Obstacles to the Integration of Abortion Into Obstetrics and Gynecology Practice


  • Lori Freedman,

    Corresponding author
    1. Lori Freedman is assistant researcher, Department of Obstetrics, Gynecology and Reproductive Sciences
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  • Uta Landy,

    1. Uta Landy is national director, Kenneth J. Ryan Residency Training Program and Fellowship in Family Planning, Bixby Center for Global Reproductive Health
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  • Philip Darney,

    1. Jody Steinauer is associate professor of clinical obstetrics and gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences–all at the University of California, San Francisco (UCSF)
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  • Jody Steinauer

    1. Philip Darney is professor of obstetrics, gynecology and reproductive sciences, UCSF, and chief of obstetrics and gynecology, San Francisco General Hospital
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CONTEXT: Obstetrics and gynecology residents who are trained in family planning and intend to provide abortions after residency often do not ultimately do so. The extent of the professional barriers physicians face trying to integrate abortion into their practice is unknown.

METHODS: In 2006, in-depth interviews were conducted with 30 obstetrician-gynecologists who had graduated 5–10 years earlier from residency programs that included abortion training. Interviews about physicians’ experiences with abortion training and practice were coded and analyzed using a grounded theoretical approach.

RESULTS: Eighteen physicians had wanted to offer elective abortions after residency, but only three were doing so at the time of the interview. The majority were unable to provide abortions because of formal and informal policies imposed by their private group practices, employers and hospitals, as well as the strain that doing so might put on relationships with superiors and coworkers. Restrictions on abortion provision sometimes were made explicit when new physicians interviewed for a job, but sometimes became apparent only after they had joined a practice or institution. Several physicians mentioned the threat of violence as an obstacle to providing abortions, but few considered this the greatest deterrent.

CONCLUSIONS: The stigma and ideological contention surrounding abortion manifest themselves in professional environments as barriers to the integration of abortion into medical practice. New physicians often lack the professional support and autonomy necessary to offer abortion services.