Abortion attitudes and practices of family and general practice physicians

Journal of Family Practice, July, 1991 by John M. Westfall, Ken J. Kallail, Anne D. Walling

Approximately 1.5 million abortions are performed each year in the United States. [1] Nearly 30% of all pregnancies that do not end in miscarriage are terminated by abortion. Each year, 3% of women of reproductive age obtain an abortion.

Women with problem pregnancies frequently present to primary care physicians, seeking advice and treatment. The views of family and general practice physicians are of special interest because these physicians often represent a woman's initial contact with the medical community even though they do not perform many abortions. Physicians may be involved with many aspects of abortion: the diagnosis of pregnancy, the detection of a problem pregnancy, counseling on the available options, referral to appropriate abortion services, and the actual performance of an abortion. In a national survey, Orr and Forrest [2] reported that 12% of all physicians performed abortions in the prior year, 74% referred women seeking abortions, and 14% did neither. Only 3% of family and general practice physicians performed abortions in the prior year, yet 83% referred women seeking abortions.

Little information has been published on American family physicians' abortion attitudes and practices. Numerous editorials in medical journals and popular news magazines provide anecdotal and individual viewpoints. Several reports on physicians' attitudes toward abortion were published just before and several years after the Roe v Wade decision by the US Supreme Court. [3,4] There are studies from Canada, [5] Australia, [6] and Denmark [7] that discuss abortion attitudes and practices among primary care and specialty physicians. These studies must be interpreted in the context of geographic, biomedical, and basic health care delivery system differences between these countries and the United States. Generally, they report approval of abortion but describe differences among physicians in attitudes and circumstances in which abortion may be appropriate.

Frequent surveys [8-10] of the views of obstetrician-gynecologists and residents in obstetrics and gynecology training programs show relatively high approval rates for abortion under most circumstances. The Alan Guttmacher Institute [11] periodically reviews the delivery patterns of reproductive health services, including abortion, but provides only a broad view of the services offered by different specialties and geographic regions.

The purpose of this investigation was to assess the abortion attitudes and practices of family and general practice physicians in Kansas. Positioned at the entry point into the medical system, family and general practice physicians play a pivotal role in the diagnosis and treatment of women seeking abortion. This role is critical in a largely rural state such as Kansas. Often the only physician caring for a small community is the family physician or general practitioner.

Kansas, a progressive though politically conservative state, was one of the first states to legalize abortion in the early 1970s. Because Kansas maintains many traditional societal and family values, we believe that information about the abortion attitudes and practices of family and general practice physicians in Kansas may be a useful adjunct to the often volatile public debate over abortion.

Methods

A 19-item self-administered survey questionnaire was designed to obtain demographic information, attitudes toward abortion, and practice experiences with abortion from family and general practice physicians in Kansas. The questionnaire was mailed to all 856 physicians on the mailing list of the Division of Postgraduate Education at the University of Kansas School of Medicine in Wichita. The list of physicians is updated weekly and considered to be the most accurate and complete census of physicians by specialty.

Physicians were asked to complete the survey questionnaire anonymously and to return it in a postpaid envelope. In addition, they were asked to return a postpaid postcard separately. The postcard identified the physician as a survey respondent, but could not be linked to that physician's completed questionnaire. A second copy of the questionnaire was mailed to nonrespondents approximately 3 weeks later.

Results

A total of 539 questionnaires were returned, a 63% response rate. The distributions of sex, age, and practice type among the responding physicians and the population of family and general practice physicians in Kansas were similar. A total of 471 male physicians, of whom 59% were older than 40 years, responded to the survey,

Table 1. Percentage of Physicians Indicating Circumstances Under Which Abortion May Be an Appropriate Option for a Pregnant Woman

Circumstance                            %
Save the life of the mother            83
Pregnancy results from rape or incest  69
Fetal anomaly                          65
Woman's personal decision              55
Age of woman                           42
Contraceptive failure                  24
Undesired sex of fetus                  3