Patient Perspectives on Accessing Medication Abortion at a Family Medicine-Led Community Health Center: An Opportunity for Person-Centered Care

Abstract

Objective:

To explore how patients who received care for early pregnancy loss (EPL) at a family medicine–led federally qualified health center (FQHC) felt about hypothetical access to medication abortion at the clinic.

Study Design:

We elicited patient perspectives on hypothetical access to medication abortion from their primary care provider via semistructured phone interviews with patients treated for EPL at one FQHC in Illinois that was using mifepristone for EPL but not abortion. The transcripts were coded using Atlas.ti and analyzed inductively. Participant demographics, including age, race, ethnicity, religion, obstetrical history, and EPL management route (expectant, medical, procedural) were collected.

Results:

We interviewed 16 patients from June to December 2022. Participants felt that offering medication abortion in the primary care setting is an opportunity for person-centered care, specifically that the primary care clinic was well equipped to provide safe, accessible care from trusted providers who respect patient autonomy. They expressed a range of feelings about abortion and, regardless of personal abortion attitude, believed that medication abortion should be offered in the primary care setting.

Conclusions:

Patients receiving care for EPL at a family medicine-led FQHC expressed a range of personal views about abortion but commonly supported offering medication abortion at their clinic.

Keywords

medication abortion primary care mifepristone qualitative research person-centered care

Introduction

Primary care providers (PCPs) may be the first and only contact a patient has with the health care system. They represent nearly half of physicians working at federally qualified health centers (FQHCs) caring for marginalized communities, including low-income and rural communities.^1,2 The patient-centered and societal benefits of primary care models are well documented. For example, continuity of care is associated with reduced health care cost and overuse.³ The longitudinal relationships developed by patients and providers at primary care clinics align with person- (or patient-) centered care (PCC) models that the Institute of Medicine and World Health Organization cite as elements of quality care.^4–6 Models specific for reproductive health, such as the person-centered care framework for reproductive health equity, propose 8 PCC domains: dignity, autonomy, privacy/confidentiality, communication, social support, supportive care, trust, and health facility environment.⁷

Many family medicine doctors are trained to provide full-spectrum reproductive health care, and those supportive of abortion feel that abortion provision aligns with the core tenets of family medicine.^8,9 Primary care clinics are well-positioned to care for low-risk patients seeking pregnancy termination, especially medication abortion, and have the potential to increase access in states with legal protections for abortion. By caring for their patients and low-risk patients from their own or neighboring states, primary care clinics have the potential to increase the capacity for obstetrician-gynecologists and providers at family planning clinics to care for patients who are medically complex, in the second trimester, and those with logistical challenges related to traveling for abortion care.¹⁰ Despite the interest and training in abortion care, only 27.1% of family medicine residents who participated in abortion training and planned to offer abortions in practice offered abortions 5 years after graduation. Barriers to abortion provision included lack of administrative and clinical support, difficulty obtaining equipment, and funding and legal restrictions.¹¹

To mitigate barriers to abortion provision in primary care, the Excellence in Providing Access to New Directions in Mifepristone Use (ExPAND Mifepristone) learning collaborative was designed to offer administrative, educational, and technical assistance to clinic administrators and PCPs interested in implementing mifepristone use for miscarriage and/or abortion.¹² In ExPAND Mifepristone’s first year, one participating FQHC implemented significant workflow changes in order to offer mifepristone and misoprostol for patients experiencing EPL, leading to successful changes in care patterns.^13,14 Clinic leaders cited concern about losing funding due to the Hyde Amendment and therefore opted not to initiate mifepristone for medication abortion.

Prior research on medication abortion in primary care has explored acceptability, preference for clinic type (family planning, primary care), and patient experience. Patient sentiment towards abortion in primary care is largely supportive, although data regarding preferred clinic and provider type are more heterogeneous depending on patient population and location of study recruitment (family planning clinic or primary care clinic).^15–19 Additionally, at clinics that do not offer abortion, providers have cited community opposition as a barrier to initiating services.²⁰ In this context, we saw an opportunity to understand patient perspectives on the desirability of abortion care at a clinic where medication abortion was not provided, even though logistical hurdles to providing mifepristone had been overcome. The objective of our study was to explore how patients at a family medicine-led FQHC who received similar care for early pregnancy loss (EPL) felt about hypothetically accessing medication abortion at the clinic.

