With an eye toward bolstering access to care, the state’s top public health official has recommended incorporating abortion care within primary care, a sector that state leaders hope to stabilize as residents struggle to connect with providers and often face long waits for appointments.
In a new report, the Department of Public Health and Commissioner Dr. Robert Goldstein wrote that, “Abortion care, particularly medication abortion and early procedural abortion, is a common medical practice that can and should be integrated into primary care.”
“However, abortion care is often siloed away from primary care services, stigmatizing abortion and decreasing its availability,” the report continues.
The 2022 shield law for reproductive and gender identity care tasked the DPH to consult with advocacy organization Reproductive Equity Now and produce a report on so-called abortion and maternity care deserts.
Massachusetts no longer has abortion deserts, defined as communities located beyond a 50-mile radius of a facility that provides abortion care, according to the report. Still, DPH warns there are “significant areas of decreased access” throughout the state based on the availability of hospital-based abortion care, procedural abortion care, and abortion care after 21 weeks of gestational age.
“For each of these categories, most of Cape Cod and the Islands and parts of Western and Northern Massachusetts remain 25-50+ miles away from care,” the report says.
The report recommends integrating abortion care into primary care “where possible,” encouraging more hospitals to publicly offer abortion care, maintaining access through telemedicine, ensuring adequate reimbursement rates, bolstering access to training, and expanding access to culturally competent care on the Cape and Islands.
Primary care already faces significant strain in Massachusetts, fueled by a dwindling workforce and declining investments in the sector. Senate President Karen Spilka has identified primary care reform as a priority this session, but consensus legislation has not emerged over the first year of the two-year session.
Spilka last week said that Bay Staters who are “lucky enough to have a primary care doctor” can end up waiting weeks or months to get an appointment.
“We need to work on that and do better,” Spilka told reporters.
The DPH report says primary care providers who want to integrate abortion care face barriers tied to increased insurance and security costs, plus prohibitions on providing abortion care in certain settings that receive federal funding.
“However, there are resources available to primary care providers that are interested in integrating abortion care into general primary care that can help address these and other barriers,” says the report, which links to an initiative at the University of California San Francisco.
“We also encourage community health centers to explore offering abortion care as one of their primary care services,” the report continues. “The Massachusetts Department of Public Health’s Sexual and Reproductive Health Program can work with healthcare systems that want to make this integration.”
Dr. Olivia Liao, president of the Massachusetts Medical Society, called abortion care “essential health care” and said the organization supports “efforts to increase local access for patients across the Commonwealth.”
“When examining the potential integration of abortion care into primary care settings, it is important to recognize that physicians who are amenable to providing this care will need appropriate training, resources, and operational support, particularly amid a severe primary care workforce crisis,” Liao said in a statement to the News Service Tuesday. “We look forward to continued collaboration with DPH and other partners to reduce disparities in access and advance equitable, evidence-based reproductive health care for all patients.”
The DPH’s recommendation to expand access to training for birth and abortion care acknowledges that the next generation of providers must also have the skills to “provide this essential care.”
“This includes primary care and women’s health specialty providers that have the capacity to offer care for complex pregnancies, abortion care at a range of gestational ages, VBAC (vaginal birth after cesarean) care, and midwifery care,” the report says. “Expanding medical training programs both inside and outside Massachusetts and attracting and retaining a skilled workforce to all parts of the Commonwealth is key to ensuring access to these services for the long term. ”
The state Primary Care Task Force is scheduled to meet on Wednesday and discuss its own slate of potential recommendations for establishing a spending target for the sector and setting standardized data and reporting requirements. The panel’s next report is due on Dec. 15.
