Patient Preferences for Provider Specialization for Induced Abortion and Miscarriage Care.

Objectives

Most induced abortions are provided by abortion specialists, despite knowledge and skills overlap with other disciplines, particularly general obstetrics and gynecology (OB/GYN). We evaluated patient preferences for abortion and miscarriage care from a family planning specialist versus other providers, and perceptions of a general OB/GYN's ability to provide safe miscarriage and abortion care. Materials and

Methods

We conducted a cross-sectional survey among individuals aged 18-44 receiving induced abortion (n = 54) or nonabortion gynecological care (n = 111) in North Carolina hospital-based gynecology or family planning clinics between April and October 2023. The primary predictor was appointment type. The primary outcome was preference for induced abortion from a family planning specialist versus other providers; secondary outcomes were provider specialty preference for miscarriage care and patient perceptions of a general OB/GYN's scope of practice. We evaluated associations between appointment type, outcomes, and participant characteristics.

Results

This was a racially diverse population with half (50.3%) using public health insurance. Most (73.0%) felt abortion is "morally acceptable and should be legal." Over half (53.1%) preferred induced abortion from a specialist provider, compared with one-third (32.7%) for miscarriage (p < 0.001), with no differences by appointment type. Educational attainment (p = 0.03) and Democratic party affiliation (p = 0.02) were independently associated with abortion specialist preference, but not significant in multivariable analysis. More participants believed a general OB/GYN can provide medications for miscarriage management compared with induced abortion (94.5% versus 86.6%, p = 0.01). Both medical and surgical first trimester induced abortions were more often identified as within-scope for a general OB/GYN than the ability to perform a hysterectomy (69.8%, p < 0.01). Most (78.8%) believed OB/GYNs should be required to train in abortion care.

Conclusions

Participants were more likely to prefer a family planning specialist for induced abortion care versus miscarriage; however, nearly half preferred nonspecialist care. Incorporation of induced abortion into general practice settings may meet patient preferences while expanding access.