Interprofessional Abortion Opposition: A National Survey and Qualitative Interviews with Abortion Training Program Directors at U.S. Teaching Hospitals

Abstract

Hospital policies and culture aff ect abortion provision. The prevalence and nature of colleague opposition to abortion and how this opposition limits abortion care in U.S. teaching hospitals have not been investigated. METHODS : As part of a mixed-methods study, a nationwide survey of residency and site directors at 169 accredited obstetrics-gynecology training programs was conducted in 2015-2016, and 18 in-depth interviews with program directors were conducted in 2014 and 2017. The prevalence and nature of interprofessional opposition were examined using descriptive statistics, and regional diff erences were investigated using logistic regression. A modifi ed grounded theoretical approach was used to analyze interview data. RESULTS : Among the 91% of survey respondents who reported that they or their colleagues had wanted or needed to provide abortions in the prior year, 69% faced opposition from colleagues. Most commonly, opposition came from nurses (58%), nursing administration (30%) and anesthesiologists (30%), manifesting as resistance to participating in or cooperating with procedures (51% and 38%, respectively). Fifty-nine percent of respondents had denied care to patients in the prior year because of colleagues' opposition. Respondents in the Midwest and South were more likely than those in the Northeast to deny abortion care to patients because of such opposition (odds ratios, 3.2 and 4.4, respectively). Interviews revealed how participants had to circumvent opposing colleagues, making abortion provision diffi cult and leading to delays in and, infrequently, denial of abortion care. CONCLUSIONS : Interprofessional opposition to abortion is widespread in U.S. teaching hospitals. Interventions are needed that prioritize patients' needs while recognizing the challenges hospital colleagues face in their abortion participation decisions.

Abortion as a sociological case

“…Beyond physicians, nurses have received the next highest level of inquiry from health services scholars, arguing for their unique orientation toward patient need (e.g., Ref [Benner, 1984]). Abortion provides a challenging case for this framing of nursing, with evidence of nurses navigating non‐participation in abortion care irrespective of patient need (e.g., Ref [Bennett et al, 2020]). Post‐ Dobbs , nurses may be shouldering a larger portion of the abortion provision work than before: the states that have preserved abortion access are also ones in which the majority of abortions are provided by advanced practice nurses 119 .…”

Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers

“…These include mifepristone REMS program requirements, institutional policies, adequate medication supplies, abortion stigma and lack of support from colleagues, insufficient medical backup in case of medical complications, and legal restrictions and laws. 55,56 Time and inadequate resources present additional barriers for training pediatric providers, given the limitations on allotted rotations for residents and fellows related to adolescent reproductive health care and clinical volume of pregnant adolescent patients. 11,51 Still, we encourage providers to become as involved as their comfort level permits and urge institutions to offer training resources and support for providers who seek such training, in order to strengthen our multi-disciplinary efforts to overcome these obstacles (see Figure 1).…”

“We had to put ourselves in their shoes”: Experiences of Medical Students and ObGyn Residents with a Values Clarification Workshop on Abortion

“…For example, many participants pointed out that the VCAT workshop itself normalized and destigmatized abortion as a part of routine health care (T1. [8][9].…”

“…However, abortion education is increasingly sparse for both groups of trainees 5,6 . In addition, abortion is highly stigmatized and polarizing, including within healthcare 7–9 .…”