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Family physicians must provide more reproductive care, Stanford doctors say

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This article is part of a series highlighting recent research on reproductive health for National Women’s Health Week, which begins on Mother’s Day each year. 

New research has found that family physicians often do not provide reproductive healthcare in key areas including long-acting contraception and abortion care despite having training in those areas, according to an article published in the Journal of the American Board of Family Medicine in March. 

Family medicine is focused on providing primary care to all ages and genders. This broad training is especially important in rural or underserved areas, where specialty care may be less accessible. 

“We say from womb to tomb,” said Meenadchi Chelvakumar, a family medicine doctor at Stanford Health Care and one of the co-authors of the article. The article comments on data compiled by researchers from the Robert Graham Center, a policy center that aims to improve family medicine and primary care. 

Family physicians also play an integral role in reproductive healthcare. However, new research shows that while most family medicine doctors are trained in key components of reproductive healthcare such as contraception, prenatal care and maternity care, a minority of these doctors actually use their training. 

The majority of family physicians do not receive training for abortion care. Only 20% of recent graduates of family medicine training programs reported training in surgical abortion or incomplete miscarriage management, and less than 5% of recent graduates reported offering these services according to the article. 

One in four women report needing abortion care during their lifetime. However, abortion care is one of the few areas of family medicine training that physicians can opt out of. 

“Unfortunately, in the U.S., reproductive care has been increasingly politicized, with federal efforts to reduce funding to Planned Parenthood and state-level legislative efforts including TRAP laws (Targeted Restrictions on Abortion Providers) in increasing number of states,” wrote Jonathan Shaw M.S. ’14, a co-author of the article, in an email to The Daily. “These pose real threats to women’s access to comprehensive reproductive care, and states with more restrictive legislation are also those with worse maternal and infant outcomes.” 

“While the majority of abortion care is provided by OB/Gyn’s, medication and early surgical abortion is within the scope of training of Family Physicians; this may become particularly important in rural areas or more restrictive states where specialty centers are inaccessible,” he added. 

Chelvakumar says that while some of these statistics can be explained by personal preference and patient population, they might also be due to a lack of opportunity. 

“There’s just in general in this country a dwindling number of abortion providers because of all the restrictions put on providers to be able to continue doing this service,” Chelvakumar said. “So even just finding training sites for the trainees that are interested in learning these services can be difficult. The opportunities are not there because a lot of these restrictions have led to people just not being able to keep up this skill and use this skill.”

Chelvakumar and Shaw also found in research published last year that, while increasing numbers of women are using long-acting reversible contraceptives (LARC) such as intrauterine devices (IUDs) and subdermal implants, less than half of family physicians provide it.

Family physicians are key to providing this preventative contraception care, according to Shaw. But both doctors told The Daily they are optimistic about the future of family medicine. 

The “broad range of care developed during training means that a family physician’s career can be dynamic, and [provides the] flexibility to brush up on skills that haven’t been used for a time, and adjust the services one provides to make sure patient, family, and community’s need are met,” Shaw wrote. 

Chelvakumar said family physicians have taken on a new role in light of the COVID-19 pandemic. 

“We play a sort of public health and public education role in terms of being able to educate the public on appropriate sanitary measures that need to be taken, kind of what rules and restrictions they need to be following and why,” she said. “There’s so much information and misinformation.” 

She also encouraged patients to reach out to their primary physicians for care before jumping to a specialist. Both doctors encourage Stanford students to consider family medicine as a possible career. 

“Family medicine is a career in medicine that offers broad opportunities and is one path to serving the needs of women’s health; family physicians play an important role in ensuring women have access to comprehensive reproductive health services,” Shaw wrote. 

Contact Emma Talley at emmat332 ‘at’ stanford.edu.

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