"Cementing Our Place on the Right Side of History": Primary Care Perspectives on Mifepristone Provision Post-Dobbs

We explored clinician and staff perspectives on primary care integration and provision of mifepristone following the Dobbs v. Jackson Women's Health Organization decision that removed the federal right to abortion.

In this qualitative study, 41 interviews were conducted with clinicians and staff from three Midwestern clinics that participated in a 1-year learning collaborative (9/2022-8/2023) designed to help primary care settings implement mifepristone for abortion and early pregnancy loss care. Interviews were transcribed verbatim, coded by two researchers independently, and analyzed thematically using inductive and deductive techniques.

Interviewees included clinicians (n = 14) and clinical support (n = 17), administrative management (n = 6), and patient-facing administrative (n = 4) staff. Dobbs created a sense of urgency among clinicians and staff, resulting in increased motivation to overcome barriers to mifepristone implementation. Participants felt that providing mifepristone aligned with primary care values, including patient-centeredness and access to care for all. The post-Dobbs political climate, along with federal cases attempting to hinder access to medication abortion, created uncertainty at the institutional and individual levels.

Participants in our sample expressed that the Dobbs decision increased their clinics' motivation to overcome barriers and expand access to abortion and early pregnancy loss care. Other primary care providers may consider leveraging concern about mounting abortion restrictions to advance access to this care in their own settings.