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Abortion in primary care

How primary care providers can support increased abortion access for all.

by Michele Gomez, MD

published 01/13/23

Primary care providers (PCPs), including family medicine physicians, internists, pediatricians, and advanced practice clinicians, safely and effectively provide early abortion care in their primary care offices. While people still think of abortion care as being performed in an operating room and under general anesthesia, that’s no longer the case. Medication abortion (MAB) is a safe and effective way to end an early pregnancy and providers can identify who is eligible using a simple screening with history alone. No labs or ultrasounds are required before prescribing abortion pills that could be dispensed in the office or delivered using a mail-order pharmacy. (ICYMI, the FDA recently approved any pharmacy to become certified to dispense mifepristone, the first of two medications used in most medication abortions. That means that patients may soon be able to get these medications from their local pharmacy the same way they get other medications you prescribe. It will likely take a while for pharmacies to get certified, so it isn't happening yet but Walgreens and CVS have expressed interest.)

Some PCPs also offer procedural abortions in their offices. Manual uterine aspirations (MUAs), also known as manual vacuum aspirations (MVAs), are simple office procedures that take about five minutes to complete and can be performed with ibuprofen for pain control. No expensive equipment is required—the small, handheld, reusable plastic device used for the procedure doesn’t require electricity and no ultrasound is medically necessary (although some states may require medically-unnecessary ultrasounds). Depending on where you practice, PCPs can add abortion care to their practice. Here’s why you should consider it and what you need to know:

It’s patient-centered

For many patients, having an abortion at a primary care office offers more privacy than going to a health center that only offers abortion care, where anyone who sees them entering or sitting in the waiting room might know why they’re there. Patients entering an abortion clinic may also face harassment and intimidation by anti-choice activists. Studies have shown that many patients would prefer to get their abortion from their family physician. In addition, integrating abortion into primary care normalizes abortion—when patients can get an abortion in their own PCP’s office it feels more like any other medical care, not something that has to be more complicated logistically and psychologically. Dispersing abortion care among many PCPs also makes abortion harder to target politically than when most abortions are provided in a small number of health centers.

It improves equitable access

Currently only 3% of family physicians provide abortion. If more primary care providers offered abortion services it would increase access and decrease the burden on already overwhelmed abortion clinics, especially given the Dobbs decision. This is an important equity issue, as 75% of people accessing abortion have low incomes. And if unable to access a desired abortion, Black and Indigenous people are two to three times more likely than white people to die related to pregnancy. Pre-Dobbs, 89% of US counties lacked an abortion provider and that number has drastically increased since. Community health centers and smaller primary care practices are the main source of health care for many people with low-incomes and those living in rural areas, which have disproportionately been impacted by decreases in access to abortion care. If PCPs in these areas provided abortion care, access would increase dramatically. Federally-qualified health centers (FQHCs) have particular challenges to providing abortion, but even there it is being done.

PCPs' patients need abortion care

Most PCPs see people of reproductive age, and early pregnancy termination is common. In the US, nearly 1 in 4 people who can become pregnant will have an abortion by the age of 45. In 2020, approximately 93% of abortions were performed in the first trimester and 80% were performed under nine weeks gestational age, meaning most could be safely performed as an MAB or an MUA in a primary care office. In addition, 10-20% of confirmed pregnancies end in miscarriage—most of them in the first trimester—so PCPs would be able to care for those patients in the office as well, as the management is the same.

How to make abortion care part of your practice as a PCP

While there are obstacles to providing abortion care in primary care settings, social science research shows that an important factor in overcoming these obstacles is having a motivated and effective clinic champion. Learning all the medical information you’ll need to know to offer MABs is straightforward and can be completed in less than one hour. And many resources already exist to help primary care practices integrate abortion care into their practice, including The Reproductive Health Access Project (RHAP) , the Access Delivered Toolkit, the TEACH (Training in Early Abortion for Comprehensive Healthcare) Curriculum, and clinician-to-clinician support via groups like MYA Network. As a co-founder of MYA Network (short for “My Abortion Network”), a group of clinicians working to expand early abortion options in primary care settings, I encourage you to consider being that champion! Our patients are counting on us to rise to the challenges presented by this new landscape by increasing abortion access in primary care.

Michele Gomez is a family medicine physician in the San Francisco Bay Area. She attended UCSF for medical school and residency, and for almost 20 years has been working in a small primary care practice that has offered medication abortion since mifepristone was approved by the FDA in 2000. During the pandemic, she helped the practice add MABs via telehealth (teleMAB), and they are one of the few practices in CA that accept Medi-Cal for teleMAB. Michele has also been training family medicine residents to perform procedural abortions through TEACH (Training in Early Abortion for Comprehensive Healthcare) since 2004. In 2020 she co-founded MYA Network whose mission is to normalize abortion, medically and culturally.
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