Abortion restrictions spreading across the county have upended people’s ability to make decisions about their lives, families, and futures. While the overall number of abortions in the U.S. has gone up since the Dobbs decision, in large part due to the growth of telehealth abortion, those numbers don’t tell the stories of people who have to move heaven and earth to get this basic, essential health care.
One in five patients is now traveling out of state to get abortion care. Those people have to pull together enough money to pay for the procedure, travel, and a place to stay. They take time off work, find someone to watch their kids, and drive for hours or get on a bus or a plane. They often have to wait days or weeks for an appointment as clinics are overwhelmed trying to serve patients from their own states as well as those who live in states with bans.
In the fallout of the Dobbs decision, there have been urgent and necessary focuses on training OB-GYNs. However, there’s a tremendous opportunity to expand abortion access that has been untapped: increasing abortion training for family physicians.
There are 118,00 family physicians in the U.S., one of the largest group of active physicians. They are the only physicians in many regions, especially in rural areas and communities that are primarily Black, Indigenous, and people of color. Family medicine is also more diverse, with substantially more Black, Indigenous, and Latinx physicians than other specialties. These doctors are more likely to provide care in under-resourced communities and have long been a critical resource for sexual and reproductive health care, including obstetric and prenatal care.
Decades of research show that primary care physicians can provide abortion care safely and effectively, in familiar office settings and with more personalized care. Primary care practices are also much less subject to the tight scheduling, protests, and stigma associated with freestanding abortion clinics.
Family physicians are already the second-most common providers of abortion care in the U.S., providing 17% of medication abortions and 7% of procedural abortions. Research has shown that many people would prefer to get abortion care from their primary care providers, appreciating the convenience and comfort of getting this care from a known and trusted source. (Our personal experience bears this out.) Family physicians are also leading the way when it comes to telemedicine abortion provision across state lines as an innovative way to expand access, often through the protection of state shield laws.
While some family physicians are already providing access to abortion, they could play a much larger role. In fact, only 3% of recently graduated family physicians currently provide this care. Increasing training for this group of physicians can access a tremendous untapped resource with potential to address the crisis in abortion access and to help reduce care inequities.
Frustratingly, the response to the Dobbs decision has not included an investment to meet the potential of this primary care workforce, such as expanding training opportunities for family physicians. Currently, fewer than 55 of the 796 family medicine residency programs offer abortion as part of routine training. Resident physicians at the other programs who want training must try to find abortion providers willing to work with learners, while also navigating complex issues related to liability insurance and finding time from their other training obligations. Some family medicine residency directors in the Northeast have sent residents as far away as Mexico City for training because they could not find local training slots. This combination of barriers is often insurmountable, even for the most dedicated trainees.
When residents can actually get this training, the impact is huge. Family medicine residents who attend programs where abortion training is part of routine instruction are eight times more likely to provide abortion care than family physicians overall. Given the large number of family physicians in the U.S., increasing the percentage who provide abortion could dramatically expand, especially in underserved, rural, and areas with restrictions but not absolute bans.
Despite the urgent need and impressive results, the Accreditation Council for Graduate Medical Education (ACGME) does not require that family medicine training include abortion care, in contrast to obstetrics and gynecology training, which must include training. The few family medicine programs that do exist to fill this gap are hanging by a thread. The Fellowship in Family Planning for Family Medicine, which provided two years of intensive clinical, research and leadership training, lost its funding and stopped enrolling new fellows in 2022. The Reproductive Health Education in Family Medicine (RHEDI) program — a national network of 36 residency programs with routine abortion training that has for 20 years provided technical support and curricula for family medicine abortion training, including in such key states for abortion access as Illinois, Minnesota, North Carolina, and New Mexico — is closing later this year due to a lack of funding.
A crisis of this magnitude requires a creative, multifaceted response, which must include prioritizing integrating abortion in primary care. Policymakers can put funding toward expanding the workforce, as California has done with its Reproductive Health Service Corps. Family medicine organizations and leaders can encourage the ACGME Family Medicine Review Committee to require programs to include medication and procedural abortion care as a routine part of training (with the option to opt out). Medical schools and residency programs can work to ensure access to abortion training, both by providing training opportunities in their own facilities and establishing mutually beneficial relationships with freestanding abortion clinics. Funders can make sure that programs like RHEDI have the resources they need to reach even more residency programs.
There are thousands of present and future primary care providers who are eager to serve their communities by integrating abortion care. With training, they could provide abortion to people in the same familiar environment where they get the rest of their health care. For that to happen, people who care about abortion access need to devote the time and resources to unlock the potential of these future abortion providers.
Christine Dehlendorf, M.D., is a family physician and professor of family and community medicine at the University of California, San Francisco and directs the Person-Centered Reproductive Health Program. Jody Steinauer, M.D., Ph.D., is an obstetrician/gynecologist and professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. She is the founder of Medical Students for Choice and currently directs the UCSF Bixby Center for Global Reproductive Health.