Submitted by: Laurel Neufeld, MS3, Katie Freeman, MD, and Chelsea Thibodeau, DO

Desired actions:

• Bring awareness to members, the public, media and/or specific groups/stakeholders
• Provide education to members, the public, media and/or specific groups/stakeholders
• Support/collaborate with other groups/organizations on work that’s already being done

WHEREAS providing full spectrum reproductive health care is a tenet of family medicine^1,2;

WHEREAS access to abortion care is limited, especially in rural areas^3,4;

WHEREAS medication abortion can be safely and effectively provided in the primary care setting⁵;

WHEREAS high quality education, tools and materials have been developed to support implementation of medication abortion care in the primary care clinic^6-9;

WHEREAS primary care clinicians across the state of Minnesota, including those in rural practice and across diverse demographics (age, location, gender, years of experience) express interest in providing medication abortion¹⁰;

WHEREAS current barriers to providing care include (A) a lack of infrastructure or workflow support from health systems, (B) a need for a network or community of providers doing this work and (C) a lack of training and education^10,11;

BE IT RESOLVED that the MAFP provide, independently or alongside partner organizations and health systems, support for establishing clinic policies and procedures to provide medical abortion in primary care for clinicians and their clinical administrative teams, such as disseminating toolkits like the Access Delivered toolkit⁶ or others cited in 7-9 and hosting workshops on provision and implementation logistics;

BE IT FURTHER RESOLVED that the MAFP facilitate opportunities for family doctors, residents and students to connect with others who provide medication abortion to enable troubleshooting and community building (these opportunities can exist across both currently existing and newly created resources: uplifting and supporting participation in Reproductive Health Access Project (RHAP)’s Minnesota Cluster, MAFP-sponsored events focused on medication abortion provision and integration, and other possible future resources like a provider hotline).

References and Supporting Information

1. Policy: Reproductive and Maternity Health Services. American Academy of Family Physicians. https://www.aafp.org/about/policies/all/reproductive-maternity-health-services.html#:~:text=The%20American%20Academy%20of%20Family,nonevidence%2Dbased%20restrictions%20on%20medical
2. Policy: Reproductive Decisions, Promoting Access to Medication and Aspiration Terminations by Family Physicians. American Academy of Family Physicians. https://www.aafp.org/about/policies/all/reproductive-decisions-promoting-access.html#Reproductive%20Decisions,%20Promoting%20Access%20to%20Medication%20and%20First%20Trimester%20Aspiration%20Terminations%20by%20Supporting%20Skilled%20Providers
3. Thompson KMJ, Sturrock HJW, Foster DG, Upadhyay UD. Association of Travel Distance to Nearest Abortion Facility With Rates of Abortion. JAMA Netw Open. 2021;4(7):e2115530. doi.org/10.1001/jamanetworkopen.2021.15530
4. Summary of Findings: Safety, Effectiveness, and Importance of Abortion Care in Minnesota. 2022. https://www.health.state.mn.us/docs/people/womeninfants/abortion/summaryabortionmn.pdf Accessed 4/15/2024.
5. Bennett IM, Baylson M, Kalkstein K, Gillespie G, Bellamy SL, Fleischman J. Early abortion in family medicine: clinical outcomes. Ann Fam Med. 2009;7(6):527-33. doi.org/10.1370/afm.1051
6. Access Delivered: A toolkit for providers offering medication abortion. 2022. https://familymedicine.uw.edu/accessdelivered/ Accessed 4/15/2024.
7. Toolkit For Integrating Medication Abortion in Primary Care. Reproductive Health Access Project. 2022. https://www.reproductiveaccess.org/resource/toolkit-medication-abortion/ Accessed 4/15/2024.
8. Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225. Obstet Gynecol. 2020 Oct;136(4):e31-e47. https://www.contraceptionjournal.org/article/S0010-7824(20)30301-2/fulltext#secst125
9. Fleming M, Shih G, Goodman S, et al. TEACH Abortion Training Curriculum, 7th Edition. UCSF Bixby Center for Global Reproductive Health. 2022. https://teachtraining.org/abortioncurriculum Accessed 4/15/2024.
10. Neufeld LMP, Mark KP. Medication Abortion in Primary Care: Clinician Interest and Barriers. J Am Board Fam Med. 2024. https://www.jabfm.org/content/medication-abortion-primary-care-clinician-interest-and-barriers
11. Razon N, Wulf S, Perez C, et al. Family physicians’ barriers and facilitators in incorporating medication abortion. J Am Board Fam Med. 2022;35(3):579-87. doi.org/10.3122/jabfm.2022.03.210266

Comments in support (8):

Elizabeth Ingersent – Evidence shows medication abortion is very safe and improves outcomes for patients. Primary care physicians should have the option to learn how to provide this care, in order to improve access for patients across the state.

Nancy Baker – I support the resolution as written.

Andrew Slattengren – Even in resource-rich settings, we have experienced logistical barriers to providing medication abortion care. This resolution envisions actions that can be taken by MAFP to help reduce those barriers to Family Physicians who are looking to provide this care to their patients.

Chris Reif – Full reproductive health services, including abortion for those women who choose it, are a critical part of Family Medicine. Our profession needs to provide for and train those Family Physicians who choose to offer abortion.

Christy Atkinson – In strong support of this resolution as written.

Roli Dwivedi – Access to reproductive health services, including abortion, is full spectrum family medicine. Family medicine needs to provide access and also train current and future Family Physicians who choose to offer abortion.

Robert Koshnick – My dad’s only sister died of an “illegal” abortion at age 16. One of my first patients as a medical student in clinical years was in the end stages of dying from sepsis from a coat hanger abortion that she had performed on herself. I thought that many women cursed the men that had impregnated them when I was delivering babies as part of my training at HCGH. What sort of life were those babies likely to have? Early-stage abortion is safe and should be available to all women.

Kim Krohn – This should not be a political issue. Physicians should have access to resources concerning abortion.

Comments against (2):

Eric Poulin – Quite simply, as physicians we have an ethical duty to “do no harm”. The ending of a pre-born human’s life in the womb thru “starvation” by blocking progesterone receptors and thereby preventing placental function is clearly harming that pre-born human life. The fewer of our profession actually doing this, the better for the community of our profession.

David Power – I do not support ending a child’s existence as a solution to a difficult pregnancy. In the same way as I oppose the death penalty, one fewer abortion spares one life.