More primary care doctors could begin to provide abortions
JACKSONVILLE, FLORIDA: The examination room in a clinic, which provides abortion care on April 30, 2024, in Jacksonville, Florida. A six-week abortion ban that Florida Gov. Ron DeSantis signed will go into effect on May 1st. (Photo by Joe Raedle/Getty Images) Joe Raedle/Getty Images hide caption
JACKSONVILLE, FLORIDA: The examination room in a clinic, which provides abortion care on April 30, 2024, in Jacksonville, Florida. A six-week abortion ban that Florida Gov. Ron DeSantis signed will go into effect on May 1st. (Photo by Joe Raedle/Getty Images)
Joe Raedle/Getty ImagesDr. Stephanie Arnold opened Seven Hills Family Medicine in downtown Richmond, Virginia two years ago.
Arnold works with a small team – a registered nurse and several medical systems. As she talks through her day, she lists a diabetes follow-up, a knee pain visit, an ADHD follow-up, gender-affirming care and three procedural abortion appointments.
"A little bit of everything today, which is very typical for family medicine," says Arnold.
Providing all sorts of care – from gender-affirming care to reproductive healthcare, including abortion – are part of the philosophy of Arnold's clinic. She started her practice a few months after the Supreme Court overturned Roe v. Wade.
Many of the abortions provided at Seven Hills are done with medication. For decades, reproductive healthcare like this was only available at specialized clinics like Planned Parenthood. But a growing number of primary care physicians are aiming to make them more accessible.
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Arnold points out the American College of Obstetricians and Gynecologists says any clinician who can screen patients and provide or refer for follow-up care can safely provide medication abortions. As Arnold sees it, abortion has been separated from other kinds of care for political reasons, not for medical reasons.
"It's just important to me to fight back against that stigma. There's no reason for this care to be siloed. It's very much a part of all the other care that I'm giving. I don't feel like it's any different than my management of chronic pain or endometriosis. This is just like a routine part of my day."
A growing movement.
For an increasing number of physicians across the United States, streamlining reproductive healthcare into their practices makes the most sense in the wake of the Supreme Court decision.
Dr. Sheila Attaie, for example, is a family doctor in Sacramento, California. If a young woman comes in complaining of abdominal pain and other symptoms, she would suggest a pregnancy test, just to be sure. And if it's positive?
"Then you kind of go through the options, counseling with them," Attaie says.
The options include continuing the pregnancy and scheduling a prenatal visit, or ending the pregnancy and getting an abortion. Both are available in the same clinic.
Attaie says that she had to fight for her patients to get access to abortion at the clinic where she works. Administrators weren't convinced. Then Roe v. Wade was overturned.
"I was like, 'Listen, we need to do these things.' And they were like, 'Yes, you're right.' And everyone was kind of emboldened."
Fort Collins, Colorado, family medicine doctor Ben Smith can relate.
"There was an all-hands-on-deck mentality that happened after times where there was an incredible kind of surge of interest and willingness and a sense of capacity."
Looking at the numbers.
NPR heard similar stories from doctors in Michigan, Minnesota and Pennsylvania. Some of these states have also loosened regulations like getting rid of waiting periods in Smith's primary care clinic.
They don't do many abortions, about one or two a month. But he says even that small number can make a difference, since Colorado has become a destination for people traveling from states with abortion bans.
There isn't much data yet on exactly how many internal medicine or family medicine doctors are beginning to provide abortion in primary care. But there is some evidence that the trend is growing.
A recent study found a surge in applications to programs that train primary care providers on abortion, and some have online resources.
The federal government estimates there are more than 250,000 primary care physicians in the U.S.
That's more than six times the number of OB-GYNs, and nearly 40 percent of U.S. counties have no OB-GYNs, which means there are reproductive health gaps to fill.
There have long been family doctors who provided abortion and advocated for access, but it hasn't caught on like this before, says Mary Ziegler, a law professor at U.C. Davis who's written extensively on the history of abortion.
Back in the fifties and sixties, she says, abortions generally happened at hospitals, but not all hospitals offered them, often for religious reasons. And access across the country was uneven.
"So in the seventies, abortion rights groups began focusing on the opening of free-standing abortion clinics," Ziegler said.
The fact that more and more doctors are signing up to train on integrating abortion into primary care is a sign that the stigma is changing, she says.