Abstract：
OBJECTIVE: The objective of our study was to identify and characterize barriers to mifepristone use among obstetrician-gynecologists (OB-GYNs) for early pregnancy loss in a southern US state.
METHODS: In this qualitative study, we conducted semistructured interviews with 19 OB-GYNs in Alabama who manage early pregnancy loss. The interviews explored participants\' knowledge of and experience with mifepristone use for miscarriage management and abortion, along with barriers to and facilitators of clinical mifepristone use. The interviews were coded by multiple study staff using inductive and deductive thematic coding.
RESULTS: Nearly all of the interviewees identified abortion-related stigma as a barrier to mifepristone use. Interviewees often attributed stigma to a lack of knowledge about the clinical use of mifepristone for early pregnancy loss. The stigmatization of mifepristone due to its association with abortion was related to religious and political objections. Many interviewees also described stigma associated with misoprostol use. Although providers believed that mifepristone use for abortion would not be accepted in their practice, most believed that mifepristone could be used successfully for miscarriage management after practice-wide education on its use.
CONCLUSIONS: Mifepristone is strongly associated with abortion stigma among OB-GYNs in Alabama, which is a barrier to its use for miscarriage management. Interventions to decrease abortion stigma and associated stigma surrounding mifepristone are needed to optimize early pregnancy loss care.
METHODS: In this qualitative study, we conducted semistructured interviews with 19 OB-GYNs in Alabama who manage early pregnancy loss. The interviews explored participants\' knowledge of and experience with mifepristone use for miscarriage management and abortion, along with barriers to and facilitators of clinical mifepristone use. The interviews were coded by multiple study staff using inductive and deductive thematic coding.
RESULTS: Nearly all of the interviewees identified abortion-related stigma as a barrier to mifepristone use. Interviewees often attributed stigma to a lack of knowledge about the clinical use of mifepristone for early pregnancy loss. The stigmatization of mifepristone due to its association with abortion was related to religious and political objections. Many interviewees also described stigma associated with misoprostol use. Although providers believed that mifepristone use for abortion would not be accepted in their practice, most believed that mifepristone could be used successfully for miscarriage management after practice-wide education on its use.
CONCLUSIONS: Mifepristone is strongly associated with abortion stigma among OB-GYNs in Alabama, which is a barrier to its use for miscarriage management. Interventions to decrease abortion stigma and associated stigma surrounding mifepristone are needed to optimize early pregnancy loss care.
摘要：
目的：我们研究的目的是在美国南部一个州的妇产科医生（OB-GYN）中发现和描述使用米非司酮对早期妊娠丢失的障碍。
方法：在这项定性研究中，我们在阿拉巴马州对19名管理早期妊娠丢失的OB-GYN进行了半结构化访谈.访谈探讨了参与者对米非司酮用于流产管理和流产的知识和经验，以及临床使用米非司酮的障碍和促进者。访谈由多个研究人员使用归纳和演绎主题编码进行编码。
结果：几乎所有的受访者都认为堕胎相关的污名是使用米非司酮的障碍。受访者通常将污名归因于对米非司酮用于早期妊娠损失的临床使用缺乏了解。米非司酮由于与堕胎有关而被污名化与宗教和政治反对有关。许多受访者还描述了与米索前列醇使用相关的污名。尽管提供者认为米非司酮用于堕胎在他们的实践中不会被接受，大多数人认为，在对米非司酮进行广泛的使用教育后，可以成功地用于流产管理。
结论：在阿拉巴马州的OB-GYN中，米非司酮与流产污名密切相关，这是其用于流产管理的障碍。需要采取干预措施以减少流产污名和米非司酮周围的相关污名，以优化早期妊娠损失护理。
方法：在这项定性研究中，我们在阿拉巴马州对19名管理早期妊娠丢失的OB-GYN进行了半结构化访谈.访谈探讨了参与者对米非司酮用于流产管理和流产的知识和经验，以及临床使用米非司酮的障碍和促进者。访谈由多个研究人员使用归纳和演绎主题编码进行编码。
结果：几乎所有的受访者都认为堕胎相关的污名是使用米非司酮的障碍。受访者通常将污名归因于对米非司酮用于早期妊娠损失的临床使用缺乏了解。米非司酮由于与堕胎有关而被污名化与宗教和政治反对有关。许多受访者还描述了与米索前列醇使用相关的污名。尽管提供者认为米非司酮用于堕胎在他们的实践中不会被接受，大多数人认为，在对米非司酮进行广泛的使用教育后，可以成功地用于流产管理。
结论：在阿拉巴马州的OB-GYN中，米非司酮与流产污名密切相关，这是其用于流产管理的障碍。需要采取干预措施以减少流产污名和米非司酮周围的相关污名，以优化早期妊娠损失护理。
