Washington Watch: Family planning cited for counseling efforts
Washington Watch: Family planning cited for counseling efforts
By Cynthia Dailard Senior Public Policy Associate The Alan Guttmacher Institute Washington, DC
Without fanfare, the Bush administration has issued an important report to Congress on nondirective pregnancy options counseling in family planning clinics. Specifically, the report sought to assess the extent to which adoption information and referral is provided as part of nondirective counseling in publicly funded clinics.
The report reviews the professional standard of care for counseling pregnant women. It summarizes conversations with nine individuals noted for their expertise in relevant fields and includes interviews with 14 clinicians working in community health centers and/or Title X family planning clinics.
This report was mandated by the "Infant Adoption Awareness Act of 2000." That legislation funds training for family planning providers, including Title X providers, on how to provide adoption information and referral on par with other options in nondirective pregnancy options counseling. Former Rep. Tom Bliley (R-VA), a staunch family planning opponent, authored the law.
Despite the report’s genesis, it is extremely favorable to family planning providers and is likely to put to rest the likelihood that the administration or members of Congress hostile to the Title X program will attempt to revive the domestic family planning gag rule. First and foremost, it acknowledges that nondirective options counseling that includes information about all of a woman’s options, including abortion, is uniformly recognized as the standard of care in federal programs and by professional organizations.
The experts agree
The experts consulted, moreover, were uniform in their understanding of nondirective counseling. They explained that nondirective counseling is more prevalent in federally funded family planning clinics than in the private sector, in part because patient education is more likely to be emphasized by the public sector and because public sector programs are held to high levels of public accountability. They emphasized that Title X providers are trained extensively in this area and that additional Title X funding would help clinics to further enhance their counseling efforts.
At the same time, the experts noted that clinicians sometimes perceive that local adoption agencies are biased against Title X clients: A "shared sentiment [among the experts consulted] was that local adoption agencies have been perceived by clinicians as sending a message to clinics treating poor women — in particular, women of color with high health risks — that their infants are not desirable and that an adoption referral is not warranted," and that some adoption agencies "have been less than enthusiastic about the referrals that come from public clinics."
Clinician interviews confirmed that they receive extensive training in nondirective counseling, which includes training on adoption information and referral. They indicated, however, that most women usually know what they want to do regarding their pregnancy before coming to the clinic. Adoption is not a popular choice among their clients, they explain, in part because adoption is frowned upon by some of the communities served by family planning clinics; children from these cultures tend to be "informally adopted" by a grandparent or other relative. The clinicians suggested that local adoption agencies needed to become more culturally sensitive to the clinic’s patient population. Some clinicians indicated that they would be interested in receiving further information on adoption "to help explain the complicated legal, confidentiality, and family issues related to the adoption process."
The report concludes that federally funded family planning providers "are expected to adhere to the general professional standard, not only as a condition of grant award, but as a basic matter of clinical and professional ethics" and that "infant adoption as part of nondirective counseling to pregnant women is an accepted and adhered-to standard among clinicians at federally funded health clinics." However, it notes that where the adoption agency in a community is perceived as culturally insensitive, "the tendency may be to avoid bringing up the subject" this, the report says, must be addressed in federally funded training programs. Finally, the report says that further research is needed to study clinical settings where there are strong relationships between health providers and adoption agencies, and that such efforts should be replicated.
Without fanfare, the Bush administration has issued an important report to Congress on nondirective pregnancy options counseling in family planning clinics. Specifically, the report sought to assess the extent to which adoption information and referral is provided as part of nondirective counseling in publicly funded clinics.Subscribe Now for Access
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