The availability of reproductive health services from U.S. private physicians

Abstract

Data on the provision of seven types of reproductive health care were collected from private physicians in four specialties: general/family practitioners (GP/FPs), general surgeons, obstetrician-gynecologists and urologists. All ob-gyns, and eight in 10 GP/FPs, provide the pill, IUD or diaphragm. Over nine in 10 ob-gyns provide infertility and obstetric care and prenatal genetic screening; but only one-third or fewer of GP/FPs do so. Ob-gyns and urologists are far more likely to perform sterilizations than are GP/FPs and surgeons (nine in 10, compared with one-fifth to one-half). Although ob-gyns are the most likely to perform abortions, only four in 10 do so. Among ob-gyns who do not perform tubal sterilizations or abortions, and among urologists who do not perform vasectomies, the primary reason is moral or religious objections (reported by 59-71 percent). For GP/FPs and surgeons who do not perform the three procedures, the leading reason is that they do not perform surgery or that type of surgery; however, 34 percent of nonproviders in these specialties report moral or religious opposition to abortion. Eight in 10 ob-gyns will provide contraceptives to minors without parental consent, but only six in 10 GP/FPs will do so. One-half of doctors who perform female sterilizations, and eight in 10 of those who do vasectomies, require spousal consent. Among those who perform abortions, half require parental consent for minors. Access to private reproductive health care is quite limited for the poor, because many physicians will not accept Medicaid reimbursements or reduce their fees for low-income patients.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: In 1983, the Alan Guttmacher Institute (AGI) began a study to investigate the extent to and conditions under which private physicians provide reproductive health services. This was in response to the minimal information on the availability and accessibility of reproductive health care services in the private sector. Data on the provision on 7 types of reproducitve health care were collected from private physicians in 4 specialties: general/family practitioners (GP/FPs), general surgeons, obstetrician-gynecologists, and urologists. All ob-gyns, and 8 in 10 GP/FPs, provide the pill, IUD or diaphragm. Over 9 in 10, ob-gyns provide infertility and obstetric care and prenatal genetic screening; but only 1/3 or fewer of GP/FPs do so. Ob-gyns and urologists are far more likely to perform sterilization than are GP/FPs and surgeons (9 in 10, compared with 1/5 to 1/2. Although ob-gyns are the most likely to perform abortions, only 4 in 10 do so. Among ob-gyns who do not perform tubal sterilizations or abortions, and among urologists who do not perform vasectomies, the primary reason is moral or religious objections (reported by 59-71%). For GP/FPs and surgeons who do not perform the 3 procedures, the leading reason is that they do not perform surgery or that type of surgery; however, 34% of nonproviders in these specialties report moral or religious opposition to abortion. 8 in 10 ob-gyns will provide contraceptives to minor without parental consent, but only 6 in 10 GP/FPs will do so. 1/2 of doctors who perform female sterilizations, and 8 in 10 of those who do vasectomies, require spousal consent. Among those who perform abortions, 1/2 require parental consent for minors. Access to private reproductive health care is quite limited for the poor, because many physicians will not accept Medicaid reimbursements or reduce their fees for low-income patients. Only 50% of physicians in the relevant specialties offer contraceptive services to Medicaid patients, and 29% or fewer offer other types of services. Only 1-15% will serve the poor at reduced fees. The study reveals that for both the poor and nonpoor the full range of reproductive health care is often not readily available from the private health sector.