2015 APHA Annual Meeting & Expo

Home Events & Meetings Annual Meeting Schedule & Program

Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

330315
A Sense of Obligation: Opinions on Abortion Referral Among Clinicians in Nebraska


Monday, November 2, 2015 : 3:15 p.m. - 3:30 p.m.

Valerie French, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Jody Steinauer, MD, MAS, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Susana Berrios, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Libby Crockett, MD, Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE
Abby Sokoloff, MPH, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
Renaisa S. Anthony, MD, MPH, Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE
Audio (mp3) recording Recorded Presentation (mp4)
Background:

Studies have found that patients are more likely to access subspecialty care when their primary care providers provide referrals. Little is known about whether US clinicians feel obligated to provide referrals for women desiring abortion.

Methods:

We surveyed Nebraska family medicine and Ob-gyn physicians and advanced-practice clinicians about their referral opinions in four reproductive health scenarios: abortion, in vitro fertilization, high-risk prenatal care and suspected gynecologic malignancy. For each we asked whether “clinicians have a professional obligation to refer.” We assessed correlates of supporting an obligation to refer for abortion using multivariate logistic regression.  We categorized religiosity into low, moderate and high religiosity. (Curlin)

Results:

Of the 1,496 clinicians surveyed, 500 responded (33%) and 479 (32%) answered the referral obligation question.  The majority of respondents reported a clinician obligation to refer for suspected gynecologic cancer (96%) and high-risk prenatal care (97%), with fewer for in vitro fertilization (78%) and abortion (51%). There was no independent association between abortion referral obligation and clinician type, specialty, sex, age, rural location, or provision of reproductive health care in practice (all p values >0.1). Clinicians with high intrinsic religiosity were less likely to agree with an obligation for abortion referral (OR 0.37, 95% CI 0.23-0.58 p <0.001) in multivariate analyses including all variables listed.

Conclusion:

Many Nebraska clinicians do not feel that clinicians are professionally obligated to refer for abortion.  This may lead to fewer referrals for women and to delayed care.

Learning Areas:

Ethics, professional and legal requirements

Learning Objectives:
Describe the opinions of Nebraska healthcare clinicians regarding their obligation to refer women seeking abortion Identify predictors of clinicians who report an obligation to refer for abortion

Keyword(s): Abortion, Accessibility

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of the study and was in charge of study design, implementation and analysis.
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.

Back to: 3384.0: Barriers to abortion care in the Midwest and innovative strategies for overcoming them