Fewer Abortions in States with More Family Physicians.

Abstract

Primary care physicians providing abortion services-particularly family physicians (FPs), who provide the majority of care in rural and underserved settings-could enhance access to abortion and family planning services. The primary objective of this study was to evaluate the association between the rate of abortions and availability of FPs by state. This was an exploratory ecological study of secondary data compiled from several state sources in the United States. The primary dependent variable was abortion rate, and the primary independent variable was FPs per population, with internists and obstetrician/gynecologists (ob/gyns) analyzed as comparison. Other variables included pregnancies and abortion clinics per population; percent of a state's population in rural areas; and state abortion law. Each comparison was analyzed with a two-tailed Pearson's correlation test followed by multivariate linear regression. The number of physicians per 100,000 population was significant in all three models when controlling for the other variables, but in different directions: more internists and more ob/gyns were associated with greater abortion rates (B = .253 [.037], P < .001 and B = .807 [.174], P < .001), while more FPs were associated with lower abortion rates (B = -.212 [.064], P = .002). Each model was reliably predictive of abortion rates and explained most of the variance in abortion rates by state. Fewer abortions in states with more FPs and more in states with ob/gyns and internists may suggest an access issue in the states with more FPs. FPs providing abortion care could be part of a solution for improving patient access to that care, particularly in rural areas.