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Comparison of Early Pregnancy Loss Management Between States With Restrictive and Supportive Abortion Policies

  • Elana Tal
    Correspondence
    Correspondence to: Elana Tal, MD, MS, Department of Obstetrics and Gynecology, University at Buffalo, Jacobs School of Medicine and Biomedical Science, 1001 Main St, 5th Floor, Buffalo, NY 14203. Phone: (716) 323-0626; fax: (716) 636-5015.
    Affiliations
    Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri

    Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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  • Rachel Paul
    Affiliations
    Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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  • Megan Dorsey
    Affiliations
    Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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  • Tessa Madden
    Affiliations
    Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Published:November 12, 2022DOI:https://doi.org/10.1016/j.whi.2022.10.001

      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.
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      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.