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

Abstract Background The influence of factors like attitudes, subjective norms, or perceived behavioral control on physicians’ intention to provide abortion care in Germany is not evaluated so far. We applied the Theory of Planned Behavior to analyzes the role of those factors, and compare providers and non-providers to identify possible barriers to abortion provision amongst physicians. 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, gender 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 abortion providers showed 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 than non-providers. Conclusions Intentions to provide abortion care are influenced by attitudes, subjective norms, and especially perceived behavioral control, indicating a need for targeted interventions addressing those factors to improve intentions to provide abortion care.