Methods

Recruitment

Participants represented a convenience sample of patients who were treated for EPL from January 2021 to December 2022 at one FQHC in Illinois that had participated in the pilot year of the ExPAND Mifepristone learning collaborative. This project is part of a larger, multimodal assessment of the ExPAND Mifepristone learning collaborative. Therefore, we included participants who received treatment for miscarriage because medical management of miscarriage was the clinical focus of the learning collaborative. January 2021 correlated with month nine of the ExPAND Mifepristone pilot period. Participants were recruited in English and Spanish using paper flyers posted in the clinic and an electronic medical record portal message. Interested participants completed a screening questionnaire, which determined eligibility using the following criteria: age greater than or equal to 18 years old, EPL diagnosed or treated at the FQHC between January 2021 and December 2022, and ability to consent in English or Spanish. One-hundred and twenty-four people completed the screening survey, and 96 did not meet inclusion criteria. The most common reasons for exclusion were miscarriage diagnosis outside of the study period and diagnosis of miscarriage during the study period, but treatment occurred at another clinic. Of the 28 eligible participants, 12 declined participation. Recruitment and thematic analysis were performed simultaneously, and analysis was done in batches of approximately four interviews to identify when we were approaching thematic saturation, when no new themes emerged after multiple interviews, and thus able to stop recruitment; this was achieved after 16 interviews.

Data collection

We conducted 16 semistructured phone interviews with English-speaking adults from June 2022 to December 2022. No participants chose to have their interview in Spanish. Oral informed consent was obtained from all participants before the interview. We used an interview guide to 1) learn about patient experiences receiving care for EPL at the FQHC and 2) elicit patient perspectives on hypothetically accessing medication abortion from their PCP at the FQHC [Supplementary Table S1]. Interview transcripts for part one of the interview guide will be analyzed and reported separately. The interviews were conducted by two authors (C.H. and L.S.) who did not provide health care services to the participants. C.H. is a White, female physician of reproductive age with notable privilege whose clinical expertise and research centers on reproductive health care. LSM is a bilingual Latina woman with reproductive capacity and prior ties to the clinic community; she conducted this research as a medical student. We reflect on our positionality and privilege and how this informs engagement with participants and interpretation of the data and recognize how these positions may influence how we view reproductive autonomy and access.

Interviews were recorded and transcribed using a HIPAA-compliant service; length ranged from 14 to 31 minutes. Interview transcripts were deidentified and verified by research team members. Participant demographics, including age, race, ethnicity, religion, obstetric history, and type of EPL management (expectant, medical, procedural), were also collected. Participants received a $50 gift card for compensation after completing the interview. The Institutional Review Board at The University of Chicago approved all aspects of the study protocol (IRB21-1802).

Analysis

Using principles of modified grounded theory, a code directory was developed from the interviews after preliminary familiarization and identification of high-level themes. Through an iterative approach, codes were created with definitions and parameters, and then themes and subthemes were identified. Two researchers (CH, LS) used the directory to independently code the transcripts using Atlas.ti. Researchers then discussed coding for all interviews and resolved any discrepancies using consensus coding. The data were analyzed inductively by creating code summaries that grouped coded data into themes and subthemes.

Findings

The FQHC network cares for patients that are predominantly 18–64 years old (60%), low-income (65% Medicaid), and racial and ethnic minorities (93% of all clinic patients).²¹ In our study, 69% of participants were 18–34 years old (Table 1). Forty-four percent self-identified as Black or African American, 31% as White, and 21% as Hispanic or Latina. Eighty-one percent of participants had received health care at the FQHC for at least 3 years. Over half of the participants (56%) reported that their family members are also patients at the clinic. Expectant (53%) and medication (35%) management were more common than procedural management of EPL; four people who underwent expectant or medication management also had procedures. Seven participants had had an abortion previously.

Table 1.

Characteristics of Participants Treated for EPL from January 2021 to December 2022 at One FQHC in Illinois

Characteristic	Total participants, n = 16 (%)
Age
18–34	11 (69)
≥35	5 (31)
Race
Black/African American	7 (44)
White	5 (31)
American Indian/Alaska Native	0 (0)
Asian	0 (0)
Other	3 (19)
Declined	1 (6)
Ethnicity
Hispanic/Latina	4 (25)
Not Hispanic/Latina	12 (75)
Religion
Christian	8 (50)
Muslim	1 (6)
Atheist	2 (13)
Other	2 (13)
Declined	3 (19)
Number of pregnancies
1–3	9 (56)
4–6	3 (19)
≥7	4 (25)
Number of miscarriages or abortions per participant
1	7 (44)
2	5 (31)
3	1 (6)
>4	3 (19)
Number of participants with previous abortions	7 (44)

	Total participants, n = 17 (%)
Initial EPL management type^a
Expectant	9 (53)
Medication	6 (35)
Procedural (surgical)	2 (12)

n = 17, one participant had two miscarriages within the study period.

