Society of Teachers of Family Medicine

STFM Group Update

Comprehensive Family Planning Education in Family Medicine

Advocating for Family Planning and Abortion Care in the Patient-centered Medical Home

By STFM Group on Abortion Training and Access members Sarah Miller, MD, and Sharon Phillips, MD, Albert Einstein College of Medicine

Integrating appropriate, full-spectrum family planning services, including early abortion care, into our training programs and practices is sound, patient-centered primary health care.

Early pregnancy loss and termination are remarkably prevalent. Many women and couples who find themselves facing an unintended pregnancy or problems with intended pregnancies come to their family doctors first. Management of early pregnancy is an everyday event.

Those of us who chose family medicine as our specialty do so because we value caring for the whole patient. Family doctors can provide prenatal care, well-child care, pregnancy termination, and miscarriage management to any patient at different times in her life.

Like many of the toughest decisions in our patients’ lives, when it comes to pregnancy and pregnancy planning, our patients seek our advice and expertise for guidance and care. We are often entrusted with the most personal and privileged information about our patients’ circumstances. Integrating comprehensive reproductive health care into our training and practices allows us to address the needs of our patients when they are most vulnerable. Given the prevalence of unintended pregnancy and the safety of providing early abortion care in the family medicine setting, the majority of our patients do not need to be referred out to free-standing clinics.   

In the United States, 50% of pregnancies are unintended. Half of these end in abortion. At current rates, one third of all American women, from all socioeconomic groups and religious backgrounds, have had at least one abortion by age 451. The face of women in need of abortions is the face of the woman of reproductive age in front of us in our offices. Fifty-six percent (56%) of women having abortions are in their 20s; 61% have one or more children; 67% have never married; 57% are economically disadvantaged; 88% live in a metropolitan area. 2

Eighty-seven percent (87%) of counties in the United States have no abortion provider. Because family physicians work in medically-underserved communities, both urban and rural, expanding abortion care in family medicine could greatly improve access. Over the past 10 years, the number of family medicine residency programs in the United States that provide abortion training as part of the core curriculum has slowly increased, but most residency programs still do not provide this training. Curricula include didactics and clinical training in options counseling, early abortion care, post-abortion care, management of early pregnancy loss, and women-centered family planning.

Family medicine residency programs that offer training in family planning and abortion care are in demand. Graduates who have taken advantage of such training look for opportunities to integrate abortion services into their post-residency practice. To increase the number of family doctors who are providing this care, more residencies need to recruit recent graduates who have had training in family planning into faculty positions; these faculty have the skills to provide for their patients and to train more residents.

We possess the necessary skills, and it is well within our scope of practice to provide all early pregnancy care. Increased training can broaden our practices to provide this care in the Patient-centered Medical Home.

The Society of Teachers of Family Medicine’s Group on Abortion Training and Access provides resources and support “to enhance and expand abortion and family planning education in family medicine by (1) expanding a network of family medicine educators who offer abortion training in their residency programs, (2) sharing and evaluating a curriculum that family medicine faculty can use to integrate abortion training in their residency programs, and (3) encouraging the network of family medicine educators to collaborate to evaluate the process and outcomes of the integration of this curriculum.”

References:  

1. Finer LB, and Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health 2006;38(2):90–6.

2. Guttmacher- An overview of Abortion in the United States.