Factors Shaping Women's Pre-abortion Communication with Their Regular Gynecologic Care Providers

Abstract

Objective To understand women’s experiences communicating with their regular gynecologic care provider about abortion decision-making prior to obtaining an abortion at a dedicated abortion clinic. Study Design Semi-structured interviews were conducted with women presenting for first-trimester surgical abortion at a high volume, hospital-based abortion clinic. Women were asked whether and why they did or did not discuss their abortion decision with their gynecologic care provider. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented. Results Thirty women who obtained an abortion were interviewed. A majority of the twenty-four women who had a regular gynecologic care provider did not discuss their decision with that provider. Themes associated with not discussing their decision included: (1) perceiving that the discussion would not be beneficial (2) expecting that gynecologic care providers do not perform abortions, (3) anticipating or experiencing logistical barriers, and (4) worrying about disrupting the patient-provider relationship. Women who did discuss their decision primarily did so because the pregnancy was diagnosed at the time of a previously scheduled appointment and generally did not believe that their provider performed abortions. Conclusion For many women, seeking counsel from a regular gynecologic provider prior to seeking an abortion may not afford a significant benefit. However, some women express concerns with regard to seeking abortion counselling from their regular provider. These concerns underscore the need for gynecologic providers to foster patient-provider relationships that allow women to feel comfortable discussing all aspects of their reproductive health.

“It's not something you talk about really”: information barriers encountered by women who travel long distances for abortion care

“…Referrals can fall along a spectrum from taking on a passive role to an active, caring one, but a key tenet undergirding best practices in referral behavior is the provision of information in an unbiased manner [24]. Findings from our study and others' [25] indicate that some health care providers are not currently meeting the needs of women who seek abortion-related information.…”

Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it

“…Perhaps she will develop a contra-indication like high blood pressure at age 35. This woman delivered by CS the last time but she was not given the option of a concurrent TO, and the doctor who operated her will rarely hear about her plight, just like there is often no feedback in developed countries [ 115 ].…”

“…Poor multiparae, including immigrants [ 74 , 75 ], for whom LARCs are often also too expensive, or too scary, become the victims of these questionable practices ― their obstetricians and GPs will often not hear about their subsequent visits to abortion clinics or even the backstreets, especially if it involves an immigrant later returned to a country in disarray and perhaps to her 4 children there. [ 76 , 115 ]. To ensure that the decision to offer and, if accepted, to perform a TO during a CS is entirely based on beneficence, a TO during a CS should perhaps not involve extra payment to the obstetrician at all.…”

“…Couples who are very grateful that IVF/ICSI made it possible to have the family they so eagerly wanted tend to be extra disturbed when facing an unintended, completely unexpected (contraception is often thought to be unnecessary), pregnancy when she is 38–49 years old. Such women are regularly seen in abortion clinics but there is seldom feedback to the IVF doctors and to those who saw her antenatally and performed the CS [ 115 ].…”

Should prenatal care providers offer pregnancy options counseling?

“…The pregnancy test visit may be an opportune time to open this discussion, [ 9 ] but many women determine that they are pregnant outside of the health care system using home pregnancy tests. Many choose not to address an unintended pregnancy with their regular gynecologist before seeking abortion [ 10 ]. Furthermore, the availability of counseling varies by provider and setting.…”