Barriers and motivations: Analyzing the factors influencing abortion provision by gynecologists in Germany – a cross- sectional study

BACKGROUND The number of abortion providers in Germany has declined significantly in recent decades. We used the Theory of Planned Behavior (TPB) as a model to explain variance of physicians’ intentions to provide abortions and explored possible influencing factors on abortion provision in Germany. METHODS A cross-sectional online survey was conducted between June and November 2024 among office-based gynecologists and abortion providers of all specialties, recruited via cluster sampling. The survey assessed a range of factors influencing the provision of abortion, including attitudes, subjective norms, perceived behavioral control, religiosity, fear of stigmatization and knowledge. Multiple regression analysis tested the TPB model, abortion providers and non-providers were compared via t-tests. RESULTS N = 213 participants completed the survey. Perceived behavioral control (β = 0,479, p < 0,001) explained the most variance in behavioral intention to provide abortions, followed by subjective norms (β = 0,326, p < 0,001) and attitudes (β = 0,136, p = 0,010). The group comparisons between abortion providers and non-providers revealed that providing abortions is associated with more positive attitudes towards abortions, stronger perceived subjective norms on providing abortions, higher perceived behavioral control of providing abortions, lower fear of stigmatization, lower religiosity and higher subjective knowledge on abortions and legal regulations. CONCLUSIONS The TPB effectively explains variance in abortion provision. The differences between providers and non-providers indicate possible barriers to abortion provision. Improving access to abortion services require structural changes that promote abortion training, social acceptance and institutional support to ensure physicians feel safe and accepted to offer abortion services.