Willing and able? Provision of medication for abortion by future internists

Schwarz, Eleanor Bimla; Luetkemeyer, Anne; Foster, Diana Greene; Weitz, Tracy A.; Lindes, Deborah; Stewart, Felicia H.

doi:10.1016/j.whi.2004.08.011

Next »Women's Health Issues
Volume 15, Issue 1 , Pages 39-44, January 2005

Willing and able? Provision of medication for abortion by future internists

Eleanor Bimla Schwarz, MD, MS
- Department of Medicine, General Internal Medicine Section, University of California, San Francisco, California
- Address correspondence to: Eleanor Bimla Schwarz, MD, MS, Clinical Instructor and Research Fellow, University of California, San Francisco, General Internal Medicine Section (111a1), VA Medical Center, 4150 Clement St, San Francisco, CA 94121.
Anne Luetkemeyer, MD
- Department of Medicine, Division of Infectious Disease, University of California, San Francisco, California
Diana Greene Foster, PhD
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
Tracy A. Weitz, MPA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
Deborah Lindes, MD
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California
Felicia H. Stewart, MD
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

Received 14 July 2004; received in revised form 20 August 2004; accepted 31 August 2004.

Introduction and background

The development of medications such as mifepristone (RU486) has created the opportunity to introduce medication abortion as a component of office practice.

Methods

Two hundred twelve residents training in internal medicine, family practice, and gynecology at 11 residency programs completed anonymous surveys assessing willingness to provide medication for abortion and perceived barriers to future provision of mifepristone.

Results

Residents training in internal medicine knew less about mifepristone and preabortion screening than other primary care trainees. Forty-two percent of internists, 84% of family practitioners, and 83% of gynecologists were willing to prescribe mifepristone (p < .001). Many internists were concerned about lacking adequate “backup” access to vacuum aspiration services (84% of internists, 74% of family practitioners, 35% of gynecologists; p < .001). In multivariable analysis, the training-related factors most predictive of whether an internist was willing to provide medication for abortion were feeling that mifepristone is very safe, abortion services are needed by the patients served, knowing to check an ultrasound before inducing abortion, and having no concern of how to manage bleeding or of lacking adequate backup should vacuum aspiration be needed.

Conclusions and discussion

Many (42%) future internists are willing to provide mifepristone, but most lack adequate knowledge of mifepristone and preabortion screening. As access to abortion services is limited in many U.S. counties, internists who are willing to provide mifepristone should be offered the necessary training to do so safely.