| NEW YORK
NEW YORK (Reuters Health) - Nearly all obstetrician-gynecologists in the U.S. have patients who want abortions, but only a small percentage of the doctors provide them, suggests a new study that finds access to abortion remains limited, especially in certain areas of the country.
In a survey of 1,144 ob-gyns, researchers found that while 97 percent said they'd had patients who sought abortions, only 14 percent ever provided them. Doctors refusing to perform the procedure were especially concentrated in rural areas, the South and Midwest.
The 14 percent figure is lower than was found in a 2008 survey, where 22 percent of ob-gyns said they performed abortions. However, that study focused on younger doctors who had all been certified after a 1996 rule that made abortion training a required part of ob-gyn residency programs.
Since the current study included doctors up to age 65, that could be the reason for the lower number performing abortions, said lead researcher Dr. Debra B. Stulberg of the University of Chicago.
But the bottom line is the same, she told Reuters Health: Only a small percentage of ob-gyns offer abortion services, despite a high demand for them.
"Almost every ob-gyn encounters patients who want abortion services," Stulberg said. "But we really are at times making it tough for women to access what is a legal service."
In some cases, ob-gyns may have personal objections, the study suggests. Of doctors who did not perform abortions, 52 percent said their religion was very important to them; that compared with 26 percent of those who did perform abortions.
And Catholic and Protestant doctors were less likely to provide the service than Jewish or non-religious doctors were.
But, according to Stulberg, the issue is not that large numbers of doctors "don't believe in abortion."
In some cases, she noted, the hospitals or group practices where ob-gyns work prohibit abortion services -- often because they don't want to become involved in controversy, especially in smaller communities.
In this study, a full 88 percent of ob-gyns who offered abortion services were from urban centers.
Similarly, doctors in the northeastern and western U.S. were more likely to provide abortions than those from the South or Midwest.
It's not clear how many ob-gyns might be influenced by fear of anti-abortion violence.
In recent years, U.S. clinics have been bombed, set on fire, threatened with anthrax and acid, and physicians have been stalked and patients harassed. In 2009, a Wichita, Kansas, abortion provider, Dr. George Tiller, was fatally shot by an anti-abortion activist.
Stulberg said that many doctors may believe it's simply best to disassociate themselves from abortion services, depending on how controversial the issue is in their community.
For women -- especially those in rural areas, the South or Midwest -- that means that finding an abortion provider can be a "struggle," Stulberg said.
She did note, however, that younger doctors in this survey -- those aged 35 or younger -- were more likely to provide abortions than their older counterparts were.
That is in line with the 2008 study, Stulberg said. And although the number of U.S. abortion providers has been on the decline for the past three decades, the increase among younger doctors suggest that could be changing.
"There are signs that the trend could be slowing down or reversing," Stulberg said.
A recent study found that the abortion rate among U.S. women increased slightly, by 1 percent, between 2005 and 2008 -- to just under 20 abortions for every 1,000 women aged 15 to 44.
The broader issue, according to Stulberg, is that there are still too many unintended pregnancies. "We are not doing a good enough job of preventing them," she said.
SOURCE: bit.ly/qor2Rs Obstetrics & Gynecology, September 2011.