EPL, early pregnancy loss.

Two themes and two subthemes emerged from our interviews: (1) patient-centered care is desirable for patients considering medication abortion with their PCP. (a) Access to providers is important. (b) Trusted PCPs may facilitate reproductive autonomy and abortion safety. (2) Abortion access is important regardless of individual values.

Theme 1: Person-centered care is desirable for patients considering medication abortion with their PCP

Participants highlighted positive experiences receiving care for EPL, drawing on elements of PCC (Table 2), and when asked, nearly all participants said they would recommend a family member or friend have an abortion at the FQHC. One participant, who is a pharmacist, shared that she felt the FQHC is positioned to be a responsive access point for medication abortion because her prior experience at the clinic demonstrated excellent continuity and coordination of care.

Table 2.

Elements of the Person-Centered Care Framework for Reproductive Health Equity⁷ That Participants Highlighted When Considering Medication Abortion at Their Primary Care Clinic

PCC domains	Examples of PCC and connection to medication abortion
Communication	• Multiple ways of contacting the clinic, including phone, in-person, and EMR.• Communication is a way to facilitate access, which is important for medication abortion.• Treatment options are presented to patients.
Autonomy	• Staff discusses medical options and respects patient’s choice regarding the best treatment for them as an individual.
Trust	• Continuity of care allows for the development of longstanding, trusted patient–provider relationships.• Doctors can facilitate safe medication abortions.
Privacy/Confidentiality	• Clinic space and staff respect privacy.
Supportive care	• Doctors are empathic and attend to emotional well-being.• Most of the clinic staff help to facilitate timely care, but also raised by some participants as an area of improvement.
Health facility environment	• Labeled as safe, welcoming, and private.
Dignity	Raised by participants in terms of respect and autonomy.
Social support	Not explicitly discussed by participants.

EMR, electronic medical record; PCC, person-centered care.

If I was I personally seeking to have an abortion, I would probably prefer to have it that way [at the FQHC]… because you would just want your privacy protected… they are very understanding, nonjudgmental, and they are very compassionate and good with following up with you, and it is easy also to access your own chart and communicate with the doctor, and see lab work. So if they were doing that [medication abortion], that would be convenient, and very good way.

Another participant emphasized attention to her emotional well-being, which is a central tenet of PCC.

The first time I went, they introduced themselves. They told me what to expect. They were very clear, crystal, from the beginning… I didn’t know I would feel like I would cry at some point, but I did. And they stayed with me because I was by myself. And then they said, “whatever you need–” and they let me choose. They were very helpful.

Six participants commented on how the clinic fosters a safe and welcoming space. A couple of participants shared that they appreciated that their privacy was respected.

PCC subtheme 1: Access to providers is important

Timely access to clinicians—both in terms of appointments and communication via telephone or portal—was an aspect of PCC that participants valued when considering obtaining a medication abortion at their primary care clinic. A mother and lifelong patient at the FQHC contrasted a negative experience seeking care at an outside clinic with her prior experience receiving care at the FQHC:

I feel like it [receiving abortion care from her PCP] would be easy. Not to have to go and make an appointment with somebody else. You can just go where you choose to. I had to make an appointment [elsewhere]. I had to wait almost two weeks. I left a voicemail. They didn’t call me back… But if it was my doctor’s office, they would have called back or they would have answered or scheduled an appointment right away. It’s just sometimes when it’s not where you used to, where you go to be able to get in there and do stuff. But if it was your actual clinic, it’d be easier.

Several participants commented on the logistical ease of receiving reproductive health care from their PCP, which they pointed out would eliminate unnecessary appointments and reduce financial costs.

I think it [receiving medications for abortion from my PCP] would be way easier. I run into this problem constantly where I’m being referred out to a specialist that can’t prescribe things that say my primary care should be…And then the primary care says, “I’m sorry, I can’t do that.

While participants generally felt that the primary care clinic excels at PCC and that this is desirable if seeking a medication abortion, two participants at the FQHC expressed frustration that they did not feel heard and were not able to be seen in what they felt was a timely manner for obstetric concerns. A lifelong patient at the clinic stated:

I just felt like there was no urgency, but I don’t think that it’s specific to that clinic… But I was just explaining to the clinic like, “This is my life. I just want to make sure I’m okay. You guys are saying I’m okay, but I’m spotting.” Just sometimes maybe not being attentive if a person is telling you something is going on with their body, and I know my body, just being more attentive.

