experienced the greatest increase in distance after the Dobbs decision. Conclusions. We document the rapidly changing abortion landscape in a highly restrictive state and show that women living in more disadvantaged and unequal areas are most affected by the increasing distance to providers. Public Health Implications. Our methods and findings will continue to be relevant in understanding the burden placed on women in areas where medical abortion has been restricted because of the Dobbs decision. (Am J Public Health. 2024;114(10):1024-1033. https://doi.org/10.2105/AJPH.2024.307652).

Comparing hospital- vs. non-hospital-affiliated clinic adoption of abortion innovations and cash-pay availability during the COVID-19 pandemic: A secondary analysis of a United States nationwide survey

ObjectivesWe examined differences between hospital-affiliated clinics and non-hospital-affiliated clinics (independent or Planned Parenthood clinics) regarding abortion service innovation and cash-pay availability in response to COVID-19. Study designWe analyzed data from all three phases of a longitudinal nationwide survey of abortion providers conducted by the Society of Family Planning. ResultsThis study utilizes a convenience sample of 74 voluntarily participating clinics, representing about 5% of clinics nationwide. Compared to non-hospital-affiliated clinics, hospital-affiliated clinics were more likely to initiate care innovations but were less likely to offer cash-pay during the pandemic. ConclusionsBoth hospital-affiliated and non-hospital-affiliated clinics enacted patient-centered care innovations during the pandemic. Hospital-affiliated clinics were more likely to initiate innovative services, particularly surrounding telemedicine. Hospital-affiliated clinics can improve cash-pay availability to expand access to abortion care in times of national emergencies.

Person-centered abortion care scale: Validation for medication abortion in the United States

ObjectiveMedication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States. Study designThis study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses. ResultsExploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction. ConclusionThis study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts. ImplicationsThis study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.

Mail-Order Pharmacy Dispensing of Mifepristone for Medication Abortion After In-Person Screening

Before 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion. To estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy. This prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days' gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023. Mifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person. Proportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications. Clinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing. The findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.

Predictors and experiences of seeking abortion services from pharmacies in Nepal.

Abortion was legalized in Nepal in 2002; however, despite evidence of safety and quality provision of medical abortion (MA) pills by pharmacies in Nepal and elsewhere, it is still not legal for pharmacists to provide medication abortion in Nepal. However, pharmacies often do provide MA, but little is known about who seeks abortions from pharmacies and their experiences and outcomes. The purpose of this study is to understand the experiences of women seeking MA from a pharmacy, abortion complications experienced, and predictors for denial of MA. Data was collected from women seeking MA from four pharmacies in two districts of Nepal in 2021-2022. Data was collected at baseline (N = 153) and 6 weeks later (N = 138). Using descriptive results and multi-variable regression models, we explore differences between women who received and did not receive MA and predictors of denial of services. Most women requesting such pills received MA (78%), with those who were denied most commonly reporting denial due to the provider saying they were too far along. There were few socio-demographic differences between groups, with the exception of education and gestational age. Women reported receiving information on how to take pills and what to do about side effects. Just under half (45%) of women who took pills reported no adverse symptoms after taking them and only 13% sought care. Most women seeking MA from pharmacists in Nepal are receiving services, information, and having few post-abortion symptoms. This study expands the previous limited research on pharmacy provision of MA in Nepal using a unique dataset that recruits women at the time of abortion seeking and follows them over time, overcoming potential biases present in other study designs. This suggests that expansion of the law to allow pharmacy distribution would increase accessibility and reflect current practice.

