Quarter of US Ob/Gyns Provide Abortion, Increase on Prior Years

Nancy A. Melville

February 19, 2019

About a quarter of obstetrician/gynecologists (ob/gyns) in the US report having performed an induced abortion in the year prior to 2016-2017, an increase from previous years. At the same time, many indicated that restrictions on the prescribing of medication to induce abortion stand in the way of them providing the option to patients.  

"Compared with the previous national survey in 2008-2009, abortion provision may be increasing among practicing ob/gyns, although important geographic disparities persist," say the authors of the study, which was published February 4 in Obstetrics & Gynecology.

"Few provide medication abortion, but uptake might increase if [abortion medication] mifepristone could be prescribed," they write.

For the study, Daniel Grossman, MD, of Advancing New Standards in Reproductive Health (ANSIRH) at the Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, in Oakland, and colleagues sampled 980 members of ACOG's Collaborative Ambulatory Research Network between 2016 and 2017, with 655 (67%) respondents providing data.

Overall, 23.8% of respondents reported providing any type of induced abortion in the previous year, an increase from the 14% who reported providing abortion care in the most recent prior survey of US ob/gyns in 2008-2009.

Also, 10.4% provided surgical and medication abortion, 9.4% surgical only, and 4.0% medication only.

REMS for Mifepristone in US a Barrier to Medical Abortion

Of the 14% of survey respondents who had provided medication abortion in the prior year, 58.1% used the combined mifepristone–misoprostol regimen, 41.9% used misoprostol alone, and 10.5% used methotrexate and misoprostol.

Although medical abortion with mifepristone (Mifeprex, Danco Laboratories) has been approved in the United States, the Food and Drug Administration (FDA) prohibits the drug from being sold in pharmacies under the drug's Risk Evaluation and Mitigation Strategy (REMS), with distribution limited to specially qualified licensed physicians.

The authors point to a recent article published in the New England Journal of Medicine indicating that, given the positive safety record, the REMS should be lifted, and they suggest that their current findings support that argument.

When those who did not provide medication abortion (n = 368) but reported having patients seeking abortion were asked whether they would offer the service if they could write prescriptions for the medications, 28% said they would offer medication abortion, 47% said they would not, and 22% said they were not sure

"This suggests that the proportion of ob/gyns offering induced medication abortion might increase from 14% currently to as much as 31% if it were not required to stock the medication in one's office," Grossman and colleagues observe.

"Our survey suggests that the REMS [for mifepristone] is a barrier to provision of medication abortion, which should add new urgency to the push to remove this medically unnecessary restriction."

Differences in Abortion Provision: Geography and Various Settings

The survey did show significant regional differences. After adjustment for factors including physician age and gender, the odds ratios (ORs) of providing induced abortion of any kind were significantly lower among those practicing in the Midwest (adjusted OR, 0.31) and South (OR, 0.22) compared with those in the Northeast, and almost three times higher among those practicing in an urban environment compared with a midsize town, rural area, or those who practice exclusively in the military.

"This inequitable geographic distribution is similar to findings in previous research, which may be related to more restrictions on abortion provision in Southern and Midwestern states," the authors say.

Of 120 practitioners who completed a longer version of the survey, 32.5% reported providing abortion only at an ambulatory surgical or hospital setting; 47.5% reported providing it in an outpatient office, and 10.8% provided at least some abortions in a specialized clinic or Planned Parenthood facility.

The fact that a third of practitioners only provide abortion in an ambulatory or hospital setting is of interest, the authors indicate.

"Given the safety of providing abortion in an outpatient setting, more research is needed to understand the reasons why ob/gyns choose to provide the service in a hospital," they note.

Number of Ob/Gyn's Increase but Abortions Fall...

Although the percentage of ob/gyns performing abortions increased according to the survey, the overall abortion rates in the United States have declined in the past decade.

According to CDC statistics for 2015, the most recent year for which data are available, there were 11.8 abortions per 1000 women aged 15 to 44, a 26% drop from 2006, when the rate was 15.9 abortions per 1000 women. The decline was notably steep among teens aged 15 to 19, who showed a decrease of as much as 54% from 2006 to 2015.

The authors have reported no relevant financial relationships.

Obstet Gynecol. Published February 4, 2019. Abstract

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