Abstract
Introduction
Mifepristone–misoprostol and office uterine aspiration used for abortion care are
also evidence-based, cost-effective strategies for early pregnancy loss management.
We aimed to compare the provision of mifepristone-misoprostol and office uterine aspiration
for early pregnancy loss between states with restrictive and supportive abortion policies.
Methods
We conducted a cross-sectional, internet-based survey regarding early pregnancy loss
management among obstetrician–gynecologists (OBGYNs) at academic medical centers.
We assessed management offered along with facilitators and barriers to implementation
of mifepristone–misoprostol and office uterine aspiration. We used χ2 and multivariable logistic regression to compare practice patterns.
Results
We analyzed responses from 350 physicians, 56% from states with restrictive abortion
policies. OBGYNs in states with restrictive abortion policies were less likely than
those in states with supportive abortion policies to offer both mifepristone–misoprostol
and office uterine aspiration (33.2% vs. 51.3%; p = .001), to report having received induced abortion training (67.3% vs. 89.6%; p < .001), and to report perceived institutional support for abortion care (49.0% vs.
85.0%; p < .001). After adjusting for confounders, restrictive state policy was no longer
associated with providing both mifepristone-misoprostol and office uterine aspiration
for early pregnancy loss (adjusted odds ratio, 1.19; 95% confidence interval [CI],
0.58–2.45). However both prior induced abortion training and institutional support
for abortion care remained significantly associated (adjusted odds ratio, 2.06; 95%
CI, 1.07–3.97 and adjusted odds ratio, 3.91; 95% CI, 2.08–7.38, respectively).
Conclusions
OBGYNs practicing in states with restrictive abortion policies are less likely than
those in states with supportive abortion policies to have received abortion training
or perceive institutional support for abortion care, and they are less likely to offer
mifepristone–misoprostol and office uterine aspiration for early pregnancy loss.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017.Contraception. 2021; 104: 496-501
- Management of first trimester pregnancy loss can be safely moved into the office.Reviews in Obstetrics Gynecology. 2011; 4: 5-14
- Early pregnancy loss practice bulletin number 200.(Available:)www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Early-Pregnancy-Loss/Date: 2018Date accessed: July 1, 2020
- Improving access to mifepristone for reproductive health indications.(Available:)
- How Abortion bans are restricting miscarriage care.(Available:)www.nytimes.com/2022/07/20/podcasts/the-daily/abortion-roe-miscarriage-treatment.html?showTranscript=1Date: 2022Date accessed: September 9, 2020
- A practitioner’s guide to cluster-robust inference.Journal of Human Resources. 2015; 50: 317-372
- Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): A randomised, double-blind, placebo-controlled trial.Lancet. 2020; 396: 770-778
- Patient preferences, satisfaction, and resource use in office evacuation of early pregnancy failure.Obstetrics and Gynecology. 2006; 108: 103-110
- Treatment of early pregnancy failure: Does induced abortion training affect later practices?.American Journal of Obstetrics and Gynecology. 2011; 204: 493.e1-493.e6
- Provider knowledge, attitudes, and treatment preferences for early pregnancy failure.American Journal of Obstetrics and Gynecology. 2010; 202: 531.e1-531.e8
- Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science.Implementation Science. 2009; 4: 50
- “One of those areas that people avoid”: A qualitative study of implementation in miscarriage management.BMC Health Services Research. 2013; 13: 123
- Barriers to and facilitators of moving miscarriage management out of the operating room.Perspectives on Sexual and Reproductive Health. 2015; 47: 141-149
- State abortion policy landscape: From hostile to supportive.(Available:)www.guttmacher.org/article/2019/08/state-abortion-policy-landscape-hostile-supportiveDate: 2020Date accessed: November 5, 2020
- The REDCap consortium: Building an international community of software platform partners.Journal of Biomedical Informatics. 2019; 95: 103208
- Research electronic data capture (REDCap)--A metadata-driven methodology and workflow process for providing translational research informatics support.Journal of Biomedical Informatics. 2009; 42: 377-381
- Increase in obstetrics and gynecology resident self-assessed competence in early pregnancy loss management with routine abortion care training.Obstetrics and Gynecology. 2022; 139: 116-119
- Unpacking organizational readiness for change: An updated systematic review and content analysis of assessments.BMC Health Services Research. 2020; 20: 106
- 13 states have abortion trigger bans—Here's what happens when Roe is overturned.(Available:)www.guttmacher.org/article/2022/06/13-states-have-abortion-trigger-bans-heres-what-happens-when-roe-overturnedDate: 2022Date accessed: September 9, 2020
- mifepristone pretreatment for the medical management of early pregnancy loss.New England Journal of Medicine. 2018; 378: 2161-2170
- Management of early pregnancy loss, with a focus on patient centered care.Seminars in Perinatology. 2019; 43: 84-94
- Availability and characteristics of abortion training in US ob-gyn residency programs: A national survey.Contraception. 2014; 89: 271-277
- State abortion policies and maternal death in the United States, 2015‒2018.American Journal of Public Health. 2021; 111: 1696-1704
- “Every person's just different”: Women's experiences with counseling for early pregnancy loss management.Womens Health Issues. 2017; 27: 456-462
- Counseling women with early pregnancy failure: Utilizing evidence, preserving preference.Patient Education and Counseling. 2010; 81: 454-461
- A comparison of medical management with misoprostol and surgical management for early pregnancy failure.New England Journal of Medicine. 2005; 353: 761-769
Biography
Elana Tal, MD, MS, is an Assistant Professor of Obstetrics and Gynecology at the Jacobs School of Medicine and Biomedical Sciences at University at Buffalo. Her research interests include implementation science regarding spontaneous and induced abortion care.
Biography
Rachel Paul, MPH, is research staff in the Department of Obstetrics and Gynecology at Washington University School of Medicine. She oversees clinical research and analysis in the department and her research interests include reproductive health care delivery.
Biography
Megan Dorsey, MPH, is research staff in the Department of Obstetrics and Gynecology at Washington University School of Medicine. She is responsible for the implementation of study protocols and is interested in mixed-methods research about reproductive health care.
Biography
Tessa Madden, MD, MPH, is an Associate Professor of Obstetrics and Gynecology and Director of the Fellowship in Family Planning at Washington University School of Medicine. Her research interests include contraceptive counseling and reducing barriers to contraceptive care.
Article info
Publication history
Published online: November 12, 2022
Accepted:
October 7,
2022
Received in revised form:
September 16,
2022
Received:
January 6,
2022
Footnotes
Funding Statement: Supported by funds from the Society of Family Planning Research Fund (SFPRF 20–22). The funders had no role in the study design; collection, analysis and interpretation of data; writing of the manuscript; or the decision to submit the article for publication. The contents are solely the responsibility of the authors and do not necessarily represent the official view of the Society of Family Planning. Dr. Madden serves on a data safety monitoring board for phase 4 safety studies of Bayer contraceptive products. The other authors do not have any potential conflicts of interest to report.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