Ontario Midwives’ Attitudes About Abortion and Abortion Provision

Objective: In Ontario and across Canada, midwives do not provide pregnancy termination but provide referrals and support for clients. This differs from a number of international jurisdictions where abortion has been added to the midwifery scope of practice, resulting in safe outcomes for women and improved access to services. This study sought to survey Ontario midwives’ general attitudes towards abortion and willingness to incorporate abortion into the midwifery scope of practice. Ethics approval for the study was obtained from the Ryerson University Research Ethics Board. Methods: An Internet-based cross-sectional survey was sent to all registered midwives in Ontario via the Association of Ontario Midwives. The survey consisted of seven sections, with a total of 43 Likert scale questions, 17 general questions, and space for open-ended comments at the end of each section. Comments were coded and analyzed for common themes. Results: The survey was distributed to 523 midwives, all of the midwives registered in Ontario at the time of the study (2011). A total of 359 midwives participated, representing a response rate of 68% of all registered midwives in Ontario. The majority of respondents identified themselves as pro-choice; however, there were “limits to choice” expressed by many participants. Abortion was considered less acceptable at later gestations or for specific reasons such as gender selection or minor fetal anomalies. Study participants were divided over whether abortion should be added to midwifery scope of practice. Comfort with providing abortion services decreased as procedures were perceived to be more invasive or as requiring more medical expertise. The addition of misoprostol to Ontario midwives’ pharmacopoeia for early medical terminations was the most favoured expansion for midwifery scope of practice. Respondents were less willing to add surgical techniques to midwifery scope of practice. Midwives identified the current models of compensation and practice in Ontario, issues related to hospital integration, and opposition from clients as significant barriers to the provision of abortion services. Limited education about abortion during midwifery training and the desire for more learning opportunities were additional themes that emerged in this study. Conclusion: This is the first study in Canada about midwives’ attitudes towards abortion and the inclusion of abortion within midwifery scope of practice. Further research in other Canadian jurisdictions would be useful to examine systemic issues, barriers, and attitudes at a national level. For abortion to be included within the scope of practice of Ontario midwives, issues related to the current model of care, compensation, and supplemental education would need to be addressed. This article has been peer reviewed.

State Abortion Policy and Provider Moral Distress Levels After Dobbs [ID 2683541

INTRODUCTION: Moral distress occurs when individuals feel powerless to carry out ethically correct actions, including when prevented from providing necessary health care. We aimed to measure self-reported moral distress levels among abortion providers after the Dobbs decision and to assess differences by state-level abortion policy. METHODS: In 2023, we surveyed abortion providers nationally through professional listervs. Institutional review board-exempt surveys queried demographics, practice characteristics, and the Moral Distress Thermometer (MDT), a validated psychometric tool that measures moral distress level from 0 (lowest) to 10 (highest). Providers reported whether their moral distress level had changed since Dobbs. We assessed overall moral distress level and differences by state restrictiveness (using Guttmacher’s classifications) using one-way ANOVA (continuous variables) and chi-squared tests (categorical variables). RESULTS: In total, 253 practitioners completed the MDT for one or more states where they practiced (N=285 MDTs analyzed), with 56.8% of responses for “protective” states and 43.2% for “restrictive” states. Moral distress levels ranged from 0 to 10 (mean=5.09) and were twice as high for providers in restrictive compared to protective states (mean=7.15 versus 3.52; P<.001). Change in distress post Dobbs differed by state restrictiveness: In restrictive states, 89.4% reported an increase compared to 71.6% in protective states (P<.01). CONCLUSION: Moral distress levels for abortion providers were high following Dobbs, and higher in restrictive states. Most providers experienced increased distress across policy contexts. Moral distress has been associated with burnout, errors in patient care, and attrition. High and increasing moral distress levels, especially in abortion restrictive states, may worsen provider shortages, and lead to poor patient outcomes.

