Changes in the clinical workforce for contraception and abortion care

However, medication abortions steadily rose from 2019 to 2021, despite a steady decrease in procedural abortion.

“The contraception and abortion workforce can enable or limit access to essential healthcare services,” said co-principal investigator Julia Strasser, DrPH, director of the Jacobs Institute of Women’s Health at George Washington University School of Public Health in Washington D.C. “Our research team has constructed a comprehensive national database of this workforce as part of an ongoing project.”

Between January 2019 and December 2021, a total of 141,837 clinicians provided at least one in-person contraception or abortion service, whereas 5,804 clinicians provided both services.

The number of physicians providing contraception did not return to prepandemic levels in 2021. By contrast, the number of advanced practice clinicians remained about the same from 2019 to 2020, then rose above prepandemic levels in 2021.

On the other hand, contraception services decreased dramatically from March through May 2020, but were restored to roughly prepandemic levels later in 2020 and through 2021.

In addition, abortion services did not markedly decline in early 2020. Instead, procedural abortion steadily decreased from 8,315 services in January 2019 to 5,665 services in December 2021.

Medication abortions also steadily increased, from 14,347 services in January 2019 to 16,074 services in December 2021.

“We found the trend of contraception services decreasing substantially from March through May 2020, then restored to approximately prepandemic levels later in 2020 and through 2021, to be similar to what other research has found for services provided in-person during the initial closures for COVID-19,” Strasser told Contemporary OB/GYN®.

Likewise, the findings that the number of physicians decreased in 2020 for all services, except medication abortion, and that the number of advanced practice clinicians stayed nearly identical from 2019 to 2020, followed by an increase to prepandemic levels in 2021, “mirror trends seen in other areas of the healthcare workforce, where the number of advanced practice clinicians is increasing and the number of physicians is decreasing,” Strasser said.

When access to contraception and abortion care is threatened -- whether through pandemic clinic closures or punitive policies, or both – “the research tells us that there are adverse health effects, lower quality of life, and other consequences for personal autonomy,” said Strasser, an assistant research professor of health policy and management at George Washington University. “Maintaining access to care relies on both a robust workforce that can provide that care and on those providers receiving the support they need.”

The pandemic placed incredible strain on the health workforce, which will continue to play out for the foreseeable future, according to Strasser. “Clinicians may drop out of the workforce, experience burnout and moral injury, and shift their service provision,” she said. “To protect these clinicians, and thereby protect access to care, the workforce needs support at multiple levels, including improving medical education on reproductive health services, expanding the pool of providers to include more primary care physicians as well as advanced practice clinicians, and state and federal policies that do not target providers for punitive action.”

The Supreme Court decision overturning Roe v. Wade will also shape the provision of abortion and contraception. “Thus 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,” Strasser said.

Reference

Strasser J, Schenk E, Dewhurst E, et al. changes in the clinical workforce providing contraception and abortion care in the US, 2019-2021. Published online November 1, 2022. JAMA Netw Open. doi:10.1001/jamanetworkopen.2022.39657