Barriers and enablers to becoming abortion providers: the reproductive health program

Despite abortion being one of the most common procedures undergone by women of reproductive age in the United States, the number of abortion providers has been declining for the last 20 years. We sought to assess the long-term impact of the Reproductive Health Program (RHP), a national elective abortion training program for primary care abortion providers that operated from 1999-2005.

We conducted a mixed-methods cross-sectional study of 220 former RHP trainees. Participants were interviewed over the phone and asked a series of questions about their training at RHP, their current practice, abortion provision since RHP, and enablers and barriers to abortion provision.

More than half of respondents (58.8%) have provided any abortions since RHP; more have provided medical abortions (56.5%) than surgical abortions (47.1%). Of respondents who have provided abortions, most have performed more than 50 surgical (87.5%) or medical (77.1%) abortions since RHP and had provided an abortion in the last 3 months (67.5%, 70.8%). More than 90% of abortion providers reported having liability insurance that covers abortion, colleague support, ease of obtaining medications and/or equipment, reimbursement, and administrative and/or staff support at the site where they provide abortions. Relative to providers, the greatest barriers reported by non-providers were lack of skills, concerns about liability, and difficulty obtaining supplies.

Our findings suggest that the RHP model of elective training can yield a substantial percentage of abortion providers. We also describe enablers and barriers to provision once trainees are in practice, highlighting the importance of continued support after training is completed.