“Disheartened and Powerless”: How Abortion Providers Discuss Moral Distress Under Dobbs [ID 2683590

INTRODUCTION: Moral distress occurs when providers feel powerless to provide ethical health care. We analyzed how abortion providers discuss moral distress since the Dobbs decision. METHODS: In 2023, we distributed an IRB exempt survey measuring moral distress to U.S. abortion providers through professional listservs. Surveys included an optional open-ended section where participants reflected on their experience of moral distress. Using thematic analysis, we compared open-ended responses between providers practicing in states protective and restrictive to abortion. Open-ended responses were deidentified, so we categorized “protective” and “restrictive” based on the written description of practice environment. RESULTS: Of 253 practitioners who completed the survey, 57% practiced in “protective” states and 43% practiced in “restrictive” states (using Guttmacher's classifications). Of these, 164 (64%) completed the optional, deidentified, open-ended section. Providers who indicated practicing in restrictive environments experienced moral distress arising from being forced to turn patients away or provide substandard care, the instability and ambiguity of abortion laws, and feeling powerless to use the specialized skills central to their identities as providers. Providers who indicated practicing in protective environments experienced moral distress arising from witnessing burdens placed on patients seeking care and the substandard care out-of-state patients received, a lack of resources to accommodate increased clinical volume, and encountering restrictive institutional policies despite the protections afforded by permissive state policy. CONCLUSION: Restrictions on abortion care can harm providers through their experiences of moral distress. Moral distress can lead to provider burnout and attrition, which exponentiates provider shortages and can ultimately lead to poor patient outcomes.

Change in Medical Students' Attitudes Towards Family Planning After Pregnancy Counseling Panel Intervention [ID 2683614

INTRODUCTION: Abortion is one of the most commonly performed procedures in the United States, but abortion education is lacking in medical curricula. This study evaluates changes in medical students’ attitudes after a pregnancy counseling panel intervention during preclinical medical education. METHODS: Second-year medical students participated in a “Pregnancy Options Panel” with obstetrician–gynecologists, a pediatrician, and a social worker. Using a case study format, panelists guided discussion of appropriate care for a patient diagnosed with an unintended pregnancy. Two identical 19-item surveys were disseminated before and after the panel to assess students’ comfort/beliefs about pregnancy counseling and treatment. Statistical analyses were performed to compare responses. The study was IRB exempt. RESULTS: The class was composed of 366 students: 207 (60.5%) completed the pre-survey and 181 (49.5%) completed the post-survey. Students reported increased comfort when contemplating referral to an abortion provider, prescribing medication abortion, and performing a surgical abortion after the panel compared to before the panel (P<.01). Students were more likely to withhold disclosing their personal beliefs about abortion when counseling a pregnant patient (64.6% versus 42.3%; P<.01), felt more capable of counseling patients in a neutral manner (86.4% versus 71.6%; P<.01), and had a significant increase in preparedness to pregnancy options counseling (P<.01). CONCLUSION: Medical students felt more prepared to counsel patients without bias of their own beliefs after the pregnancy options counseling panel. Expert panels comprised of health professionals with diverse perspectives on pregnancy options can improve preclinical medical curriculum on the often-neglected topic of abortion.

States' Abortion Laws Associated With Intimate Partner Violence-Related Homicide Of Women And Girls In The US, 2014-20.

Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.

The making of clandestinity: “strategic ignorance” in abortion practices in Latin America

ABSTRACT Abortion is a “public secret” in Latin America. It is highly restricted across most of the continent and yet millions of abortions take place every year. We use the sociological framework of “strategic ignorance” to argue that convenient not knowing, erasure, and concealment simultaneously prevent and facilitate abortions in Latin America. By drawing on interviews with people involved in abortion activism and access across the continent, we examine three sets of actors: the state, abortion providers, and individuals seeking abortions. When wielded by the state, strategic ignorance reproduces the status quo of the criminalization of abortion; however, when wielded by abortion providers and individuals seeking abortions, it creates the conditions for “clandestine” abortions to be procured without prosecution. Strategic ignorance is therefore mobilized by the powerful as well as the less powerful who are resisting state control of their fertility and reproductive lives.

“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.

Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States

IntroductionMedication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients’ interest in these models. MethodsBetween 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants. ResultsAmong 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly. ConclusionsAlthough most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.

