Determinants of physician unwillingness to offer medical abortion using mifepristone.
OBJECTIVE
We sought to identify factors associated with contemplating versus not contemplating offering medical abortion with mifepristone among physicians not opposed to it.


METHODS
We analyzed data from a Kaiser Family Foundation survey of a nationally representative sample of 790 American obstetrician/gynecologists and primary care physicians. Our study sample consisted of 419 physicians who were not personally opposed to medical abortion and could be classified as not actively considering (precontemplation) or actively considering (contemplation) offering mifepristone. We conducted multivariate logistic regression to predict being unlikely to offer mifepristone (i.e., in the precontemplation stage of change).


RESULTS
In 2001, 1 year after U.S. Food and Drug Administration (FDA) approval, 5% of physicians surveyed were offering mifepristone. Among the 750 physicians not offering mifepristone, 57% were not opposed. Of those not opposed, 74% reported that they were unlikely to offer mifepristone in the next year (precontemplation) as compared to 23% who might offer it (contemplation). Independent predictors of being in the precontemplation stage were being a primary care versus OB/GYN physician (odds ratio [OR] 3.29, p = .02), being in private versus hospital-based practice (OR 2.40, p = .03), and lacking concerns about FDA regulations (OR 2.06, p = .01) or violence and protests (OR 1.93, p = .03) as barriers to offering mifepristone.


CONCLUSIONS
For precontemplation-stage physicians, the most efficient strategy for increasing the availability of medical abortion may be to design programs that emphasize clinical benefits and feasibility to stimulate interest in the procedure. For contemplation-stage physicians, the optimum approach may be one that helps to overcome barriers associated with FDA regulations and concerns about violence and protests.
David Geffen School of Medicine at UCLA, Department of Family Medicine, Los Angeles, California 90024-4142, USA. mseelig@mednet.ucla.edu
Michelle D
MD
Seelig
Lillian
L
Gelberg
Paula
P
Tavrow
Martin
M
Lee
Lisa V
LV
Rubenstein
D000021:Abortifacient Agents, Steroidal; D000028:Abortion, Induced; D000328:Adult; D003625:Data Collection; D003657:Decision Making; D005260:Female; D006176:Gynecology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015735:Mifepristone; D009774:Obstetrics; D010820:Physicians / Q000523:psychology*; D016079:Refusal to Treat; D014481:United States
D000021:Abortifacient Agents, Steroidal; D015735:Mifepristone