US doctors already face big hurdles to access the abortion pill | Health, Medicine and Fitness

Alan Mozes

WEDNESDAY, May 25, 2022 (HealthDay News) — Even with Roe v. Still wading the law of the land, primary care doctors in the United States are struggling to prescribe abortion pills approved by the US federal government, according to a new study.

The barriers are a complex combination of state and federal regulations, insufficient training and institutional barriers, the researchers found when they interviewed dozens of doctors.

“As family physicians provide comprehensive medical care to individuals throughout their lives – including supporting their reproductive choices – they are the primary individuals to provide medical abortion,” explained the senior author of the study, Dr. Na’amah Razon.

“We found a series of barriers that prevented family physicians from integrating medical abortion into their primary care practices,” said Razon, assistant professor in the Department of Family and Community Medicine at the University of California at Davis.

It’s a landscape that will likely only get worse, Razon said, as Roe v. Whether or not Wade is overturned, though a leaked draft from the U.S. Supreme Court says it will.

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“Given the recent movement toward restricting abortions in the United States, family physicians may face increasing barriers to providing medical abortions,” she noted.

The two-pill regimen includes mifepristone and misoprostol. Planned Parenthood notes that this non-invasive method is 94%-96% safe and effective. And the Guttmacher Institute says the medication approach now accounts for more than half of all abortions in the United States.

Until December 2021, the United States Food and Drug Administration only allowed mifepristone to be administered in person at a clinic, hospital, or under the direct supervision of a certified medical provider. Pickup from retail pharmacies and mail orders were not permitted. The December FDA decision removed the in-person requirement, allowing consultation via telehealth, although all physicians in the current study were interviewed before this decision was made.

For the study, 48 U.S. primary care physicians were surveyed in 2019 and classified into one of three groups: those who did not perform abortions and had not been trained to do so (11 physicians ); those who did not perform abortion, although they received training (20 doctors), and those who were trained and provided abortion services (17 doctors).

About two-thirds were not practicing abortion at the time of the survey.

Those in the untrained/non-provider group stated that their lack of training was the main reason for not offering abortion care.

These physicians variously said that their lack of skills in abortion care made them “uncomfortable,” unfamiliar with the drugs involved, and/or unconvinced that abortion services were truly in the business. of family medicine. They were also the most likely to cite their state’s anti-abortion political climate, a lack of community support, and a poor understanding of local hospital regulations as discouraging factors.

In contrast, those who did not provide abortion services despite their training generally said they understood only too well the wide range of primary care, clinic and hospital restrictions in place in their region.

This group also cited the federal Hyde Amendment as a barrier to providing care in their own practice and elsewhere. This law prohibits the use of federal funds for abortion.

In addition, the group pointed to the FDA’s REMS (Risk Assessment and Mitigation Strategy) as another hurdle. REMS is a drug safety protocol applied to certain drugs. Since 2011, the FDA has applied REMS to mifepristone to restrict how, where, and when it can be prescribed and obtained.

Of primary care physicians who have been trained and currently provide abortion care, 60% said they do not offer abortion pill prescriptions as part of their family practice, only at specialized clinics in reproductive health.

The researchers also found that the practitioners who offered abortion pill prescriptions in their primary care setting were either in the Northeast or the West; none resided in states with highly restrictive abortion laws.

Some also noted that the gynecological facilities and/or hospital departments they worked with prohibited abortion services of any kind.

Several said that in order to make abortion pills available in a family practice or specialty clinic, it was necessary to have a “champion” on board ready to jump through the regulatory hoops involved.

Elisa Wells is co-founder and co-director of Plan C, an organization dedicated to ensuring unlimited, stigma-free access to abortion pills. She expressed her frustration with the status quo.

“The science on the absolute safety of medical abortion does not support these additional barriers to access,” Wells said. “Many of the primary care providers we spoke to don’t have practices that allow them to perform abortions, so that’s a huge barrier,” even among those who are trained and willing.

Wells, who was not involved in the study, said ensuring widespread access to abortion pills would mean convincing the FDA to remove all REMS restrictions for mifepristone.

“Mifepristone is an extremely safe drug,” she noted, “and any licensed provider should be able to write a prescription for a patient who qualifies for it, and the patient should be able to fill that prescription in any location. what pharmacy.”

The results were published in the May-June issue of Journal of the American Board of Family Medicine.

There’s more about abortion drugs at Plan C.

SOURCES: Na’amah Razon, MD, PhD, assistant professor, department of family and community medicine, University of California, Davis, Sacramento; Elisa Wells, MPH, Co-Founder and Co-Director, Plan C; Journal of the American Board of Family Medicine, May-June 2022

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