Physicians' abortion attitudes and intentions regarding future practice

Since abortion became legal in the U.S. in 1973, the number of abortions performed annually has been relatively stable, while the number of abortion providers has drastically decreased. As a result, women and girls must overcome financial, travel, and other obstacles to obtain abortions. This lengthens the time of the pregnancy, thus increasing the medical and psychological risks of abortion. Alternatively, they may not be able to locate a provider and then have an unwanted child, who is at increased risk of abuse and neglect. The decrease in abortion providers has prompted the American Council of Graduate Medical Education to require abortion training in obstetrics and gynecology residency programs. Factors associated with physicians' abortion performance have been examined, and physicians' abortion attitudes have been found to correlate with abortion performance. This study examines differences between first and second trimester abortion attitudes among U.S. obstetrics and gynecology residents, and explores factors contributing to their abortion attitudes including training experiences. Residents' attitudes are used because they reflect current influences on newly trained physicians. Factors related to physicians' intentions to perform abortions including clinic violence, low reimbursement and legal restrictions on doctor-patient relations are also addressed. The results indicate that in addition to religious affiliation, religious intensity, and gender, training experiences were significantly related to abortion attitudes in all residents surveyed. In residents with experience performing abortion, the number of abortions performed and negative emotional responses to performing abortions were also related to abortion attitudes. Abortion attitudes, training experiences and religious intensity were significantly related to abortion intentions in the entire sample of residents. In residents with experience performing abortions, negative emotional response to providing abortions and concern about harassment from antichoice activists were also significantly related to abortion intentions. When explaining the variance in residents' training experiences, the availability of training and residents' intentions to provide abortions in the future were more important than abortion attitudes, suggesting that the more training is available, the more residents will participate, not just based on a supportive abortion attitude. Thus, the relationship between abortion attitudes and training is likely interactional and deserves further research. Also, training experiences, negative emotional responses to providing abortion, and concern about harassment are all factors which can be addressed to increase physicians' performance of abortion. Implications for training programs and future research are discussed.