Provision of medication and procedural abortion among Massachusetts obstetrician-gynecologists

The aim of the study was to understand the rates of first-trimester medication and procedural abortion provision, sufficiency in abortion training, and factors associated with abortion provision among obstetrician-gynecologists (OB/GYNs) in Massachusetts.

Electronically fielded surveys of a census of OB/GYNs in Massachusetts in 2021 queried physicians on abortion provision, training, practice type, and demographics. Using weighting to account for nonresponse, we generated estimates of the proportion of OB/GYNS providing abortion and used multivariate regression analysis to explore factors associated with abortion provision including practice type, physician sex, and sufficient abortion training.

A total of 198 OB/GYNs responded to the survey (response rate = 29%). Of 158 OB/GYNs not in training, 55% provide some abortion care. More respondents reported sufficient training for surgical abortion (84%) than for medication abortion (43%). The most cited reasons for not providing abortion care were lack of integration into their clinical practice (29%), institutional opposition (27%), or personal opposition to abortion (23%). In multivariate analysis, female physicians were more likely to provide abortion care (adjusted odds ratio [aOR] 2.72, 95% CI [1.63-4.55], p < 0.01), and those with insufficient training less likely to provide abortion (aOR 0.18, 95% CI [0.10-0.33], p = 0.01). Those in private practice (aOR 0.47, 95% CI [0.28-0.80], p < 0.01) or "other" practice types (aOR 0.16, 95% CI [0.09-0.27], p < 0.01) were less likely to provide abortion compared to physicians in academic practices.

Only half of OB/GYNs in a state supportive of abortion provide abortion. Despite high patient interest in medication abortion, a majority of OB/GYNs report insufficient training in medication abortion.

This study highlights the need for support from practice, institution, and health system leaders to facilitate the provision of abortion care and the need for increased training among OB/GYNs in medication abortion.