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

Pro-choice physicians were more likely than pro-life physicians to perform a follow-up examination of a patient who received an abortion elsewhere (76% vs 59%, P < .001) and to have literature discussing all options for pregnant women readily accessible (33% vs 12%, P < .001). Pro-life physicians were more likely than pro-choice physicians to discuss their personal opinion on abortion with women considering an abortion (63% vs 27%, P < .001).

Discussion

Most family and general practice physicians reported that abortion is appropriate under some circumstances. This finding was similar to previous findings in both physician and public opinion polls. [3-10,12-14] Significant subgroups existed, however, within this sample, based on sex, age, and self-classification.

Male physicians aged 40 years and younger were the most conservative in their approach to abortion. They classified themselves as pro-life more often and reported fewer circumstances under which abortion may be appropriate. Female physicians over the age of 40 years were the most liberal in their approach to abortion. In fact, the older age group of physicians, regardless of sex, had a more liberal approach to women facing a problem pregnancy. Despite the age-related attitude differences, no age-related practice differences were observed.

Differences related to the sex of respondents might have been expected in this study. Abortion is often perceived as a "woman's issue." Two recent surveys of obstetrician-gynecologists showed that female physicians were more likely than male physicians to report that abortion should be performed under some circumstances. [9,10]

Female respondents to this survey revelaed both attitude and practice differences. They more frequently classified themselves as pro-choice and believed that a woman's personal decision was the important factor that makes abortion an appropriate option. These attitudes were reflected in their specific practice patterns. Female physicians reported more practice activities designed to identify women facing a problem pregnancy and to deal with these women in a personal manner.

One explanation may be that women are more sensitive to the abortion issue because they often bear the greater responsibilities associated with pregnancy and the issues surrounding it. Gilligan [15] reports that women's moral development is rooted in "responsibility and relationship," whereas men's moral development is through the manifestation of "rights and rules." Within this context, women may approach a problem pregnancy by seeking to find the most responsible action in light of current relationships and life situations. From this conceptual framework it can be argued that female physicians may be less likely to view abortion as simply an issue of right or wrong, but rather view it as one of several responsible options.

Female physicians in this study were more likely to practice in urban areas than were male physicians. The opportunity to become involved with abortion issues is probably more likely to occur in the urban areas of Kansas, where the larger abortion clinics are located. Rural areas often maintain strong traditional values. In addition, female physicians generally see a larger percentage of female patients than male physicians, thereby increasing the likelihood that they will become involved in the issues surrounding problem pregnancies.