Only one in 10 patients who received a recent positive pregnancy test reported their reproductive health provider discussed all pregnancy options at clinics in a Southern publicly funded family planning system, researchers noted.1

The patients whose providers mentioned all pregnancy options were more likely to rate their counseling as excellent on all items, compared with patients who did not receive information on all options.

“Our objective was to estimate the association between having providers discuss all pregnancy options, including abortion, adoption, and parenting, and the patient-reported experience with how the counseling session was,” says Katherine Ahrens, PhD, MPH, assistant research professor with the Muskie School of Public Service at the University of Southern Maine.

The researchers found that discussion of all options during pregnancy counseling was associated with a more positive patient experience.

“This was done in the U.S. South, an area of the country where they might have a particular reluctance to talk about abortion, sometimes,” she says. “Even in areas where abortion might be stigmatized, we found that people had a better experience if their provider discussed all pregnancy options, including abortion.”

The findings might surprise some healthcare providers who worry that patients could be offended if they mention abortion or adoption.

“When we looked at these groups separately — the women who were planning to have an abortion and those who were planning on continuing pregnancy, including adoption — each of those groups overall reported better experience with counseling when all three options were discussed,” Ahrens explains.

“We felt this was an important finding to share because in the Southern United States, where our work at Provide is focused, many of the providers we train tell us that they only refer for prenatal care, or that they’ll only offer information about abortion or adoption if the client expresses despair about the pregnancy,” says Kristin Nobel, MPH, senior director of evaluation at Provide Inc. in Round Rock, TX. “Many are afraid they’ll offend their clients if they mention other options. But in our study, which was conducted in the deep South, clients were more satisfied when their provider offered them all their options — particularly when the providers were trained to do this in a way that was professional and supportive.”

In a separate project, researchers conducted 37 interviews of women. Clients told the researchers that they viewed providers as more professional and competent when they offered all options in an unbiased, respectful, and nonjudgmental way, Nobel says.

“One point we feel is important to get across is that because there is cultural stigma around deciding not to parent, clients are often afraid to mention to their provider that they’re considering alternatives,” Nobel explains. “They’re usually willing to forgo information about these alternatives in order to avoid being judged by their provider.”

When providers mention abortion and adoption as options, it takes the burden of potential stigma off the shoulders of the patient. “It allows for a much more honest and effective conversation that will help the client access the care and support services they actually want and need,” Nobel explains. “That’s what we found in our study.”

Patients’ hesitancy to mention abortion or adoption can give providers the impression that their patients are not interested in or do not want to discuss these options.

“Despite the fact that about one in five pregnancies ends in abortion — even in red states and rural areas — providers will say, ‘That’s not an option my clients are interested in,’” Nobel says.

Study findings show that providers can give their patients a better experience by discussing all three options, Ahrens says. Researchers also found that providers who had been recently trained on options counseling were more likely to discuss all three pregnancy options.

“There are resources available to help train your staff to do options counseling in a way that is without bias or judgment,” Ahrens says.

Among the people whose providers did not discuss all three options, 11% indicated in a post-visit survey that they were leaving with an unmet need for abortion referral.

“There will always be some clients who just don’t feel comfortable disclosing an interest in abortion or adoption to their provider,” Nobel adds. “But the percentage of clients leaving without the information they need can be reduced dramatically through client-centered counseling and quality referrals.”

The study used 19 patient-reported experience rating items, including:

  • Gave me the right amount of help;
  • Answered all my questions;
  • Did not make me feel ashamed;
  • Showed me care and compassion;
  • Made sure I had privacy.1

In each of the items, the patients who reported that their provider discussed all pregnancy options rated the item higher than those who said their provider did not discuss all pregnancy options.

“The patient experience is assessing how much patient-centered care was provided,” Ahrens says.

“Rather than taking a highly customized approach, which can be subject to stigma and misunderstandings, offering all options every time helps ensure that all clients have an opportunity to receive the information they are seeking,” Nobel says. “My hope is that this study will reassure providers that most, if not all, clients will ultimately be happier with their experience if they’re offered all their options without bias or judgment.”

REFERENCE

  1. Nobel K, Ahrens K, Handler A, Holt K. Patient-reported experience with discussion of all options during pregnancy options counseling in the US South. Contraception 2021;S0010-7824(21)00368-1.