Original Research Article Abortion referral patterns among generalist OB/GYNs and primary care practitioners: A qualitative study q Allison Linton a , Samuel R. Mendez b , Melissa A. Simon b,c,⇑ a Department of Obstetrics & Gynecology, Medical College of Wisconsin, Milwaukee, WI 53226, United States b Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States c Department of Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States article info Article history: Received 30 August 2018 Received in revised form 17 October 2019 Accepted 27 October 2019 Available online xxxx Keywords: Abortion Patient referral Qualitative research abstract Objective: An informed, timely referral from a generalist practitioner has the potential to facilitate care for a patient seeking an abortion. However it is unclear what barriers, if any, generalist practitioners per- ceive in this process. The objective of this study was to qualitatively characterize abortion referral pat- terns among generalist practitioners. Study design: We conducted individual interviews with generalist practitioners practicing at Northwestern Medicine, encompassing four hospitals across the greater Chicago metropolitan area. The interview guide focused on abortion-related topics including: referral patterns, attitudes about pro- viding referrals, and specifics of the abortion referral process. We analyzed the data for content and themes using an inductive approach. Results: We completed 37 interviews. Practitioners in all fields and practice sites were willing to provide abortion referrals. Practitioners perceived barriers in the referral process, with a lack of knowledge chief among them. Further, practitioners saw abortion referrals as more burdensome than other specialty referrals. Conclusion: Generalist practitioners are willing to provide abortion referrals, but perceive multiple barri- ers in the abortion referral process. Generalist practitioners can help to ensure their patients receive timely and quality abortion care if they feel prepared and empowered to assist with these referrals. Ó 2019 Elsevier Inc. All rights reserved. 1. Introduction Many obstacles can delay or block a woman who is seeking abortion services. First, it’s unlikely that her current obstetrician- gynecologist is an abortion provider: less than one quarter of obstetrician-gynecologists in the US report performing an induced abortion within the past year [1]. If a woman primarily sees a fam- ily medicine physician, an internal medicine physician, a general practitioner, or a pediatrician, the chances are even lower [2,3]. Thus, she may have to spend time looking for another provider on her own or obtaining a referral from a generalist health care provider. Presenting for an abortion referral may be a negative experience, as previous studies have shown women’s concerns over their general practitioner judging them, opposing the abor- tion, delaying the process, or even turning them away [4,5]. Depending on where she turns for assistance, a woman seeking an abortion may face negative effects of stigmatization or harass- ment; further, she may receive misinformation or care that is intentionally delayed [5–8]. If a woman decides to reach out to a clinician for an abortion referral, she may not end up receiving one [9], even after prompt- ing [10]. Harris and colleagues found that the willingness to help patients obtain an abortion may vary depending on clinical context [11], with Kimport and colleagues introducing the dangerous con- cept of a ‘‘stratified legitimacy” of abortion depending on the patient’s circumstances [12]. A woman may encounter further hur- dles to receiving an abortion referral stemming from their provi- der’s lack of knowledge [13,14]. When general practitioners do provide an abortion referral, additional delays may arise from prac- titioners recommending unindicated follow up or unnecessary testing prior to the transfer of care [14–17]. Further treatment delays may arise from referrals to clinics that do not provide abor- tion services [18,19]. https://doi.org/10.1016/j.contraception.2019.10.009 0010-7824/Ó 2019 Elsevier Inc. All rights reserved. q Competing interest: The authors declare that they have no competing interests. Melissa Simon is a member of the United States Preventive Services Task Force (USPSTF). This article is the sole responsibility of the authors and does not necessarily represent the views and policies of the USPSTF. ⇑ Corresponding author. E-mail address: m-simon2@northwestern.edu (M.A. Simon). Contraception xxx (xxxx) xxx Contents lists available at ScienceDirect Contraception journal homepage: www.elsevier.com/locate/con Please cite this article as: A. Linton, S. R. Mendez and M. A. Simon, Abortion referral patterns among generalist OB/GYNs and primary care practitioners: A qualitative study, Contraception, https://doi.org/10.1016/j.contraception.2019.10.009