STEPHANIE ARNOLD: All right. Y'all ready to huddle?
UNIDENTIFIED PERSON #1: Yes.
JUANA SUMMERS, HOST:
That's Dr. Stephanie Arnold. She opened Seven Hills Family Medicine in downtown Richmond, Va., two years ago. NPR's Selena Simmons-Duffin and Elissa Nadworny visited the clinic. Dr. Arnold works with a small team - a registered nurse and several medical assistants.
ARNOLD: I'm doing chronic condition management via telehealth in five minutes. At 10 a.m., I'm doing a follow-up on diabetes. And then I'm seeing a knee pain visit and an ADHD follow-up. And then we have three aspiration abortion appointments.
SUMMERS: That's three procedural abortion appointments alongside all the other appointments.
ARNOLD: A little bit of everything today, which is very typical for family medicine.
SUMMERS: In the doctor's office, there is a follow-up for a patient with GI issues.
ARNOLD: So your labs came back and honestly are, like, looking pretty good. There was no evidence of celiac to explain...
SUMMERS: Then another patient comes in for gender-affirming care, gearing up to start testosterone.
ARNOLD: But I think I mentioned that there's, like, kind of two extremes on the dosing approach...
UNIDENTIFIED PATIENT: Yeah. We want to go in the middle.
ARNOLD: ...Fast track or the scenic route. We're going in the middle.
UNIDENTIFIED PATIENT: Yeah.
ARNOLD: All right.
SUMMERS: Providing all sorts of care - gender-affirming care and all aspects of reproductive health care, including abortion - are part of the philosophy of Dr. Arnold's clinic. She started her practice a few months after the Supreme Court overturned Roe v. Wade. Many of the abortions provided here are done with medication. The first pill people take is mifepristone.
UNIDENTIFIED PERSON #2: So this is the mifepristone. It's in a box. There's six in a box. And so they take this here.
SUMMERS: The second medication is misoprostol, which patients get to take home with them. And the staff follows up with all abortion patients to find out how they're doing.
KATIE: Hey there. This is Katie (ph). I'm just calling from the doctor's office. I wanted to try again to check in with you about how you're feeling.
SUMMERS: Anti-abortion rights activists oppose primary care doctors like Dr. Arnold providing abortion care. Dr. Christina Francis, an OB-GYN in Indiana who runs the American Association of Pro-Life OB-GYNs, says abortion is nothing like managing a chronic condition like diabetes.
CHRISTINA FRANCIS: Chemical abortion drugs end the life of my fetal patient so that in and of itself makes it different from a diabetes drug. But also, the complications related to a diabetes drug are not going to require an expertise that's outside of the skill set of a family medicine physician to manage.
SUMMERS: But Dr. Stephanie Arnold points out the American College of OB-GYNs 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.
ARNOLD: It's just important to me to, like, fight back against that stigma. There's, you know, 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, you know, endometriosis. This is just, like, a routine part of my day.
SUMMERS: CONSIDER THIS - for decades, people seeking abortions had to go to specialty clinics like Planned Parenthood, sometimes with people opposed to abortion protesting outside. But since Roe v. Wade was overturned, a movement to take abortion out of its silo and integrate it into everyday primary care has gained momentum.
(SOUNDBITE OF MUSIC)
SUMMERS: From NPR, I'm Juana Summers.
(SOUNDBITE OF MUSIC)
SUMMERS: It's CONSIDER THIS FROM NPR. NPR's Selena Simmons-Duffin dug into the trend of more and more family doctors beginning to provide abortions, and she explored how abortion care got separated from other care in the first place. She takes it from here.
SELENA SIMMONS-DUFFIN, BYLINE: Imagine a young woman makes an appointment with her family doctor. She has some abdominal pain and some other symptoms she wants to get checked. Her doctor says...
SHEILA ATTAIE: Why don't we just run a pregnancy test just to be sure? And it's positive.
SIMMONS-DUFFIN: That's Dr. Sheila Attaie, a family doctor in Sacramento, Calif. After a pregnancy test comes back positive...
ATTAIE: Then you kind of, like, go through that, like, options counseling with them.
SIMMONS-DUFFIN: The options include continue the pregnancy and schedule a prenatal visit or end the pregnancy and get an abortion. Both are available right there in the same clinic.
ATTAIE: For some people, they know right away. For some people, I've seen them week after week to support them through whichever route they choose.
SIMMONS-DUFFIN: Attaie fought hard to fully integrate abortion into the clinic where she works. She says for a long time, clinic administrators weren't convinced. Then Roe v. Wade was overturned in the Dobbs decision.
ATTAIE: I was like, listen, we need to do these things. And they were like, yes, you're right. And, like, everyone was kind of, like, emboldened - right? - like, after Dobbs in the blue states.
SIMMONS-DUFFIN: In Fort Collins, Colo., family medicine Dr. Ben Smith can relate.
BEN SMITH: There was an all-hands-on-deck mentality that happened after Dobbs, where there was, you know, an incredible kind of surge of interest and willingness and a sense of capacity.
SIMMONS-DUFFIN: 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.
SMITH: Every abortion that we do in primary care becomes a space for a more nationally facing organization that can accommodate someone who is traveling from Texas, from Florida.