PCC subtheme 2: Trusted PCPs may facilitate reproductive autonomy and abortion safety

Respect for reproductive autonomy, trust in the patient–provider relationship, and safety were inextricable subthemes that arose when participants discussed hypothetical access to medication abortion at their primary care clinic. When asked to imagine if their PCP offered medication abortion, participants emphasized the importance of choice when it comes to deciding whether to have an abortion, which route is desired, and what type of provider to seek out. A participant who previously had an abortion said:

I feel like it’s good to have options because I want to know what might work for you. And with the abortion, you able to get the pill or you could have it surgically removed. But I feel like it’s good to have options and not just have somebody to choose for you. Whatever you’re comfortable with, go with it.

A mother of three and patient at the FQHC for three years reflected that the primary care clinic is well-suited to offer medication abortion because of the trusting relationship developed over time:

And I wholeheartedly think, not just in reproductive care, abortion, or anything like that, that anybody should be able to have the medical options available to them but be able to manage their own care according to their own bodies. And not just in reproductive care. In everything. Because if you don’t feel safe, you don’t trust the person that’s treating you, even if it would have worked, it may not work.

Another participant said she’d consider going to her PCP for a medication abortion because, “I can talk about [abortion]- I trust her with my life.”

Multiple participants felt that primary care doctors can play a key role in abortion safety. One participant said, “I do think that a doctor should be involved [with medication abortion]. I don’t think they should be over the counter, obviously, because it is a serious experience. It’s definitely a medical event.” When reflecting on the primary care clinic as a hypothetical access point, participants perceived medication abortion facilitated by a health care provider as safer than self-managed or procedural abortion. A mother of two who had been a patient at the FQHC for 8 years described self-managed abortion with harmful methods that may result in maternal morbidity or mortality:

I think when women sometimes want to have abortions and there’s no options… People can get desperate and do other things to end their pregnancy which is not safe for the mom…I’ve heard stories of people hurting themselves to end the pregnancy. I would think that that’s actually a thing that more women should know about to have those options in their primary care physician like abortion… If this was offered within our network, I think that will be really good for women to feel more comfortable in receiving an abortion.

Another participant said, “I think it is a good thing that if they offer that [medication abortion at the primary care clinic]. You know give women more choices than just the procedure, because you know the procedure is really dangerous.” Although these participants were supportive of medication abortion in primary care, support was based on misconceptions that procedural or self-managed medication abortion is unsafe.

Theme 2: Abortion access is important irrespective of individual values

All participants felt that receiving medication abortion from a primary care clinic is needed or acceptable. A patient at the clinic for over 10 years and mother of five shared how her view of abortion changed to be more supportive over time, while simultaneously holding on to the misconception that unplanned pregnancies can always be prevented by using contraception.

Honestly, I was really really really against abortions at first, I really was. Just because I’ve always felt like, ‘hey, if you lay down and have conceived that child, take care of it.’ But at the same time, I feel like now sometimes you don’t be ready to have a child, and sometimes you don’t know the situation why somebody wants to abort the baby or something like that. But I also feel like if you know that you’re going to have unprotected sex, get on birth control because you know the risk of having unprotected sex with somebody, you know that you can get pregnant.

When asked if the interviewee thought that offering medication abortion at the clinic was a good option, another participant said, “To each its own. If someone needs this and you guys have it, then that’s great.” This participant also perceived it to be “beneficial” to have medication abortion accessible at primary care clinics, and would recommend a family member or friend seek abortion care at the primary care clinic if needed based on their prior experiences.

Participants acknowledged that individuals have unique needs, and although not everyone will need or want an abortion, they supported hypothetical access at the primary care clinic regardless of their individual beliefs or preferences. When asked about hypothetically receiving medication for abortion at the clinic, one participant said:

I mean, I don’t think I’m against abortion, in the sense of somebody doing it for their reasons; there’s always a reason for it. I don’t think anybody who wants to have an abortion is doing it in the intent of– in a harmful way… Some people are just not ready to have babies or are not in a good place to have one, which is, again– that’s their situation.

A participant whose daughter is also a patient at the clinic said:

I don’t want to say that I’m totally against abortions because there are events and things that happen where it’s out of your control. For instance, a woman gets raped or a family member impregnates another family member. That may [be] cause for an abortion. So I’m not totally against it, but however, for me, I wouldn’t want to have one, especially if I’m not in one of those bad situations.

