238022 Abortion politics and the provision of evidence-based care for miscarriage

Wednesday, November 2, 2011: 10:30 AM

Blair Grant Darney, MPH , Department of Health Services, University of Washington, Seattle, WA
Deborah VanDerhei, BSW , Department of Family Medicine, University of Washington, Seattle, WA
Marcia Weaver, PhD , Center for Health Education and Research, Seattle, WA
Nancy Stevens, MD, MPH , Department of Family Medicine, University of Washington, Seattle, WA
Sarah Prager, MD, MAS , Department of OB/Gyn, University of Washington, Seattle, WA
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.

Learning Areas:
Advocacy for health and health education
Implementation of health education strategies, interventions and programs
Provision of health care to the public

Learning Objectives:
1) Identify ways that abortion stigma impacts miscarriage services 2) Articulate strategies to facilitate comfort with miscarriage services 3) Describe how miscarriage provides a way to clarify values about abortion

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the lead evaluator on this practice change initiative that aims to improve care for miscarriage.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.