An assessment of clinical outcomes of medication abortion without pretreatment ultrasonography in Planned Parenthood, United States, 2020–2021

ObjectivesRoutine ultrasound before medication abortion (MAB) may create an impediment to expanding abortion access. This study examines clinical outcomes of MAB without pretreatment ultrasound evaluation at Planned Parenthood health centers in multiple states. Study designWe conducted a secondary analysis of data from 23 US-based Planned Parenthood affiliates that provided MAB without pretreatment ultrasound for eligible patients from March 2020 to December 2021. Affiliates aggregated electronic health record data from MABs at ≤77 days gestation (based on self-report of last menstrual period) without a pretreatment ultrasound (N = 18,041). Among MABs with known outcomes (N = 9821), we calculated the incidence rates and 95% confidence intervals (CI) for completed abortion, ongoing pregnancy, subsequent procedure, emergency department/hospital visits associated with MAB, ectopic pregnancies, and gestational duration greater than 77 days. ResultsAmong MABs with known outcomes, 96.3% had a complete abortion (95% CI = 95.9%–96.7%), and 2.0% had an ongoing pregnancy (95% CI = 1.7%–2.3%). Four percent had a subsequent procedure (95% CI = 3.6%–4.4%), and 2.3% had a documented emergency department/hospital visit (95% CI = 2.0%–2.6%). Less than 1% had a confirmed ectopic pregnancy (0.15%, 95% CI = 0.09%–0.25%) and had a gestational duration later identified to be greater than 77 days (0.13%, 95% CI = 0.05%–0.29%). ConclusionsOur calculated incidence rates of clinical outcomes align with rates from the previous literature on MAB and from the emerging literature on MAB without pretreatment ultrasonography. Findings from this analysis suggest that MAB without pretreatment ultrasound is safe and effective for eligible patients. ImplicationsThis large US study found that medication abortion without pretreatment ultrasonography results in similar clinical outcomes to prepandemic models that include pretreatment ultrasonography. Medication abortion without a pretreatment ultrasound may be adopted by abortion providers seeking to expand options for their patients as access to abortion continues to erode.

Willingness of Pharmacists to Prescribe Medication Abortion in California

Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.

An estimate of lifetime incidence of abortion in the United States using the 2021–2022 Abortion Patient Survey

ObjectivesThe Guttmacher Institute estimated that, in 2014, 24% of US women of reproductive age would have an abortion by age 45 if the 2014 abortion rate was maintained. This study updates the estimated lifetime incidence of abortion in the year(s) just prior to the Dobbs decision, which removed federal protections for abortion. Study designWe used data from the Guttmacher Institute’s 2021–2022 Abortion Patient Survey and population data for 2020 and 2021 from the Census Bureau, as well as abortion counts from the Guttmacher Institute’s 2020 Abortion Provider Census, to estimate abortion rates, first-abortion rates, and cumulative abortion rates, all by age group. We calculated multiple estimates of lifetime incidence under varying hypothetical conditions as tests of sensitivity. ResultsWe estimate that 24.7% (95% CI: 22.9–26.3) of women aged 15–44 in 2020 would have had an abortion by age 45 if abortion rates in 2020 remain constant. These figures changed slightly when we examined scenarios assuming a 5% increase in abortion between 2020 and 2021 (25.9, 95% CI: 24.0–27.6) and when we adjusted for the potential overrepresentation of adolescent and young adult respondents in the 2021–2022 Abortion Patient Survey (23.9, 95% CI: 22.2–25.6). ConclusionsIn the year(s) prior to the Dobbs decision, one-quarter of US women would have been expected to have at least one abortion in their lifetime if abortion rates for those years stayed the same. ImplicationsSignificant numbers of individuals are being affected by abortion bans, but we are unable to predict how these restrictions will impact abortion incidence or the lifetime incidence in the coming years.