Study highlights need for increased physician training to care for patients following self-managed medication abortion

As more states restrict clinician-managed abortion in the wake of Dobbs v. Jackson Women’s Health Organization, the Supreme Court decision that overturned Roe v Wade in 2022, more patients are pursuing self-managed medication abortion (SMMA). Definitions of SMMA can vary, but SMMA typically refers to the use of mifepristone and/or misoprostol to induce abortion outside of a clinical context. Despite the 97% completion rate and excellent safety record of a medication abortion, patients who pursue SMMA sometimes experience symptoms that prompt them to visit an emergency department or primary care clinic for evaluation.

While most emergency and primary care physicians are willing to provide post-SMMA care, a new study finds that knowledge gaps exist, and more training is needed. Furthermore, physicians at Catholic health systems may feel curtailed in their ability to provide post-SMMA care to their patients.

“In the evolving landscape of abortion care, educational efforts should prepare physicians in all specialties to care for patients post-SMMA,” says corresponding author Xanthia Tucker, MD, assistant professor of internal medicine and pediatrics at Boston University Chobanian & Avedisian School of Medicine.

In an effort to investigate the practices, confidence, knowledge and attitudes related to post-SMMA care among emergency medicine (EM), family medicine (FM), and internal medicine (IM) physicians, researchers invited 505 EM, FM, and IM physicians at an academic medical center and Catholic nonprofit health system in Michigan to complete a confidential online survey. Michigan is a state with legal access to abortion and more than 20% Catholic hospital beds.

The survey contained four sections assessing exposure to and confidence in caring for patients after spontaneous miscarriage, clinician-managed medication abortion, and SMMA; knowledge of eight signs and symptoms following medication abortion; attitudes toward post-SMMA care; and participant demographics. The work is published in the Journal of Women’s Health.

Among their findings:

• While most (89%) physicians had not knowingly cared for patients after SMMA, 96% of these physicians would, if given the opportunity to do so.
• Confidence managing spontaneous miscarriage, clinician-managed medication abortion, and SMMA did not vary between the academic and Catholic locations, but more participants at the Catholic system reported feeling limited by their employer’s policies in caring for patients after SMMA.
• Participants reported less confidence caring for patients following SMMA compared to spontaneous miscarriage or clinician-managed medication abortion, and confidence differed by specialty. EM physicians reported higher confidence in providing post-SMMA care than primary care physicians, and FM physicians were more confident than IM physicians. Knowledge of expected signs and symptoms following medication abortion did not differ by specialty.
• Confidence managing all three conditions was significantly associated with having received abortion training during residency.

While the increasing politicization and criminalization of abortion make post-SMMA care challenging to study, Tucker believes further projects should explore where and how patients are receiving post-SMMA care since the Dobbs ruling. She hopes that addressing knowledge gaps in abortion care among emergency and primary physicians, who are often the first point of contact for patients after SMMA, will improve patients’ access to care.

Tucker adds, “Training emergency and primary care physicians in abortion and post-abortion care may help address not only abortion-related patient concerns but also a variety of pregnancy-related issues. Competence in abortion care means better care for all patients capable of pregnancy.”

As more states restrict clinician-managed abortion in the wake of Dobbs v. Jackson Women’s Health Organization, the Supreme Court decision that overturned Roe v Wade in 2022, more patients are pursuing self-managed medication abortion (SMMA). Definitions of SMMA can vary, but SMMA typically refers to the use of mifepristone and/or misoprostol to induce abortion outside of a clinical context. Despite the 97% completion rate and excellent safety record of a medication abortion, patients who pursue SMMA sometimes experience symptoms that prompt them to visit an emergency department or primary care clinic for evaluation.

While most emergency and primary care physicians are willing to provide post-SMMA care, a new study finds that knowledge gaps exist, and more training is needed. Furthermore, physicians at Catholic health systems may feel curtailed in their ability to provide post-SMMA care to their patients.

“In the evolving landscape of abortion care, educational efforts should prepare physicians in all specialties to care for patients post-SMMA,” says corresponding author Xanthia Tucker, MD, assistant professor of internal medicine and pediatrics at Boston University Chobanian & Avedisian School of Medicine.

In an effort to investigate the practices, confidence, knowledge and attitudes related to post-SMMA care among emergency medicine (EM), family medicine (FM), and internal medicine (IM) physicians, researchers invited 505 EM, FM, and IM physicians at an academic medical center and Catholic nonprofit health system in Michigan to complete a confidential online survey. Michigan is a state with legal access to abortion and more than 20% Catholic hospital beds.

The survey contained four sections assessing exposure to and confidence in caring for patients after spontaneous miscarriage, clinician-managed medication abortion, and SMMA; knowledge of eight signs and symptoms following medication abortion; attitudes toward post-SMMA care; and participant demographics. The work is published in the Journal of Women’s Health.

Among their findings:

• While most (89%) physicians had not knowingly cared for patients after SMMA, 96% of these physicians would, if given the opportunity to do so.
• Confidence managing spontaneous miscarriage, clinician-managed medication abortion, and SMMA did not vary between the academic and Catholic locations, but more participants at the Catholic system reported feeling limited by their employer’s policies in caring for patients after SMMA.
• Participants reported less confidence caring for patients following SMMA compared to spontaneous miscarriage or clinician-managed medication abortion, and confidence differed by specialty. EM physicians reported higher confidence in providing post-SMMA care than primary care physicians, and FM physicians were more confident than IM physicians. Knowledge of expected signs and symptoms following medication abortion did not differ by specialty.
• Confidence managing all three conditions was significantly associated with having received abortion training during residency.

While the increasing politicization and criminalization of abortion make post-SMMA care challenging to study, Tucker believes further projects should explore where and how patients are receiving post-SMMA care since the Dobbs ruling. She hopes that addressing knowledge gaps in abortion care among emergency and primary physicians, who are often the first point of contact for patients after SMMA, will improve patients’ access to care.

Tucker adds, “Training emergency and primary care physicians in abortion and post-abortion care may help address not only abortion-related patient concerns but also a variety of pregnancy-related issues. Competence in abortion care means better care for all patients capable of pregnancy.”