Willing but unable: Physicians' referral knowledge as barriers to abortion care

Abstract

Abortion care is a crucial part of reproductive healthcare. Nevertheless, its availability is constrained by numerous forces, including care referrals within the larger healthcare system. Using a unique study of physician faculty across multiple specialties, we examine the factors associated with doctors' ability to refer patients for abortion care among those who were willing to consult in the care of a patient seeking an abortion ( N = 674). Even though they were willing to refer a patient for an abortion, half (53%) of the physicians did not know how and whom to make those referrals, though they care for patients who may need them. Those with the least referral knowledge had not been taught abortion care during their medical training and were in earlier stages of their career than those who had more knowledge. This research exposes another obstacle for those seeking an abortion, a barrier that would be overcome with a clear and robust referral system within and across medical specialties.

State of Confusion: Ohio’s Restrictive Abortion Landscape and the Production of Uncertainty in Reproductive Health Care

“…Variation in policy across institutions and regions can contribute to uncertainty in referral practices as well. A recent study found that half of physicians across different specialties did not know how to refer patients for abortion (Anderson et al 2022). Turning to others to mitigate uncertainty is limited in this context because policies vary and colleagues may have inaccurate understandings of them.…”

Characterizing physician concerns with publicly supporting abortion at Wisconsin's largest medical school

“…We measured sociodemographic characteristics including age, gender, and race/ethnicity in addition to medical specialty, religiosity (dichotomized into low versus high), exposure to abortion in medical training (binary), and concern with legislative interference in the doctor‐patient relationship (dichotomized into low versus high). Our attitudes‐toward‐abortion‐providers scale follows a 1–5 Likert model of unfavorable to favorable 12 . We also created two three‐level variables that captured willingness to refer for abortion care and willingness to participate in abortion care, separating those who have ever referred/participated in abortion care, those who have not but are willing to given the opportunity, and those who have not and are unwilling to refer for/participate in abortion care.…”

“…Our attitudes-toward-abortion-providers scale follows a 1-5 Likert model of unfavorable to favorable. 12 We also created two three-level variables that captured willingness to refer for abortion care and willingness to participate in abortion care, separating those who have ever referred/participated in abortion care, those who have not but are willing to given the opportunity, and those who have not and are unwilling to refer for/participate in abortion care.…”

Aligning health worker education and learning approaches with population health needs: WHO’s Family Planning and Comprehensive Abortion Care Toolkit for the primary healthcare workforce

“…Limitations in FP and CAC health workforce education, learning and continuing professional development compromise standards 3 4. In many countries, health workers lack the competencies required to deliver quality FP and CAC services 5–18. Globally, despite overwhelming agreement that medical school curricula should include FP and CAC, training in FP has often been found to be inadequate11 and training in CAC is either altogether missing or significantly limited12 13; especially in low-income countries and countries where abortion is heavily restricted 5–7 12.…”