Counseling and referrals for women with unplanned pregnancies at publicly funded family planning organizations in Texas

Abstract

Objectives: To compare pregnancy options counseling and referral practices at state- and Title X-funded family planning organizations in Texas after enforcement of a policy restricting abortion referrals for providers participating in state-funded programs, which differed from Title X guidelines to provide referrals for services upon request. Study design: Between November 2014 and February 2015, we conducted in-depth interviews with administrators at publicly funded family planning organizations in Texas about how they integrated primary care and family planning services, including pregnancy options counseling and referrals for unplanned pregnancies. We conducted a thematic analysis of transcripts related to organizations’ pregnancy options counseling and referral practices, and compared themes across organizations that did and did not receive Title X funding. Results: Of the 37 organizations with transcript segments on options counseling and referrals, 15 received Title X and 22 relied on state funding only. All Title X-funded organizations but only nine state-funded organizations reported offering pregnancy options counseling. Respondents at state-only-funded organizations often described directing pregnant women exclusively to prenatal care. Regardless of funding source, most organizations provided women a list of agencies offering abortion, adoption and prenatal care. However, some respondents expressed concern that providing other information about abortion would threaten their state funding. In contrast, respondents indicated staff would make appointments for prenatal care, assist with Medicaid applications and, in some instances, directly connect women with adoption-related services. Conclusions: Pregnancy options counseling varied by organizations’ funding guidelines. Additionally, abortion referrals were less common than referrals for other pregnancy-related care. Implications: Programmatic guidelines restricting information on abortion counseling and referrals may adversely affect care for pregnant women at publicly funded family planning organizations.

Factors related to Pregnancy Outcome Among Lebanese Women During COVID-19 Confinement

“…Our results showed that women who visit their physician for routine checkups have a lower probability of unwanted pregnancy. Similarly, previous ndings have shown that providing women with birth control techniques and counseling reduces unplanned pregnancies and abortions (84)(85)(86). A prospective study of 10,000 reproductive-aged women found that structured counseling could improve knowledge and consistent use of contraceptive methods, which lowers the rate of unintended pregnancy, abortion, and births (87).…”

The economics of abortion and its links with stigma: A secondary analysis from a scoping review on the economics of abortion

“…A study participant in Canada explained how their doctor refused to provide care or refer to another facility because it was against the doctor’s beliefs [ 43 ]. Others participants in the United States were unable to get referrals from their doctors to receive abortion services in the hospital, which would have been covered by Medicare (the federal government health coverage program), because of the doctor’s personal beliefs [ 45 ]. Even in cases where providers do not hold personal views against abortion, perceptions of abortion opposition in the community can lead facility staff to withhold information about available services to women [ 45 ].…”

“…Others participants in the United States were unable to get referrals from their doctors to receive abortion services in the hospital, which would have been covered by Medicare (the federal government health coverage program), because of the doctor’s personal beliefs [ 45 ]. Even in cases where providers do not hold personal views against abortion, perceptions of abortion opposition in the community can lead facility staff to withhold information about available services to women [ 45 ]. These findings point to the importance of continuing to investigate how refusals to provide abortion care are defined by providers and communicated to their patients [ 44 ], and to determine the overall economic impact on women and their decisions around care.…”

“…(2) Facility staff and providers may provide inadequate information to individuals regarding public funding for abortion services [ 45 ]. In the United States, confusion regarding state funding and rules regarding abortion can jeopardize that funding and lead to procedural barriers for women [ 45 ]. Facility staff may be reluctant to provide women with information about abortion out of fear that sharing information could threaten their state family planning funding.…”

Pregnancy Options Counseling and Abortion Referral Practices Among Colorado Nurse Practitioners, Nurse‐Midwives, and Physician Assistants

“…In 2019, Title X, a federal grant program funding sexual and reproductive health care, stopped requiring grantees to provide pregnancy options counseling and prohibited clinicians from providing abortion referrals, even at the patient's request 13 . Individual states may also prohibit state‐funded organizations from providing abortion referrals 14 …”