More primary care doctors could begin to provide abortions

This episode explores the increasing trend of primary care physicians providing abortion services, especially after the Supreme Court's reversal of Roe v. Wade.

1. The overturning of Roe v. Wade has catalyzed a shift towards integrating abortion services into primary care settings.
2. Medication abortions are commonly provided in these settings, emphasizing a holistic approach to patient care.
3. There is significant opposition from anti-abortion activists, citing the need for specialized care that general practitioners may lack.
4. Proponents argue that incorporating abortion into primary care removes unnecessary stigmatization and makes it a routine part of healthcare.
5. The episode showcases personal stories from patients and doctors, illustrating the practical and emotional impacts of this integration.

1. Introduction to the Issue

Overview of the trend of primary care doctors offering abortion services and the political landscape influencing it. Juana Summers: "But since Roe v. Wade was overturned, a movement to take abortion out of its silo and integrate it into everyday primary care has gained momentum."

2. Personal Perspectives

Discussion on how patients and doctors perceive and experience the integration of abortion services into primary care. Dr. Stephanie Arnold: "It's very much a part of all the other care that I'm giving. I don't feel like it's any different than my management of chronic pain or, you know, endometriosis."

3. Political and Legal Considerations

Analysis of the legal and societal implications of primary care physicians providing abortions, with views from both sides of the abortion debate. Christina Francis: "Abortion is nothing like managing a chronic condition like diabetes, chemical abortion drugs, and the life of my fetal patient."

1. Understand the role of primary care in providing comprehensive healthcare, including abortion.
2. Recognize the importance of supporting healthcare settings that offer inclusive services.
3. Educate oneself about the legal and medical aspects of abortion to better participate in related discussions.
4. Advocate for accessible healthcare that respects patient choices and needs.
5. Stay informed about changes in healthcare policies and their implications for services like abortion.

For decades, people seeking abortions went to specialty clinics like Planned Parenthood. But since Roe v. Wade was overturned, more general practitioners are stepping in to provide abortions.

People

Juana Summers, Stephanie Arnold, Christina Francis

Content Warnings:

None

Stephanie Arnold
All right, y'all ready to huddle? Yes. That's doctor Stephanie Arnold. She opened seven Hills family medicine in downtown Richmond, Virginia. Two years ago, NPR's Selena Simmons Duffin and Alyssa Nadworny visited the clinic.

Juana Summers
Doctor Arnold works with a small team, a registered nurse and several medical assistants. I'm doing chronic condition management via telehealth in five minutes at 10:00 a.m. i'm doing a follow up on diabetes, and then I'm seeing a knee pain visit and an ADHD follow up. And then we have three aspiration abortion appointments. That's three procedural abortion appointments alongside all the other appointments.

Stephanie Arnold
A little bit of everything today, which is very typical for family medicine. In the doctor's office, there is a follow up for a patient with GI issues. So your labs came back and honestly are, like, looking pretty good. There was no evidence of celiac to explain. Then another patient comes in for gender affirming care, gearing up to start testosterone.

But I think I mentioned that there's, like, kind of two extremes on the dosing approach. Fast track or the scenic route? We're going in the middle. Yeah. All right.

Juana Summers
Providing all sorts of care. Gender affirming care and all aspects of reproductive health care, including abortion, are part of the philosophy of Doctor Arnold's clinic. She started her practice a few months after the Supreme Court overturned Roe v. Wade. Many of the abortions provided here are done with medication.

The first pill people take is mifepristone. So this is the mifepristone. We get a box. It's six in a box. And so they take this here.

The second medication is mesoprostole, which patients get to take home with them. And the staff follows up with all abortion patients to find out how they're doing. Hey there. This is Katie. I'm just calling from the doctor's office.

Katie
I wanted to try again to check in with you about how you're feeling. Anti abortion rights activists oppose primary care doctors like doctor Arnold providing abortion care. Doctor Christina Francis, an Ob Gyn in Indiana who runs the American association of Pro Life ob Gyns, says abortion is nothing like managing a chronic condition like. Diabetes, chemical abortion drugs, and the life of my fetal patient. So that in and of itself makes it different from a diabetes drug.

Christina Francis
But also the complications related to a diabetes drug are not going to require an expertise that's outside of the skill set of a family medicine physician to manage. But doctor Stephanie Arnold points out, the American College of Ob Gyn says any clinician who can screen patients and provide or refer for follow up care can safely provide medication abortions. As Arnold sees it, abortion has been separated from other kinds of care for political reasons, not for medical reasons. It's just important to me to, like, fight back against that stigma. There's, you know, no reason for this care to be siloed.

Stephanie Arnold
It's very much a part of all the other care that I'm giving. I don't feel like it's any different than my management of chronic pain or, you know, endometriosis. This is just like a routine part of my day. Consider this. For decades, people seeking abortions had to go to specialty clinics like Planned Parenthood, sometimes with people opposed to abortion protesting outside.

Juana Summers
But since Roe v. Wade was overturned, a movement to take abortion out of its silo and integrate it into everyday primary care has gained momentum.

From NPR, I'm Juana Summers.

It's consider this from NPR. NPR's Selena Simmons. Duffin dug into the trend of more and more family doctors beginning to provide abortions, and she explored how abortion care got separated from other care in the first place. She takes it from here. Imagine a young woman makes an appointment with her family doctor.

Selena Simmons-Duffin
She has some abdominal pain and some other symptoms she wants to get checked. Her doctor says, why don't we just run a pregnancy test just to be sure? And it's positive. That's doctor Sheila Attaye, a family doctor in Sacramento, California. After a pregnancy test comes back positive, then you kind of like go through that, like options counseling with them.

