Abortion politics and the provision of evidence-based care for miscarriage

Conflict surrounding the provision of abortion services is well-known. Access to evidence-based care for miscarriage, and miscarriage training in many Family Medicine (FM) residency programs, may also be affected by abortion stigma. Miscarriage is common and part of routine women's health care; it can be managed in the office setting by generalists, but is usually managed by specialists in the operating room under general anesthesia. Evidence supports offering women a choice of management options, including manual vacuum aspiration (MVA).

The Residency Training Initiative in Miscarriage Management (RTI-MM) was designed to train FM residents, faculty, and support staff in MVA for miscarriage and to normalize office-based uterine evacuation. The RTI-MM is multi-dimensional and theory-based. We sought to understand the impacts of abortion politics on implementation of MVA for miscarriage. Methods. Our process evaluation utilized program data and semi-structured interviews with 35 RTI-MM participants at 10 FM residency sites in Washington State. Interviews focused on barriers and facilitators to implementation of MVA. We used case summaries and matrices to organize the qualitative data. Results. Participant views about abortion, reproduction, and patient preferences impact implementation of evidence-based miscarriage care. Clarifying the difference between induced and spontaneous abortion, presenting a patient-centered care model, and providing scripts were cited as helpful to implementation of MVA for miscarriage. Conclusions. Miscarriage provides a context to clarify values about abortion, and efforts to improve access to evidence-based care for miscarriage should address views about abortion. Providers and staff may have misconceptions about patient preferences for miscarriage management.