title: Barriers to D&E practice among family planning subspecialists.
abstract: OBJECTIVE
  Over 95% of all second-trimester abortions are managed by dilation and evacuation procedures (D&E) and account for nearly 9% of all abortions in the United States annually. The Fellowship in Family Planning (FFP) offers subspecialty training in abortion and contraception to obstetrician-gynecologists and family medicine physicians. Twenty years after the FFP founding, we report on the abortion practice characteristics and specific barriers these subspecialists face.
  
  
  METHODS
  We surveyed obstetrician-gynecologist family planning (FP) subspecialists by email regarding second-trimester abortion training and practice barriers with a focus on D&E.
  
  
  RESULTS
  Our response rate was 62% (105/169) of all fellowship-affiliated physicians. Respondents were composed primarily of young women working in academic settings in the West and Northeast regions. Nearly all FP subspecialists have been trained to 24 weeks' gestation and currently provide D&Es, with an average of nearly 200 per year. D&E practice barriers vary by geographical location and degree of "regional restrictiveness." FP subspecialists practicing in more abortion-restrictive regions were four times more likely to report a personal main barrier (such as concern for safety) than other types of main barriers (p=.05). Providing D&Es in a hospital operating room was associated with 2.8 times higher odds of reporting an institutional or coworker main barrier (p=.02). High-volume D&E practice was associated with three times lower odds of reporting an institutional/coworker main barrier (p=.02).
  
  
  CONCLUSIONS
  By identifying the barriers to D&E practice experienced by FP subspecialists, we can begin to develop a coordinated approach to eradicating modifiable barriers and, ultimately, improve access for women seeking D&E services.
authors.affiliation: The Bixby Center for Reproductive Health Research and Policy, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco. Electronic address: turkj@obgyn.ucsf.edu.
authors.forename: Jema K
authors.initials: JK
authors.lastname: Turk
authors.forename: Jody E
authors.initials: JE
authors.lastname: Steinauer
authors.forename: Uta
authors.initials: U
authors.lastname: Landy
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kerns
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects* / Q000193:education; D001291:Attitude of Health Personnel; D004107:Dilatation and Curettage / Q000009:adverse effects; D004503:Education, Medical, Graduate; D034742:Electronic Mail; D005193:Family Planning Services / Q000193:education; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009873:Operating Rooms; D016134:Organizational Policy; D010044:Outpatient Clinics, Hospital; D010820:Physicians; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013038:Specialization; D014481:United States; D000078329:Workforce
keywords: Abortion; Barriers; D&E; Family planning; Providers