Discussion

This qualitative study explored patient perspectives about hypothetically accessing medication abortion at the clinic among those who had received EPL care at a primary care clinic in Illinois that utilized mifepristone and misoprostol for EPL, but not abortion. Participants largely supported this hypothetical service at the FQHC, sharing examples of PCC—accessible care in a safe environment that is responsive to individual preferences, needs, and values—they received for management of EPL at the clinic. Specific elements of PCC raised by participants included timely communication and access to providers, trust, autonomy, empathic care, emotional support, safety, privacy, and continuity of care.^6,7 Participants had a range of opinions about abortion and overall supported improving access to medication abortion, highlighting that patient autonomy supersedes an individual’s personal beliefs.

Our findings support those published by Rubin et al., who found that reproductive age patients at family medicine clinics feel that abortion care in this setting is acceptable.¹⁴ Specifically, participants in our study saw added value in having a longstanding relationship with the clinic and provider. Our findings also support those from a qualitative study by Summit et al. in 2016 that found that patients who received abortion care at an FQHC reported high satisfaction with their care, specifically related to access, continuity of care, and privacy.¹⁵ No concerns were raised by participants about any potential negative impact of starting abortion services at the primary care clinic. Evidence of continued support for medication abortion in the primary care setting is informative because these clinics, depending on geography and state laws, may be well suited to increase access to medication abortion after drastic changes in abortion access in the United States because the Dobbs decision in 2022.

In other studies, patients who received care at an abortion clinic had mixed preferences regarding accessing care from a general women’s health provider versus an abortion clinic, and some did not seek care with their primary provider because they assumed they did not offer abortions.^16,17,21,22 These findings suggest that patients have preconceptions about whether their PCP is supportive of, or offers, abortion care.

In some cases, participant support for medication abortion was linked to misconceptions about abortion safety, specifically that procedural abortion and self-managed abortion are more dangerous.^23,24 Stigma related to why people become pregnant, such as choosing not to use contraception was also mentioned by participants in our study. This highlights the pervasive nature of misinformation and stigma in sexual and reproductive health care.

One strength of this study is that perspectives regarding hypothetical access to medication abortion at the clinic were elicited from people who had experienced EPL management at the clinic network. Because medication and procedural management options for miscarriage are analogous to abortion care, participants were uniquely qualified to comment on the clinic’s workflow and capacity to provide time-sensitive reproductive health care. The qualitative design allowed for nuanced exploration of participants’ thoughts, beyond surveying their general preference for seeking care at a primary care clinic or abortion clinic. This study also has limitations. While our interview guide focused on the hypothetical provision of medication abortion, only six (35%) participants initiated medical management of miscarriage; participants may have had prior experience from previous pregnancies. Furthermore, participant responses to hypothetical questions may not accurately represent thoughts and feelings about lived experiences. All participants had a history of EPL, and it is not known how other people who receive care at the FQHC feel about hypothetically accessing abortion at the clinic. Lastly, this study took place in a state where abortion is legally protected, and all participants had an established primary care provider, which limits generalizability.²⁵

In conclusion, participants in our study were largely supportive of the FQHC network, hypothetically offering medication abortion. Patients who received care for EPL at the primary care clinic felt that it was well-positioned to offer trusted, accessible, compassionate care and expressed desirability in accessing abortion care at the clinic.

Authors’ Contributions

C.H. contributed to conceptualization, study design, data collection, and analysis and led article writing. L.S. contributed to study design, data collection, data analysis, and article writing. G.B. contributed to project management, data analysis, and article review. J.C. contributed to conceptualization, study design, data analysis, and critical review. D.S. contributed to conceptualization, study design, data analysis, critical review, and funding acquisition.

Footnotes

Acknowledgments

The authors would like to thank the FQHC staff and clinical champions for their partnership while participating in the ExPAND Mifepristone learning collaborative.

Author Disclosure Statement

The authors have no conflicts of interest to disclose.

Funding Information

This study was funded by the Irving Harris Foundation, Argosy Foundation, Collaborative for Gender + Reproductive Equity, Lisa & Douglas Goldman Fund, and a grant from an anonymous donor.