The options include continue the pregnancy and schedule a prenatal visit or end the pregnancy and get an abortion. Both are available right there in the same clinic. For some people, they know right away. For some people, I've seen them week after week to support them through whichever route they choose. Atay fought hard to fully integrate abortion into the clinic where she works.

She says for a long time, clinic administrators weren't convinced. Then Roe v. Wade was overturned in the Dobbs decision. I was like, listen, we need to do these things. And they were like, yes, you're right.

And like, everyone was kind of like emboldened, right? Like after Dobbs in the blue states. In Fort Collins, Colorado, family medicine doctor Ben Smith can relate. There was an all hands on deck mentality that happened after DOBBS where there was, you know, an incredible kind of surge of interest and willingness and a sense of capacity. NPR heard similar stories from doctors in Michigan, Minnesota and Pennsylvania.

Some of these states have also loosened regulations like getting rid of waiting periods in Smith's primary care clinic. They don't do many abortions, about one or two a month. But he says even that small number can make a difference. Since Colorado has become a destination for people traveling from states with abortion bans. Every abortion that we do in primary care becomes a space for a more nationally facing organization that can accommodate someone who is traveling from Texas, from Florida.

There isn't a lot of data yet on exactly how many internal medicine or family medicine doctors are beginning to provide abortion and primary care, but there is some evidence that the trend is growing. A recent study found a surge in applications to programs that train primary care providers on abortion. Some have online resources. This training video shows a doctor talking with a patient about what plans they have for getting pregnant and using different kinds of birth control. I am here for you to talk about any of the different options.

Katie
And also if you do get pregnant and you don't want to continue the pregnancy, I have pills for that, too. Great. Thank you. No problem. Okay, so let's go back to talking about your diabetes.

Selena Simmons-Duffin
There are barriers for clinics, including stigma and administrative hurdles, like the FDA's rules for prescribing abortion pills, says Elizabeth Janiak. She's a professor at Harvard Medical school who co leads expand one of the training programs. She says those barriers help explain why the portion of primary care doctors offering abortion is quite small. But one thing that I think is really important to remember is that even if we were to be really conservative and say 5%, there are so many primary care doctors in this country. So we're talking thousands and thousands of providers.

The federal government estimates there are more than 250,000 primary care physicians in the US. That's more than six times the number of OB gyns. And Janiak points out, nearly 40% of us counties have no OB gyns, which means there are reproductive health gaps to fill. There have long been family doctors who provided abortion and advocated for access, but it hasn't caught on like this before, says Mary Ziegler, a law professor at UC Davis who's written extensively on the history of abortion. Back in the fifties and sixties, she says, abortions generally happened at hospitals, but not all hospitals offered them, often for religious reasons.

And access across the country was uneven. Seventies, abortion rights groups began focusing on the opening of freestanding abortion clinics. On one hand, she says, the clinics did expand access. On the other hand, they physically and symbolically isolated abortion from other health services and made them easier to stigmatize, made it easier for abortion clinics to be protested, and made it easier to argue that abortion was very different from other forms of health care. For years, a key anti abortion strategy was to target those clinics with regulations known as trap laws that mandated a certain width of hallways or required doctors to have admitting privileges at hospitals.

For instance, here is Ziegler. Trap laws combined with the rise of clinic blockades and clinic protesting and even violence against abortion doctors led to a pretty precipitous decline in the number of physicians who were either trained to perform abortions or willing to perform abortions. The fact that more and more doctors are signing up to train on integrating abortion into primary care is a sign that the stigma is changing, she says. Doctor Christina Francis, an Ob gyn in Indiana who runs the American association of Pro Life ob Gyns, does not think the regulations that have separated abortion from other kinds of health care were just political. In general, the abortion industry has been actually largely under regulated, not regulated as stringently as hospitals.

She also says that family medicine doctors don't have the specialized training that Ob gyns do to provide productive health care, and that includes abortion, which she opposes. I'm not saying that family medicine physicians are not good physicians. They certainly are. But their training is not the same as Obgyn's in these kinds of things, she says. The trend concerns her.

She does not consider abortion essential health care for women. Many organized medical groups disagree with her. The American College of OB Gyns says any clinician who can screen patients for eligibility can prescribe medication abortion safely as long as they themselves can provide or refer patients for follow up care as needed, usually a uterine evacuation. From the patient perspective, Liz Johnson has had two different abortion experiences. She's a graduate student in Pittsburgh getting her master's in social work.

Years ago, she had an abortion at a specialty clinic. It's honestly like, I think it can feel very, like, impersonal and fast and like procedural, like da da da da da, you know. In October 2022, she had an abortion with her primary care doctor. She liked that her doctor already knew her and her medical history. I really appreciated the personal touch of being able to text, to check in and stuff like that.

Juana Summers
So it went really smoothly to the point I can't even elaborate. No problems. Johnson describes herself as an open book. More and more patients have been willing to speak publicly about their experiences with abortion, but that openness isn't always present among the primary care clinics that have recently begun to provide abortions. In Sacramento, doctor Sheila Itahi says after the clinic she works for started to provide abortion, we weren't allowed to advertise that we do it because they don't want that attention, attention that might come with protesters or threats from people who oppose abortion.

Selena Simmons-Duffin
Atai says she gets it, but she also finds the secrecy frustrating. If we act in fear, how do we expect anything to be changed? If we like our hush hush about all these things, how do we normalize them as healthcare? Harvard's Janiek says this may be evidence of the need for broader cultural change, but just because right now primary care providers don't have abortion on their lists of services or on their websites doesn't mean, she says, they'll never get there. That was NPR's Selena Simmons Duffin.

Juana Summers
This episode was produced by Matt Ozug and Breonna Scott. It was edited by Diane Weber and Courtney Dorting. Our executive producer is Sammy Yenigun.

It's consider this from NPR. I'm Juana Summers.