U.S. Primary Care Clinic Staff Attitudes Toward Providing Medication Abortion.

INTRODUCTION

We assessed pre-intervention staff attitudes toward providing medication abortion (MAB) in 10 clinics participating in a program to adopt MAB into primary care.

METHODS

In 2024, staff MAB "champions" from 10 organizations in eight states administered our online survey to staff at clinics preparing to introduce MAB (N = 888). Eligibility criteria included any staff who could directly or indirectly be involved in a patient MAB visit and did not self-identify as champions. Surveys queried on staff perceptions of implementation acceptability, belonging in primary care, readiness for change, and comfort working in an MAB-providing clinic, and they included open-ended questions on benefits and concerns. We organized open-ended responses into themes.

RESULTS

A total of 711 responded (80.0%); 446 met eligibility criteria. Most (86.2%) believed MAB belongs in primary care, but fewer (34.6%) were ready to implement it. Staff from other community health centers (compared with federally qualified health centers) and LGBTQ-specific clinics (compared with non-LGBTQ) had significantly higher odds of holding all positive MAB attitudes. Compared with providers, nonclinician clinic staff had lower odds of finding MAB implementation acceptable (adjusted odds ratio .47; 95% confidence interval [.23, .97]) when adjusting for clinic characteristics. Perceived benefits included increasing access (50.3%), aligning with primary care (36.9%), and promoting reproductive autonomy (10.7%). Concerns included safety risks (31.6%), lack of training (28.4%), and staff opposition (17.8%). Only 4.0% personally opposed abortion; 33.7% explicitly stated no concerns.

CONCLUSIONS

Many primary care staff are supportive of offering MAB, although they have concerns that should be identified and addressed. Organizations should consider thoughtful implementation planning, training, and education to prepare staff and shift culture.