Supplemental Material

Abbreviations

References

National Association of Community Health Centers. Community health centers: Providers, partners and employers of choice. 2024. Available from: https://www.nachc.org/wp-content/uploads/2023/07/Community-Health-Center-Chartbook-2023-2021UDS.pdf

Health Resources & Services Administration. National health center program uniform data system (UDS) awardee data. 2023. Available from: https://data.hrsa.gov/topics/healthcenters/uds/overview/national [Last accessed: Oct 2024, 23].

Bazemore

, Merenstein

, Handler

, et al. The impact of interpersonal continuity of primary care on health care costs and use: A critical review. Ann Fam Med, 2023; 21(3):274–279.

Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. National Academies Press: Washington, DC; 2001. Available from: http://www.nap.edu/catalog/10027

World Health Organization, World Bank Group. OECD. Delivering quality health services: A global imperative for universal health coverage. World Health Organization: Geneva; 2018. Available from: https://hdl.handle.net/10986/29970

NEJM Catalyst. What is patient-centered care? Catalyst carryover. NEJM Catalyst, 2017; 3(1). Available from: https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559

Sudhinaraset

, Afulani

, Diamond-Smith

, et al. Advancing a conceptual model to improve maternal health quality: The person-centered care framework for reproductive health equity. Gates Open Res, 2017; 1:1.

RHEDI Programs . RHEDI programs. 2023. Available from: https://rhedi.org/programs/ [Last accessed: Jun 28, 2024].

Wulf

, Carvajal

, Razon

, et al. “They go hand in hand”: Perspectives on the relationship between the core values of family medicine and abortion provision among family physicians who do not oppose abortion. J Am Board Fam Med, 2023; 36(4):583–590.

10.

Singer

, Bartz

, Pace

. Access to abortion services. JAMA Internal Medicing, 2022; 182(9):897–898.

11.

Srinivasulu

, Maldonado

, Prine

, et al. Intention to provide abortion upon completing family medicine residency and subsequent abortion provision: A 5-year follow-up survey. Contraception, 2019; 100(3):188–192.

12.

Calloway

, Stulberg

, Janiak

. Mifepristone restrictions and primary care: Breaking the cycle of stigma through a learning collaborative model in the United States. Contraception, 2021; 104(1):24–28.

13.

, Nutting

, Harriett

, et al. ExPAND mifepristone : Medical management of miscarriage and abortion in FQHCs. Ann Fam Med, 2023; 21(5):468.

14.

Hennessey

, Wu

, Harriett

, et al. Assessing change in medical management of early pregnancy loss before and after implementation of a learning collaborative for initiation of mifepristone use. Matern Child Health J, 2025; 29(9):1318–1325.

15.

, Godfrey

, Prine

, et al. Women’s satisfaction with abortion care in academic family medicine centers. Fam Med, 2015; 47(2):98–106.

16.

Rubin

, Godfrey

, Gold

. Patient attitudes toward early abortion services in the family medicine clinic. J Am Board Fam Med, 2008; 21(2):162–164.

17.

Summit

, Casey

LMJ

, Bennett

, et al. I don’t want to go anywhere else”: Patient experiences of abortion in family medicine. Fam Med, 2016; 48(1):30–34.

18.

Godfrey

, Rubin

, Smith

, et al. Women’s preference for receiving abortion in primary care settings. J Womens Health (Larchmt), 2010; 19(3):547–553.

19.

Shochet

, Trussell

. Determinants of demand: Method selection and provider preference among US women seeking abortion services. Contraception, 2008; 77(6):397–404.

20.

Razon

, Wulf

, Perez

, et al. Family physicians’ barriers and facilitators in incorporating medication abortion. J Am Board Fam Med, 2022; 35(3):579–587.

21.

Health center program uniform data system (UDS) data overview. Available from: https://data.hrsa.gov/topics/healthcenters/uds/overview?grantNum=H80CS00276 [Last accessed: Aug 20, 2025].

22.

Weitz

, Cockrill

. Abortion clinic patients’ opinions about obtaining abortions from general women’s health care providers. Patient Educ Couns, 2010; 81(3):409–414; doi: 10.1016/j.pec.2010.09.003

23.

McLaren

, Hennessey

. First-trimester procedural abortion. Clin Obstet Gynecol, 2023; 66(4):676–684; doi: 10.1097/GRF.0000000000000808

24.

Johnson

, Michels-Gualtieri

, Gomperts

, et al. Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States. Perspect Sex Reprod Health, 2023; 55(1):4–11; doi: 10.1363/psrh.12219

25.

Institute G. Interactive map: US abortion policies and access after Roe25. Available from: https://states.guttmacher.org/policies/ [Last accessed: Nov 15, 2025].

Supplementary Material

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