Provision of medication and procedural abortion among Massachusetts obstetrician-gynecologists.

Objectives: The aim of the study was to understand the rates of first-trimester medication and procedural abortion provision, sufficiency in abortion training, and factors associated with abortion provision among obstetrician-gynecologists (OB/GYNs) in Massachusetts.

Study Design: Electronically fielded surveys of a census of OB/GYNs in Massachusetts in 2021 queried physicians on abortion provision, training, practice type, and demographics. Using weighting to account for nonresponse, we generated estimates of the proportion of OB/GYNS providing abortion and used multivariate regression analysis to explore factors associated with abortion provision including practice type, physician sex, and sufficient abortion training.

Results: A total of 198 OB/GYNs responded to the survey (response rate = 29%). Of 158 OB/GYNs not in training, 55% provide some abortion care. More respondents reported sufficient training for surgical abortion (84%) than for medication abortion (43%). The most cited reasons for not providing abortion care were lack of integration into their clinical practice (29%), institutional opposition (27%), or personal opposition to abortion (23%). In multivariate analysis, female physicians were more likely to provide abortion care (adjusted odds ratio [aOR] 2.72, 95% CI [1.63-4.55], p < 0.01), and those with insufficient training less likely to provide abortion (aOR 0.18, 95% CI [0.10-0.33], p = 0.01). Those in private practice (aOR 0.47, 95% CI [0.28-0.80], p < 0.01) or "other" practice types (aOR 0.16, 95% CI [0.09-0.27], p < 0.01) were less likely to provide abortion compared to physicians in academic practices.

Conclusions: Only half of OB/GYNs in a state supportive of abortion provide abortion. Despite high patient interest in medication abortion, a majority of OB/GYNs report insufficient training in medication abortion.

Implications: This study highlights the need for support from practice, institution, and health system leaders to facilitate the provision of abortion care and the need for increased training among OB/GYNs in medication abortion.