Access Bridge Fellowship Increases Access to Life-Saving Reproductive Health Care through Emergency Departments

Emergency department (ED) clinicians have traditionally received minimal training in reproductive healthcare. This lack of training, coupled with legal uncertainties surrounding reproductive care, can lead to hesitation in providing even basic services. This is particularly concerning considering nearly one million people visit EDs annually with pregnancy-related complications and other reproductive needs. Existing racial and socioeconomic disparities also mean people of color often face greater barriers in addressing this essential care.

PHI’s Access Bridge fills critical gaps in reproductive health care in EDs across the United States, helping to improve access to evidence-based reproductive health services and increase health equity by building the capacity of EDs to serve as reproductive health safety nets, focusing on communities with limited access.

In 2023, Access Bridge launched a fellowship with 22 clinicians working in 19 hospitals across 13 states, providing fellows with tools, resources and support to implement core reproductive health services in their EDs. Fellows are located throughout the country, in the following locations:

1. Four states with reproductive health care restrictions: Florida, Indiana, Ohio and Texas.
2. Five states where demographic, geographic or political realities threaten access to reproductive health care: Iowa, Maine, Michigan, Minnesota, and Pennsylvania.
3. Four states with progressive policies that enable the program to expand the vision for this work: California, New Jersey, New York, and Washington.

Access Bridge fellows receive training on how to build culture change in their EDs through facilitated virtual meetings, peer-to-peer expert coaching and comprehensive resource-sharing. Topics included Miscarriage management; EC counseling and provision; Contraception 101; Role of Community Health Workers (CHWs) in Contraception and Preconception Counseling; and Medication abortion in the ED.

Impact at Six Months: Changing ED Culture & Capacity

In the first six months of the yearlong program, fellows and hospitals reported the following impacts:

• 18 out of 19 hospitals have at least one drug for miscarriage management, mifepristone and/or misoprostol available at their hospital. They are working on integrating their provision for miscarriage (early pregnancy loss) into ED workflows (an increase of five hospitals from a baseline of 13).
• 13 out of 19 hospitals have at least one drug for emergency contraception, Ella and/or Plan B available at their hospital. Physicians from the remaining five hospitals are working to connect with their respective pharmacies and OB/GYNs to move forward with an emergency contraception provision.
• 10 out of 19 hospitals have at least one prescription contraception option (pills, patches, or rings) available to prescribe to patients.

Fellows also reported that Access Bridge trainings, meetings and grand round slides are essential components of their education through the program.

• 21 out of 22 physician fellows reported the fellowship meetings are “extremely useful” to them.
• 19 out of 22 physician fellows reported that sample slide decks were “extremely useful” to them, highlighting that training on reproductive health topics in emergency medicine is historically inadequate, so physicians need help building clinical expertise; and grand round training slide decks are critical for physicians, especially in abortion-restricted and banned states where making the case for drugs like mifepristone is important for achieving buy-in—and having on-demand teaching resources is invaluable.

Fellows are interested in addressing additional complex topics through the fellowship:

• 8 out of 19 physicians expressed interest in learning how to offer medication abortions in their respective EDs.
• 4 out of 19 physicians expressed interest in learning more about managing ectopic pregnancies in their respective EDs.