Decision making and referral prior to abortion: a qualitative study of women's experiences

Kumar, Uday; Baraitser, Paula; Morton, Sheila; Massil, Helen

doi:10.1783/147118904322702009

Cited by 53 publications

(53 citation statements)

References 8 publications

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“…Thus, our findings challenge these laws' implicit characterization of women making abortion decisions-as compared to other healthcare decisions-as particularly conflicted. Our results are also consistent with previous research [10][11][12][13][14] indicating that the majority of women are certain of their decision when they present for abortion care. A unique contribution of our study is that, unlike previous research, we measured decisional certainty using two scales, one of which has been extensively validated and is considered to be the gold standard for measuring this construct across diverse health domains [35], and the other of which was developed by abortion providers explicitly for counseling purposes.…”

Section: Discussionsupporting

confidence: 93%

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Measuring decisional certainty among women seeking abortion

et al. 2017

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STRUCTURED ABSTRACT ObjectiveEvaluating decisional certainty is an important component of medical care, including pre-abortion care.However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy. MethodsEligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews three weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at followup. ResultsFive hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=0.93 and 0.72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses. ConclusionThe DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care.Comparing scores on the DCS in this population to other studies of decision-making suggests that the level of uncertainty in abortion decision-making is comparable to or lower than other health decisions. ImplicationsThe high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling, and ultrasound viewing.

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Section: Discussionsupporting

confidence: 93%

“…Previous research suggests that the majority of women are certain of their abortion decision when they present for care [10][11][12][13][14]. However, minimal research has examined how to effectively measure certainty among women seeking abortion, or how women's certainty about abortion compares to other health decisions.…”

Section: Introductionmentioning

confidence: 99%

Measuring decisional certainty among women seeking abortion

et al. 2017

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“…Rather, gains in certainty are more likely to be related to the information visit than due to waiting. As we reported previously and others have also found, many women reported finding extra waiting time to think as difficult or, at best, not helpful (Kumar, Baraitser, Morton, & Massil, 2004;Roberts et al, 2016).…”

Section: Discussionsupporting

confidence: 65%

Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study

Roberts

Belusa

Turok

et al. 2017

Women's Health Issues

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Purpose: This paper examines how Utah's 72-hour waiting period and two-visit requirement influence women's certainty about their decision to have an abortion.Procedures: This study uses data from a prospective cohort study of 500 women who presented at an abortion information visit at four Utah family planning facilities. At the information visit, participants completed a baseline survey; three weeks later, they completed telephone interviews that assessed their pregnancy outcome, change in certainty, and an open-ended question about factors affecting changes in certainty.Main findings: Two-thirds (63%) reported no change in certainty due to the information visit and three-fourths (74%) reported no change in certainty due to the waiting period. Changes in certainty were primarily in the direction of increased certainty, with more than five times more women reporting an increase (29%) than a decrease (5%) in certainty due to the visit and two times more women reporting an increase (17%) than a decrease (8%) due to waiting. Changes in certainty were concentrated among the minority (8%) who were conflicted about their decision at baseline. Decreases in certainty due to waiting were concentrated among those who became less certain due to the visit. Learning about the procedure, meeting staff, and discovering that the facility was a safe medical environment were main contributors to increased certainty. Conclusion:As changes in certainty were concentrated among the small minority who were conflicted at the information visit and occurred due to the information visit, a universal waiting period does not appear appropriate.

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“…Professional assistance tends to be sought once a decision has been made. 9,16 Delay in obtaining abortion A relatively large proportion of the sample (60%) reported one or more reasons for delay between requesting an abortion and having the procedure. Forty-two per cent waited over two weeks between requesting and obtaining an abortion, whilst 23% waited over three weeksbeyond the minimum time period recommended by the RCOG.…”

Section: Delay In First Asking For Abortionmentioning

confidence: 99%