What barriers to abortion practice do obstetrician-gynecologists face after residency?

Objective: To determine the barriers to abortion practice after residency among obstetrician-gynecologists who participated in routine abortion training.

Methods: Interviews approximately one hour in length were conducted in person and over the phone with graduates five to ten years out of residency. Graduates were drawn from four US residency programs, chosen for their long history of abortion training and geographical diversity. Graduates were asked in detail about their experiences with abortion training, their interest in providing abortion to patients, and their experience with abortion practice after residency. Interviews were transcribed, coded, and analyzed for thematic content.

Results: A total of 30 practicing obstetrician-gynecologists were interviewed from the four residency programs; they included 9 from the West, 9 Midwest, 7 East, and 5 South. Barriers to abortion practice included prohibitions on abortion in private practice and both public and private hospitals in all areas of the country. Barriers such as stigma play out through staff, patient, and inter-collegial conflict, and generalized fear of failure in practice through lack of community support in conservative areas. Findings will be substantiated with excerpts from interviews.

Conclusion: While residency abortion training gives obstetrician-gynecologists surgical skills they need and critical exposure to the social psychological context of abortion, the politics of abortion make integration of abortion into practice difficult for new obstetrician-gynecologists. Obstetrics-gynecology training programs should prepare new graduates for these barriers and give them skills to negotiate for their rights and preferences around abortion care.