Legislative proposals restricting abortion access have dominated the headlines this year. From a near outright abortion ban in Alabama that seeks to levy 99-year jail sentences against participating physicians to "heartbeat" bills that have been introduced in more than a dozen states, abortion and reproductive rights have been at the center of a constitutional firestorm.
The American Medical Association (AMA) has recently intervened by filing a lawsuit that challenges two North Dakota laws, alleging they are politically motivated and force physicians to "provide patients with false, misleading, non-medical information about reproductive health." The laws require physicians to inform patients that abortions performed via the administration of medications are reversible — a claim for which there is no scientific backing — and that abortion terminates "the life of a whole, separate, unique, living human being," which crosses into forbidden ideological territory.
While most of these proposals will endure months, if not years, of litigation and appeals before they can fully impact patients, they represent an opportunity for primary care physicians (PCPs), regardless of geographic location and opinions on abortion, to transform a deeply polarizing issue into a commitment to provide extensive, evidence-based reproductive health education to patients — a move that preserves patient autonomy and reduces the likelihood patients will ever face a difficult abortion decision or fall prey to reckless misinformation campaigns.
With nearly half of all pregnancies unintended, according to research by Guttmacher Institute, the scope of reproductive rights and access to associated services like abortion and birth control remain prominent public health issues. A renewed and focused push for earlier, targeted interventions as well as wide accessibility to family planning and sexual well-being tools, resources and education could potentially shift the entire dynamic of care.
Here's how PCPs can adopt a comprehensive, nonjudgmental and patient-centered approach to sexual health, conception and even abortion — independent of political influences.
The gamut of primary care
As cradle-to-grave caregivers, PCPs are arguably the most influential healthcare provider over the course of patients’ lifespan. This ongoing relationship is ideal for identifying the wide-ranging reproductive care needs of patients, with pregnancy prevention accounting for only a portion of those services.
|Read the AAFP policy on reproductive decisions:
"The American Academy of Family Physicians (AAFP) encourages all family physicians to provide patient education on contraceptive options at every available opportunity to avoid unintended pregnancies. In the event of an unintended pregnancy, family physicians should educate patients about all options. If a patient desires termination of their pregnancy or adoption, family physicians should provide resources to facilitate those services. If a family physician's moral or ethical beliefs conflict with the ability to provide the requested resources or education, the family physician should ask a colleague to provide this information in a timely fashion rather than omit it. Additionally, the AAFP encourages family physicians to stay informed of all state and federal laws as they apply to reproductive health."
"In order to truly provide comprehensive care, primary care physicians must recognize the importance of meeting patients' sexual and reproductive health needs across the reproductive life course, from sex education to family planning to infertility to menopause," says Christine Dehlendorf, MD, MAS, a board-certified family medicine physician, member of the Society of Family Planning (SFP), and director of the Person-Centered Reproductive Health Program (PCRHP) at the University of California, San Francisco. "While some of these services may be provided by obstetrician/gynecologist colleagues, it is still the responsibility of the primary care physician to make sure that these needs are being met holistically."
To that point, many family physicians are already operating within their full scope of practice by prescribing birth control, providing family planning support, performing pelvic exams and vasectomies and screening for and treating sexually transmitted infections (STIs). This follows the guidelines from the American Academy of Family Physicians (AAFP), which encourage a well-rounded approach to patient education, encompassing everything from contraception and abstinence to sterilization, counseling and emergency contraception care.
Despite such efforts, PCPs may still underestimate the need for clear and targeted conversations with their patients about reproduction.
"I'll be honest. I don't always think about [family planning and reproductive health] as a discrete entity," says Jennifer Caudle, DO, a board-certified osteopathic family medicine physician in Sewell, N.J., and associate professor in the department of family medicine at Rowan University-School of Osteopathic Medicine. "[Reproductive health] is an important life stage for our patients, [so we need to] make sure that we're [having] this conversation, providing options and supporting them through their journey — not ignoring the issue or failing to bring it up. [This] is a good reminder for us to be engaged and do more [for our patients]."