"It's a reality that we in medicine should catch up with": Physician's attitudes about self-sourced and managed abortion in the United States.

Background: The evolution of medical standards in stigmatized areas like abortion is influenced by medical, political, and social factors. Self-sourcing and managing medication abortion (SSMA) is on the rise in the United States, where individuals obtain medications to end their pregnancies outside traditional medical settings. Physician attitudes towards SSMA are not well understood, despite physicians' role in setting care standards, providing medical oversight, and de-stigmatizing healthcare both within and outside clinical environments.

Materials And Methods: We interviewed 40 physicians (MD/DOs) who perform abortions about their views on SSMA. We used inductive-deductive coding for transcript analysis and qualitatively assessed how attitudes shifted before and during the interviews.

Results: Most participants were aged 31-35 years (n = 16, 40%), non-Hispanic White (n = 29, 72.5%), and female (n = 33, 82.5%). We oversampled family medicine-trained physicians (n = 31, 78%) compared to OB/GYNs (n = 9, 22.5%). Participants were from 24 states, with half from states supporting abortion rights and the other half from states with hostile or neutral stances. Half of the cohort supported SSMA, while the other half was ambivalent. Medical evidence alone did not sway physician views on SSMA; instead, participants adjusted their attitudes by clarifying their professional values, evaluating SSMA's alignment with these values, and considering values-based frameworks as alternatives to medicalization.

Discussion: Although medical care is typically seen as objective and standardized, physicians' ethics to ensure safe access to care often clash with political restrictions in this stigmatized field. Physicians are more worried about the broader structural issues related to SSMA, such as how political and social vulnerabilities could harm the most vulnerable patients, rather than the medical care itself, which they see as safe and effective, with or without physician oversight. Positive attitudes toward SSMA were strengthened by exposure to values-based frameworks that offer alternatives to strict medicalization.