Physician perspectives of abortion advocacy: findings from a mixed-methods study

Physician engagement in reproductive health advocacy: findings from a mixed methods evaluation of a leadership and advocacy program

BACKGROUND

Medical curricula include advocacy competencies, but how much physicians engage in advocacy and what enables this engagement is not well characterized. The authors assessed facilitators and barriers to advocacy identified by physician alumni of a reproductive health advocacy training program.

METHODS

The authors present secondary results from a mixed methods program evaluation from 2018 to 2020, using alumni data from a cross-sectional survey (n = 231) and in-depth interviews (IDIs, n = 36). The survey measured engagement in policy, media, professional organization, and medical education advocacy and the value placed on the community fostered by the program (eight questions, Cronbach's alpha = 0.81). The authors estimated the association of community value score with advocacy engagement using multivariable Poisson regression to estimate prevalence ratios and analyzed IDI data inductively.

RESULTS

Over one third of alumni were highly engaged in legislative policy (n = 90, 39%), professional organizations (n = 98, 42%), or medical education (n = 89, 39%), with fewer highly active in media-based advocacy (n = 54, 23%) in the year prior to the survey. Survey and IDI data demonstrated that passion, sense of urgency, confidence in skills, and the program's emphasis on different forms of advocacy facilitated engagement in advocacy, while insufficient time, safety concerns, and sense of effort redundancies were barriers. The program community was also an important facilitator, especially for "out loud" efforts and for those working in environments perceived as hostile to abortion care (e.g., alumni in hostile environments with high community value scores were 1.8 times [95% CI 1.3, 2.6] as likely to report medium/high levels of media advocacy compared to those with low scores after adjusting for age, gender, and clinical specialty).

CONCLUSION

Physician advocacy training curricula should include both skills- and community-building and identify a full range of forms of advocacy. Community-building is especially important for physician advocacy for reproductive health services such as abortion care.

Sexual and Reproductive Health Advocacy Successes, Failures, and Needs in the United States: Perspectives From Key Stakeholders

Physician advocates for sexual and reproductive health (SRH) care have been active in the United States for decades. Despite such activism, access to SRH services has been fraught with persistent restrictions, particularly for abortion care. We sought the perspectives of key stakeholders on what makes for an effective SRH physician advocate and thoughts about the successes, failures, and needs of the abortion advocacy movement. We interviewed 15 SRH key informants (KIs) in sectors with expertise in organizational policy and advocacy (n = 6); clinical leadership and education (n = 3), media (n = 3), and reproductive justice (n = 3). The analytic team coded repeating ideas and conducted a thematic analysis, organizing findings within KI perspectives on the role of physician advocates in the field of abortion and contraception; successes, failures, and needs in abortion and contraception advocacy; and recommendations on the composition and components of an ideal clinician advocacy training program. KIs relayed that skill building related to communication, developing relationships with changemakers, and understanding political systems was critical for effective advocacy. They felt clinician advocacy training programs should include providers other than physicians and be designed for trainees to build relationships with one another over time. KI perspectives can be valuable in informing advocacy training programs and for contributing strategic approaches to increasing equitable and widespread access to SRH services.

Analysis of the health advocacy concept from the perspective of the evolutionary method

OBJECTIVE

To analyze the concept of Health Advocacy from the methodological framework of the Evolutionary Model.

METHOD

The concept of interest was evaluated from the perspective of published studies identified in the databases: Web of Science, CINAHL, EMBASE, SCOPUS, MEDLINE and articles of interest. The attributes were determined from 19 scientific productions. Data were analyzed using thematic analysis, proposed by Bardin.

RESULTS

The following operational definition was obtained: Health Advocacy is an intentional action, implemented jointly and in favor of individuals and communities, especially for those who suffer from health inequalities, with the aim of preserving and improving health, well-being and empowerment for health promotion.

FINAL CONSIDERATIONS

Thus, a broader concept of Health Advocacy was abstracted, from the micro to the macro, which contemplates the development of the patient's autonomy; includes individuals and groups in care plans and involves them in political activities as possibilities to provide assistance and correct health inequalities.

Physicians and healthcare professionals as advocates for abortion care and reproductive choice

PURPOSE OF REVIEW

The current review discusses the overarching role of advocacy as a primary component of access to abortion care. Abortion is viewed differently from any other form of health care, resulting in a marginalized, but essential healthcare component: without ongoing effective and strategic advocacy, abortion will not become or remain available. Lack of access to abortion care disproportionately affects historically excluded communities.

RECENT FINDINGS

Advocacy is core to the provision of sexual and reproductive health. The antiabortion community has effectively used policy to achieve long-term goals of severely restricting access to abortion. Crisis pregnancy centers, the COVID-19 pandemic, and the antiabortion legislation of 2022 have exacerbated existing health inequities. Community engagement and advocacy skills assist providers to support access and combat inequities. Provider and trainee education, interprofessional collaboration, and leadership are critical in the effort to support comprehensive reproductive health care.

SUMMARY

Through this literature review and our lived experiences as abortion providers, we assert the importance of healthcare professionals as advocates for abortion rights and services. The need for advocacy crosses specialties and communities; together we are stronger advocates as we continue to support and fight for access to safe legal and equitable abortion care.