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RESEARCH SPOTLIGHT

What Happened to Contraception and Abortion Services – and the Workforce Providing Those Services – from 2019 to 2021? 
  • ​Contraception services decreased substantially from March through May 2020 but were restored to approximately pre-pandemic levels later in 2020 and through 2021. Procedural abortion services steadily decreased, and medication abortion services steadily increased.
Citation: Strasser J, Schenk E, Dewhurst E, Chen C. Changes in the Clinical Workforce Providing Contraception and Abortion Care in the US, 2019-2021. JAMA Network Open. Published online November 1, 2022. doi:10.1001/jamanetworkopen.2022.39657
  • The number of physicians decreased in 2020 for all services except medication abortion, and the number of physicians providing contraception did not reach pre-pandemic levels in 2021. The number of advanced practice clinicians stayed nearly identical from 2019 to 2020 and increased above pre-pandemic levels in 2021.
  • COVID-19 placed incredible strain on the health workforce, and we find a concerning loss of physicians providing contraception services during this time.
  • This study describes the workforce until the year before the Supreme Court decision overturning Roe v. Wade, a watershed event that will shape the provision of abortion and contraception for the foreseeable future. It will be critical to continue to track this workforce in the coming years, as access to care intrinsically relies on the workforce that provides it.
OBGYNS Are Only One Component of the Abortion Care Workforce
Strasser J, Schenk E, Das K, et al. Workforce Providing Abortion Care and Management of Pregnancy Loss in the US. JAMA Internal Medicine. 2022. doi:10.1001/jamainternmed.2022.0223

Key Points:
  • This study identifies a small but essential national workforce of clinicians who provide abortions and who have billed insurance for their services.
  • Most abortion providers and pregnancy loss management providers were physicians, with OBGYNs providing most services. APRNs, nurse-midwives, and physician assistants also provide induced abortion and management of pregnancy loss.
  • Most clinicians who managed pregnancy loss also did not appear to provide induced abortion services, despite the skill set being the same. 
PENALIZING ABORTION PROVIDERS WILL HAVE RIPPLE EFFECTS ACROSS PREGNANCY CARE
Strasser J, Chen C, Rosenbaum S, Schenk E, Dewhurst E. (2022, May 3). Penalizing Abortion Providers Will Have Ripple Effects Across Pregnancy Care [Blog]. Health Affairs Forefront. 10.1377/forefront.20220503.129912.

Key Points:
  • If Roe is reversed, the workforce providing abortion care will be severely damaged. This loss of abortion providers is a huge blow to population health and reproductive justice. 
  • Providers may opt not to provide medication or procedural abortion services, even if they are not directly providing induced abortion care, because of the perceived association with abortion care.  
  • Lack of adequate pregnancy loss management training could reinforce a cycle of lack of trained faculty, leading to an even more constricted pipeline of providers willing and able to provide full-scope pregnancy care.  
Contraception workforce varies across the United states
Chen C, Strasser J, Banawa R, et al. Who is Providing Contraception Care in the United States? An Observational Study of the Contraception Workforce. American Journal of Obstetrics & Gynecology. 2022;226(2):232.e1-232.e11. doi:10.1016/j.ajog.2021.08.015

Key Points:
  • Of the 3,006 total U.S. counties, 1,411 had no contraception-providing OBGYNs or nurse-midwives. However, 674 of these 1,411 counties had family medicine, advanced practice nurses, or physician assistant contraception providers.
  • Medicaid acceptance varied widely by state. The proportion of contraception providers accepting Medicaid in 2019 ranged from 55.5% in Texas to 89.1% in Vermont.
  • Contraceptive prescribing varies by provider specialty. Compared with 51.4% of family medicine physicians, 32.4% of pediatricians, 25.2% of advanced practice nurses, 19.8% of internal medicine physicians, and 19.4% of physician assistants, nearly three-fourths of obstetrician-gynecologists (73.1%) and nurse-midwives (72.6%), prescribed the pill, patch, or ring.
pharmacist prescribing of contraception could improve access
Strasser J, Schenk E, and Chen C. Pharmacist Prescribing of Hormonal Contraception (Research Brief). Washington, DC: Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University, 2021.

Key Points:
  • In the 12 states where pharmacists were authorized to prescribe hormonal contraception in 2019, we identified 1,970 pharmacists who issued 11,304 new contraception prescriptions. Pharmacist-prescribed contraception prescriptions made up less than 1% of all contraception prescriptions in all 12 states.
  • Most pharmacists who prescribe contraception do so at a low volume, with fewer than 10 prescriptions in a calendar year.
  • Limited uptake of pharmacist prescribing in states where it is authorized may be due to a number of factors, including lack of payment for pharmacist services, training requirements, employer regulations, and lack of implementation support at the state level.
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