Abortion provision in primary care in New England: A qualitative study and conceptual framework

Lee, Charlotte

Full Metadata

Overview

Year:: 2021
Contributor:: Lee, Charlotte (creator); Allen, Rebecca (Advisor); Janiak, Elizabeth (Reader); Brown University. Biology and Medicine: Population Medicine (sponsor)
Genre:: theses
Subject:: Reproductive health; Abortion; Comprehensive Primary Care; Family medicine; conceptual framework
Extent:: vi, 33 p.

Files

Description

Abstract:: Purpose: Primary care physicians (PCPs) have unique potential to improve abortion access because primary care settings are geographically easier for many patients to access compared to specialty providers, most patients would prefer to get abortions from their PCPs, and abortion care co-located with other clinical services holds high potential for sustainability. This study describes structural and interpersonal barriers to and facilitators of abortion provision among abortion-trained PCPs. Methods: We conducted 21 qualitative in-depth interviews with 20 family physicians and 1 internal medicine physician in New England. Interviews were recorded, transcribed, and iteratively coded independently by two investigators, using a consensus method to agree upon final coding schema. Results: Our results suggest that PCPs are able to provide abortions in primary care if individual-level facilitators allow them to cross a hypothetical “threshold to provide” that is set by institutional-level barriers in primary care. Each primary care practice had a different threshold, depending on how difficult it was to provide abortion care in that setting; PCPs who could cross that threshold were able to provide abortion care. Conclusion: Whether a trained PCP provided abortion in primary care was driven by a combination of their practice environment and their individual-level characteristics. Our findings suggest that there are two main ways to increase primary care abortion provision: (1) to support PCP motivation and self-efficacy to provide and (2) to reduce the practice-level threshold to provide. Establishing that abortion care is an essential primary care service, demonstrating local need, increasing training case volume, and ensuring training exposure to PCP abortion providers are strategies to increase PCP motivation and self-efficacy. Eliminating the Hyde amendment, ending federal regulations requiring in-person medication abortion dispensing, and expanding grant opportunities for establishing primary care abortion services are interventions to lower the practice-level threshold to provide.
Notes:: Thesis (Sc. M.)--Brown University, 2021

Content

Access Conditions

Rights: In Copyright

Citation

Lee, Charlotte, "Abortion provision in primary care in New England: A qualitative study and conceptual framework" (2021). Biology and Medicine Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:6qpm6kqf/

Relations

Collection:

Biology and Medicine Theses and Dissertations

Theses and Dissertations for the Biology and Medicine department.
...