Primary Care Providers Can Help Safeguard Abortion

Several states have immediately banned essential care that is used by roughly one in four Americans who can become pregnant because of the Supreme Court's decision to overturn constitutional protections for abortion. Many people in the health professions say that these prohibitions will undermine bodily autonomy, criminalize a wide range of pregnancy outcomes and limit the personal and professional lives of millions of Americans. They will increase morbidity and mortality when it comes to pregnant women.

We believe that the health service should not be limited to abortion clinics and ob-gyn practices. They are already overburdened. America needs to expand its abortion care workforce and primary care providers are crucial to that. People who are pregnant can be seen by family physicians, internists, pediatricians and nurse practitioners. Only 3 percent of family physicians provide abortion care, even though they can and do provide both medication and procedural abortions in their offices.

More primary care clinicians should provide the abortion services that fall within their scope of practice as a matter of health equity. Many people prefer to access abortion and other sexual and reproductive health services from their primary care doctors. Providing abortions in primary care improves continuity with other health care services. Access to abortion is increased by it.

The issue of access is important. State laws, federal funding bans, conservative courts, and structural inequalities have eroded the right to abortion. Forced birth and the criminalization of abortion will hurt low-income, rural, Black, Indigenous and immigrant communities the most. People are being charged with crimes for having abortions or miscarrying.

Many pregnant people won't be able to access these services because they don't have funds, internet access or a secure mailing address Some patients won't be eligible for remote services due to the fact that 19 states prohibit abortion provision. This will make reproductive injustice and inequity worse.

Primary care practices will face the same legal and financial risks in states where abortion is completely banned. Primary care clinicians can help to meet the surge in demand that is already overwhelming abortion clinics in border states. Rural and exurban areas of states already have a shortage of abortion providers. Primary care clinicians are the sole providers of health care in these areas. Patients in rural areas are often at a disadvantage when trying to access health care, as most abortion providers are concentrated in larger cities, which makes it difficult for patients to manage transportation, lodging, and lost wages. Many of the primary care abortion providers will be close to restricted states.

There arechallenges to expanding the primary care abortion workforce. Academic medical centers are often located in urban areas with less abortion restrictions. The abortion care workforce is not as diverse as the general medical workforce. New restrictions on abortion and sexual and reproductive healthcare will make it more difficult to build trust and improve health outcomes.

There is good evidence that change can be achieved. After graduation, the rate of providing abortions increases dramatically when family medicine residents train at programs that include abortion education. The underrepresentation of Black, Indigenous and Latinx clinicians is related to the racist evolution of the U.S. medical profession. Research shows that primary care clinicians who are underrepresented are more likely to work in the communities that are most affected by the abortion ban. A growing body of research indicates that racial/ethnic minorities have a better experience with clinicians who look like them, something that will be particularly important for patients fleeing abusive and unjust state laws.

The following actions are proposed to support increased abortion provision.

• In the border regions of less restricted states, such as southern Illinois, western Pennsylvania, western and eastern Maryland, and eastern Washington, abortion training needs to be expanded and funded. The renewal of this vital medical workforce should be a priority for states considering abortion rights.

• There are barriers that limit the use of telemedicine, prescription of abortion drugs, and training for doctors. We need to make sure that professional certifications include non-ob-gyn physicians and advanced practice clinicians and that more restrictive states don't limit abortion provision to subspecialists.

• Implement policies to diversify and build the abortion care workforce in communities most affected by criminalization. This means expanding primary care with intentional efforts to increase recruitment, retention and mentorship of people underrepresented in medicine. It also means collaborating with abortion funds and listening to and working with reproductive justice organizations. We must also seek out and hear the perspectives of people on the ground in restricted states.

We know that the crisis of abortion access and reproductive injustice has been going on for a long time and that it will take a long time to fix it. We need to stand with other human rights movements. We need to stand for the rights of all people. The coalition struggle is needed to ensure that all pregnant women in the U.S. have access to sexual and reproductive health care.

The views expressed by the author or authors are not necessarily those ofScientific American.