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Like many matters of personal health and privacy, women’s
preferences for abortion care are complex. Each of us experiences the health
care system differently depending on where we live, our cultural experience, our
economic position, and who we are as individuals. When it comes to abortion, widespread stigma along with anti-abortion harassment and violence
can further shape our expectations of abortion care, narrowing our perceptions
of where and from whom we might receive this care as well as limiting our
access.
In the U.S.,
abortion is most visibly associated with Planned Parenthoods and private
abortion clinics. While these are extremely important, they are not the only providers
of care. In communities around the
country, private physician offices and primary care clinics are also providing
abortion, many in areas where they are the sole provider. On-site services from these clinicians offer the
opportunity for earlier procedures, reduced travel time and costs, continuity
of care, and freedom from harassment by protesters who target better-known,
larger providers. These benefits along
with the safety of early abortion have prompted organizations like AAP to
promote early abortion in primary care settings – but do women trust and want abortions
in these settings? Many of the providers
with whom AAP works describe their patients’ profound appreciation. A recent
study by Susan Rubin, Emily Godfrey
In their study, 70% of women surveyed agreed their family medicine
clinic should offer medication abortion.
Of women who would personally consider an abortion, 73% stated that they
would prefer to receive such care from their family physician.
and Marji Gold further supports this model.
The Rubin study surveyed women in a waiting room of a family
medicine clinic in a predominantly minority, low income neighborhood – and
illustrates the potential for improving these women’s access, were abortion to
be offered in this setting. New providers and new settings for abortion care
help make abortion more accessible for all women. This is why targeted engagement of new
providers – particularly those working in settings where women are already
accessing health care - is one of AAP’s priorities, as is work to ensure that
training is available to those who most wish to provide abortion for their
patients.
But perhaps a larger question is also suggested by the study: what is the ideal system of abortion
care? Anti-abortion rhetoric, harassment
and stigma threaten to limit not only women’s perceptions of abortion care but,
as abortion providers and advocates, our own.
More research on the complex dynamic between anti-abortion activities
and discourse, women’s personal experience of and feelings about abortion, and women’s
experience of the health care system generally might help those of us who are working
to improve and sustain women’s access to abortion envision a system that meets
this need. A better understanding of
women’s expectations and the factors that shape these might also suggest ways
to increase the demands that women make on health care providers and policy
makers when it comes to their preparedness to address abortion. Finally, such a
vision might suggest new allies as we pay increased attention to health care
reform, new technologies, and other trends in health care delivery, and engage
in these discussions as part of the “visioning” process.
At AAP’s 2008 National Convening, held earlier this
October, we raised the question: do we have a vision for an optimal system of
abortion care? What would this system
look like? Many of our colleague
organizations attending the meeting responded with interest and we are seeking
their input the best way to move the conversation forward. In what ever way the conversation proceeds,
it will be open, collaborative and an opportunity to engage with others equally
committed to women’s access to safe abortion.
We welcome hearing your thoughts.
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