Society for Maternal-Fetal Medicine Special Statement: Maternal-fetal medicine subspecialist survey on abortion training and service provision

Published:April 09, 2021DOI:
      Following a collaborative workshop at the 39th Annual Pregnancy Meeting, the Society for Maternal-Fetal Medicine Reproductive Health Advisory Group identified a need to assess the attitudes of maternal-fetal medicine subspecialists about abortion services and the available resources at the local and regional levels. The purpose of this study was to identify trends in attitudes, beliefs, and behaviors of practicing maternal-fetal medicine subspecialists in the United States regarding abortion. An online survey was distributed to associate and regular members of the Society for Maternal-Fetal Medicine to assess their personal training experience, abortion practice patterns, factors that influence their decision to provide abortion care, and their responses to a series of scenarios about high-risk maternal or fetal medical conditions. Frequencies were analyzed and univariable and multivariable analyses were conducted on the survey responses. Of the 2751 members contacted, 546 Society for Maternal-Fetal Medicine members completed all (448 of 546, 82.1%) or some (98 of 546, 17.9%) of the survey. More than 80% of the respondents reported availability of abortion services in their state, 70% reported availability at their primary institution, and 44% reported provision as part of their personal medical practice. Ease of referral to family planning subspecialists or other abortion providers, institutional restrictions, and the lack of training or continuing education were identified as the most significant factors contributing to the respondents’ limited scope of abortion services or lack of any abortion services offered. In the univariable analysis, exposure to formal family planning training programs, fewer years since the completion of residency, current practice setting not being religiously affiliated, and current state categorized as supportive by the Guttmacher Institute’s abortion policy landscape were factors associated with abortion provision (all P values <.01). After controlling for these factors in a multivariable regression, exposure to formal family planning training programs was no longer associated with current abortion provision (P=.20; adjusted odds ratio, 1.34; 95% confidence interval, 0.85–2.10), whereas a favorable state policy environment and fewer years since the completion of residency remained associated with abortion provision. The results of this survey suggest that factors at the individual, institutional, and state levels affect the provision of abortion care by maternal-fetal medicine subspecialists. The subspecialty of maternal-fetal medicine should be active in ensuring adequate training and education to create a community of maternal-fetal medicine physicians able to provide comprehensive reproductive healthcare services.

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      1. Increasing access to abortion: ACOG committee opinion, number 815.
        Obstet Gynecol. 2020; 136: e107-e115
        • Society for Maternal-Fetal Medicine
        Access to abortion services.
        (Available at:)
        • National Academies of sciences, engineering, and medicine
        The safety and quality of abortion care in the United States.
        National Academies Press (US), Washington (DC)2018
        • Espey E.
        • Dennis A.
        • Landy U.
        The importance of access to comprehensive reproductive health care, including abortion: a statement from women’s health professional organizations.
        Am J Obstet Gynecol. 2019; 220: 67-70
        • Nash E.
        Unprecedented wave of abortion bans is an urgent call to action. Guttmacher Institute.
        (Available at:)
        • Nash E.
        • Mohammed L.
        • Cappello O.
        • Naide S.
        State policy trends 2019: a wave of abortion bans, but some states are fighting back. Guttmacher Institute.
        (Available at:)
        • Nash E.
        • Mohammed L.
        • Cappello O.
        • Naide S.
        State policy trends 2020: reproductive health and rights in a year like no other. Guttmacher Institute.
        (Available at:)
        • Blackwell S.
        • Louis J.M.
        • Norton M.E.
        • et al.
        Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning.
        Am J Obstet Gynecol. 2020; 222: B2-B18
        • Heuser C.C.
        • Eller A.G.
        • Byrne J.L.
        Survey of physicians’ approach to severe fetal anomalies.
        J Med Ethics. 2012; 38: 391-395
        • Tosello B.
        • Dany L.
        • Bétrémieux P.
        • et al.
        Barriers in referring neonatal patients to perinatal palliative care: a French multicenter survey.
        PLoS One. 2015; 10e0126861
        • Jacobs A.R.
        • Dean G.
        • Wasenda E.J.
        • et al.
        Late termination of pregnancy for lethal fetal anomalies: a national survey of maternal-fetal medicine specialists.
        Contraception. 2015; 91: 12-18
        • The Accreditation Council for Graduate Medical Education
        The American Board of Obstetrics and Gynecology, The American College of Obstetricians and Gynecologists.
        The Maternal-Fetal Medicine milestone project, 2016
        • Kerns J.L.
        • Steinauer J.E.
        • Rosenstein M.G.
        • Turk J.K.
        • Caughey A.B.
        • D’Alton M.
        Maternal-fetal medicine subspecialists’ provision of second-trimester termination services.
        Am J Perinatol. 2012; 29: 709-716
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Nash E.
        State abortion policy landscape: from hostile to supportive. Guttmacher Institute.
        (Available at:)
        • Kerns J.L.
        • Turk J.K.
        • Corbetta-Rastelli C.M.
        • Rosenstein M.G.
        • Caughey A.B.
        • Steinauer J.E.
        Second-trimester abortion attitudes and practices among maternal-fetal medicine and family planning subspecialists.
        BMC Womens Health. 2020; 20: 20
        • Society for Maternal-Fetal Medicine
        Fellowship directory.
        (2021. Available at:)
        Date accessed: March 16, 2021
        • Society of Family Planning
        The fellowship in complex family planning. 2020.
        (Available at:)
        Date accessed: March 16, 2021
        • The Kenneth J.
        Ryan residency training program in abortion & family planning. Ryan Program Locations.
        (January 3, 2021. Available at:)
        • Jones R.K.
        • Witwer E.
        • Jerman J.
        Abortion incidence and service availability in the United States. Guttmacher Institute. 2017. 2019.
        (Available at:)
        • Fuentes L.
        • Jerman J.
        Distance traveled to obtain clinical abortion care in the United States and reasons for clinic choice.
        J Womens Health (Larchmt). 2019; 28: 1623-1631
        • Hawkins S.S.
        • Ghiani M.
        • Harper S.
        • Baum C.F.
        • Kaufman J.S.
        Impact of state-level changes on maternal mortality: a population-based, quasi-experimental study.
        Am J Prev Med. 2020; 58: 165-174
        • Kerns J.L.
        • Lederle L.I.
        • Rosenstein M.G.
        • Turk J.K.
        • Caughey A.B.
        • Steinauer J.E.
        Barriers to dilation & evacuation practice among maternal-fetal medicine subspecialists: quantitative and qualitative results from a national survey.
        Clin Obstet Gynaecol Reprod Med. 2016; 2: 120-126
        • Aziz M.M.
        • Calfee A.
        • Wallett S.
        • Houser M.V.
        • Albright C.
        584: maternal-fetal medicine physician’s opinions regarding risk of death and medically indicated termination of pregnancy.
        Am J Obstet Gynecol. 2019; 220: S388
        • Grossman D.
        • Grindlay K.
        • Altshuler A.L.
        • Schulkin J.
        Induced abortion provision among a national sample of obstetrician-gynecologists.
        Obstet Gynecol. 2019; 133: 477-483