Women's Preference for Receiving Abortion in Primary Care Settings

Godfrey, Emily M.; Rubin, Susan E.; Smith, Erica J.; Khare, Manorama M.; Gold, Marji

doi:10.1089/jwh.2009.1454

Cited by 29 publications

(26 citation statements)

References 15 publications

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“…The majority (60%) preferred to see a doctor at a primary care clinic because they were comfortable with their known provider and the doctor was familiar with their medical history. Women who expressed a preference for an abortion at a dedicated clinic listed reasons such as “specialisation”, “privacy and anonymity” when the procedure is “separate” from the usual source of care 57. In a survey of a clinical sample of women in New York, the majority (87%) expressed a preference for receiving a medication abortion from their primary care doctor 11.…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review

Doran

Nancarrow

2015

J Fam Plann Reprod Health Care

101

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ObjectivesTo identify the barriers and facilitators to accessing first-trimester abortion services for women in the developed world.MethodsSystematic review of published literature. CINAHL, PubMed, Proquest, MEDLINE, InformIT, Scopus, PsycINFO and Academic Search Premier were searched for papers written in the English language, from the developed world, including quantitative and qualitative articles published between 1993 and 2014.ResultsThe search initially yielded 2511 articles. After screening of title, abstract and removing duplicates, 38 articles were reviewed. From the provider perspective, barriers included moral opposition to abortion, lack of training, too few physicians, staff harassment, and insufficient hospital resources, particularly in rural areas. From the women's perspective, barriers included lack of access to services (including distance and lack of service availability), negative attitudes of staff, and the associated costs of the abortion procedure. Service access could be enhanced by increasing training, particularly for mid-level practitioners; by increasing the range of service options, including the use of telehealth; and by creating clear guidelines and referral procedures to alternative providers when staff have a moral opposition to abortion.ConclusionDespite fewer legal barriers to accessing abortion services, the evidence from this review suggests that women in developed countries still face significant inequities in terms of the level of quality and access to services as recommended by the World Health Organization.

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Section: Resultsmentioning

confidence: 99%

Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review

Doran

Nancarrow

2015

J Fam Plann Reprod Health Care

101

View full text Add to dashboard Cite

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“…However, some participants voiced concerns about speaking to their regular gynecologic provider about their abortion decision. In a prior study assessing women’s preferences for abortion care, nearly 40% of women preferred to obtain their abortion in a dedicated abortion clinic rather than with a regular provider, because of concerns of privacy, anonymity, judgment, and wanting to keep the procedure separate (Godfrey, Rubin, Smith, Khare, & Gold, 2010). Therefore, gynecologic providers may not be adequately conveying to women that they can be trusted to provide non-judgmental guidance and care for the full spectrum of women’s reproductive health experiences.…”

Section: Implications For Practicementioning

confidence: 99%

“…In one survey of women obtaining an abortion, 17% of respondents felt their health care provider would treat them differently if they knew of their abortion (Shellenberg & Tsui, 2012). In a survey of 229 women presenting for abortion at one of two abortion clinics in New York and Chicago, Godfrey and colleagues found that only 27% of women had seen their primary care provider regarding pregnancy decision-making before their abortion (Godfrey, Rubin, Smith, Khare, & Gold, 2010). Women reported not seeing their primary care physician due to fears of not being supported (23%), concerns for judgement (22%), and being sure of the decision (17%) (Godfrey, Rubin, Smith, Khare, & Gold, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…In a survey of 229 women presenting for abortion at one of two abortion clinics in New York and Chicago, Godfrey and colleagues found that only 27% of women had seen their primary care provider regarding pregnancy decision-making before their abortion (Godfrey, Rubin, Smith, Khare, & Gold, 2010). Women reported not seeing their primary care physician due to fears of not being supported (23%), concerns for judgement (22%), and being sure of the decision (17%) (Godfrey, Rubin, Smith, Khare, & Gold, 2010). Women who did see their primary care physician did so to seek advice or options counseling (46%), confirm a positive pregnancy test or seek a referral (42%)(Godfrey, Rubin, Smith, Khare, & Gold, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Women reported not seeing their primary care physician due to fears of not being supported (23%), concerns for judgement (22%), and being sure of the decision (17%) (Godfrey, Rubin, Smith, Khare, & Gold, 2010). Women who did see their primary care physician did so to seek advice or options counseling (46%), confirm a positive pregnancy test or seek a referral (42%)(Godfrey, Rubin, Smith, Khare, & Gold, 2010). Although these quantitative data are limited in scope, they indicate that many women did not perceive their trusted providers to be a resource for non-judgmental support in abortion decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Factors Shaping Women's Pre-abortion Communication with Their Regular Gynecologic Care Providers

Chor

Tusken

Lyman

et al. 2016

Women's Health Issues

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Objective To understand women’s experiences communicating with their regular gynecologic care provider about abortion decision-making prior to obtaining an abortion at a dedicated abortion clinic. Study Design Semi-structured interviews were conducted with women presenting for first-trimester surgical abortion at a high volume, hospital-based abortion clinic. Women were asked whether and why they did or did not discuss their abortion decision with their gynecologic care provider. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented. Results Thirty women who obtained an abortion were interviewed. A majority of the twenty-four women who had a regular gynecologic care provider did not discuss their decision with that provider. Themes associated with not discussing their decision included: (1) perceiving that the discussion would not be beneficial (2) expecting that gynecologic care providers do not perform abortions, (3) anticipating or experiencing logistical barriers, and (4) worrying about disrupting the patient-provider relationship. Women who did discuss their decision primarily did so because the pregnancy was diagnosed at the time of a previously scheduled appointment and generally did not believe that their provider performed abortions. Conclusion For many women, seeking counsel from a regular gynecologic provider prior to seeking an abortion may not afford a significant benefit. However, some women express concerns with regard to seeking abortion counselling from their regular provider. These concerns underscore the need for gynecologic providers to foster patient-provider relationships that allow women to feel comfortable discussing all aspects of their reproductive health.

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

Grossman,

Raifman,

Morris

et al. 2024

JAMA Intern Med

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ImportanceBefore 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion.ObjectiveTo estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.Design, Setting, and ParticipantsThis 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.InterventionMifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person.Main Outcomes and MeasuresProportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications.ResultsClinical 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.Conclusions and RelevanceThe 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.

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Women's Preference for Receiving Abortion in Primary Care Settings

Cited by 29 publications

References 15 publications

Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review

Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review

Factors Shaping Women's Pre-abortion Communication with Their Regular Gynecologic Care Providers

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

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