SIMMONS-DUFFIN: There isn't a lot of 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. Some have online resources. This training video shows a doctor talking with a patient about what plans they have for getting pregnant and using different kinds of birth control.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED ACTOR #1: (As character) I'm here for you to talk about any of the different options. And also, if you do get pregnant and you don't want to continue the pregnancy, I have pills for that, too.
UNIDENTIFIED ACTOR #2: Great. Thank you.
UNIDENTIFIED ACTOR #1: No problem. OK, so let's go back to talking about your diabetes.
SIMMONS-DUFFIN: There are barriers for clinics, including stigma and administrative hurdles, like the FDA's rules for prescribing abortion pills, says Elizabeth Janiak. She's a professor at Harvard Medical School who co-leads ExPAND, one of the training programs. She says those barriers help explain why the portion of primary care doctors offering abortion is quite small.
ELIZABETH JANIAK: But one thing that I think is really important to remember is that even if we were to be really conservative and say 5%, there are so many primary care doctors in this country. So we're talking thousands and thousands of providers.
SIMMONS-DUFFIN: 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 Janiak points out nearly 40% 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 UC Davis who's written extensively on the history of abortion. Back in the '50s and '60s, she says, abortions generally happened at hospitals, but not all hospitals offered them, often for religious reasons, and access across the country was uneven.
MARY ZIEGLER: So in the '70s, abortion rights groups began focusing on the opening of free-standing abortion clinics.
SIMMONS-DUFFIN: On one hand, she says, the clinics did expand access.
ZIEGLER: On the other hand, they physically and symbolically isolated abortion from other health services and made them easier to stigmatize, made it easier for abortion clinics to be protested and, you know, made it easier to argue that abortion was very different from other forms of health care.
SIMMONS-DUFFIN: For years, a key anti-abortion strategy was to target those clinics with regulations, known as trap, laws that mandated a certain width of hallways or required doctors to have admitting privileges at hospitals, for instance. Here is Ziegler.
ZIEGLER: Trap laws, combined with the rise of clinic blockades and clinic protesting and even violence against abortion doctors, you know, led to a pretty precipitous decline in the number of physicians who are either trained to perform abortions or willing to perform abortions.
SIMMONS-DUFFIN: 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. Dr. Christina Francis, an OB-GYN in Indiana who runs the American Association of Pro-Life OB-GYNs, does not think the regulations that have separated abortion from other kinds of health care were just political.
FRANCIS: In general, the abortion industry has been actually largely under-regulated, not regulated as stringently as hospitals.
SIMMONS-DUFFIN: She also says that family medicine doctors don't have the specialized training that OB-GYNs do to provide reproductive health care, and that includes abortion, which she opposes.
FRANCIS: I'm not saying that family medicine physicians are not good physicians. They certainly are, but their training is not the same as OB-GYNs in these kinds of things.
SIMMONS-DUFFIN: She says the trend concerns her. She does not consider abortion essential health care for women. Many organized medical groups disagree with her. The American College of OB-GYNs says any clinician who can screen patients for eligibility can prescribe medication abortion safely, as long as they themselves can provide or refer patients for follow-up care as needed, usually a uterine evacuation. From the patient perspective, Liz Johnson has had two different abortion experiences. She's a graduate student in Pittsburgh, getting her master's in social work. Years ago, she had an abortion at a specialty clinic.
LIZ JOHNSON: It's honestly - like, I think it can feel very, like, impersonal and fast and, like, procedural, like, da, da, da, da, da (ph), you know?
SIMMONS-DUFFIN: In October 2022, she had an abortion with her primary care doctor. She liked that her doctor already knew her and her medical history.
JOHNSON: I really appreciated, like, the personal touch of, like, being able to, like, text to check in and stuff like that. So it went really smoothly to the point I can't even, like, elaborate, like, the problems.
SIMMONS-DUFFIN: Johnson describes herself as an open book. More and more patients have been willing to speak publicly about their experiences with abortion. But that openness isn't always present among the primary care clinics that have recently begun to provide abortions. In Sacramento, Dr. Sheila Attaie says after the clinic she works for started to provide abortion...
ATTAIE: We weren't allowed to advertise that we do it, because they don't want that attention.
SIMMONS-DUFFIN: Attention that might come with protesters or threats from people who oppose abortion. Attaie says she gets it, but she also finds the secrecy frustrating.
ATTAIE: If we act in fear, how do we expect anything to be changed? If we, like, are hush-hush about all of these things, how do we normalize them as health care?
SIMMONS-DUFFIN: Harvard's Janiak says this may be evidence of the need for broader cultural change. But just because right now primary care providers don't have abortion on their lists of services or on their websites doesn't mean, she says, they'll never get there.
(SOUNDBITE OF MUSIC)
SUMMERS: That was NPR's Selena Simmons-Duffin. This episode was produced by Matt Ozug and Brianna Scott. It was edited by Diane Webber and Courtney Dorning. Our executive producer is Sami Yenigun.
(SOUNDBITE OF MUSIC)
SUMMERS: It's CONSIDER THIS FROM NPR. I'm Juana Summers.
Copyright © 2024 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.