Physician attitudes about abortion at a Midwestern academic medical center

ABSTRACT Background Almost every medical professional organization supports abortion access. Meanwhile, federal and state-level policies continue to erode abortion-related healthcare. Physicians are instrumental to abortion access, and their evidence-based attitudes could significantly influence public understanding. However, most studies of physician attitudes about abortion focus on specific subgroups. A study of abortion attitudes among a broader population of clinicians is important for at least three reasons. First, results could provide insights and strategies to improve access and reduce stigma at academic medical centers and beyond. Second, findings could explain discrepancies between expressions of support for abortion by the medical community and the inability or unwillingness of the same community to provide sufficient access to abortion services. Third, gauging the climate of opinion among physicians in a politically contested state is likely to be informative given that most abortion-related judicial decisions will occur in state-versus federal-level courts, and physician attitudes could potentially influence public policy. Objective To use leading survey methodologies to assess abortion-related attitudes among all physicians at the largest academic medical center in a politically contested Midwestern state. Study Design Investigators developed a cross-sectional survey to gauge abortion-related knowledge, attitudes, and practices. The university’s survey research center disseminated the survey to all 1,357 physician faculty members of the school of medicine and public health using a web and mail mixed-mode methodology (67% response rate). Analyses included chi-squared tests and binary logistic regression models of support for abortion procedures and willingness to consult in abortion care. Results Across more than 20 specialties and all sociodemographic categories, physicians reported strong support for abortion. Majorities expressed support for medication (81%) and surgical abortion (80%), that abortion should be legal in all or most cases (88%), and that a state law banning abortion would make women’s health worse (91%). While nearly all physicians (94%) care for women of reproductive age, most (69%) reported no opportunity to participate in abortion care and fewer than half (44%) knew whom to contact to refer a patient for abortion care. Female physicians and those who considered their expertise relevant to abortion were more supportive, while physicians of color and highly religious physicians were less supportive. Few physicians reported participating in any aspect of abortion care (14%), though nearly two-thirds were willing to consult in such care (65%). Those with relevant expertise were more willing to consult, while physicians of color and highly religious physicians were less willing. While most physicians said they support unrestricted access to abortion (63%) and the efforts of abortion providers (70%) “a lot,” a majority perceived relatively less support among their professional peers, revealing a climate of pluralistic ignorance. Conclusions Despite overwhelming support for abortion among this population, participation in any aspect of abortion care is remarkably low. Physicians across all disciplines need clear training and guidelines on how to refer patients for abortion care, and abortion should be normalized and integrated into mainstream medicine. Given professional organizations’ support of abortion and physicians’ cultural influence, these results can be used to inform public policy regarding abortion access.