A Qualitative Study of Women's Decision to View or Not View an Ultrasound Image Before Early Medication Abortion

Cappiello, Joyce; Merrell, Joy; Rentschler, Dorothy

doi:10.1016/j.whi.2014.04.004

Cited by 6 publications

(10 citation statements)

References 8 publications

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“…In a study of 20 women interviewed after receiving an ultrasound as part of abortion care, women’s accounts illustrated that ultrasound viewing can cause emotional difficulty for women who plan to terminate their pregnancy [16], but other studies have found that the most common emotional response to ultrasound viewing is a neutral one, with many women reporting that viewing had no impact on them [19]. However, given findings that many women appreciate having the choice whether to view their ultrasound image [17, 20–22], it is unclear if we can generalize from findings on the effects (or lack thereof) of voluntary viewing to settings where viewing is mandatory, such as Wisconsin.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study

et al. 2017

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BackgroundSince mid-2013, Wisconsin abortion providers have been legally required to display and describe pre-abortion ultrasound images. We aimed to understand the impact of this law.MethodsWe used a mixed-methods study design at an abortion facility in Wisconsin. We abstracted data from medical charts one year before the law to one year after and used multivariable models, mediation/moderation analysis, and interrupted time series to assess the impact of the law, viewing, and decision certainty on likelihood of continuing the pregnancy. We conducted in-depth interviews with women in the post-law period about their ultrasound experience and analyzed them using elaborative and modified grounded theory.ResultsA total of 5342 charts were abstracted; 8.7% continued their pregnancies pre-law and 11.2% post-law (p = 0.002). A multivariable model confirmed the law was associated with higher odds of continuing pregnancy (aOR = 1.23, 95% CI: 1.01–1.50). Decision certainty (aOR = 6.39, 95% CI: 4.72–8.64) and having to pay fully out of pocket (aOR = 4.98, 95% CI: 3.86–6.41) were most strongly associated with continuing pregnancy. Ultrasound viewing fully mediated the relationship between the law and continuing pregnancy. Interrupted time series analyses found no significant effect of the law but may have been underpowered to detect such a small effect.Nineteen of twenty-three women interviewed viewed their ultrasound image. Most reported no impact on their abortion decision; five reported a temporary emotional impact or increased certainty about choosing abortion. Two women reported that viewing helped them decide to continue the pregnancy; both also described preexisting decision uncertainty.ConclusionsThis law caused an increase in viewing rates and a statistically significant but small increase in continuing pregnancy rates. However, the majority of women were certain of their abortion decision and the law did not change their decision. Other factors were more significant in women’s decision-making, suggesting evaluations of restrictive laws should take account of the broader social environment.

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Section: Introductionmentioning

confidence: 99%

Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study

et al. 2017

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“…The variety of PCV approaches described in this studyincluding who is trained to show tissue, when and where viewing occurs, and how viewing benefits patients and staffdemonstrates that independent providers have long developed practices that best fit their missions, clinic resources, and patient needs. Understanding PCV as a component of quality, patient-centred abortion care echoes prior work on tissue viewing following surgical abortion, miscarriage, stillbirth, or termination for fetal anomaly, 7,15,33 as well as preabortion ultrasound image viewing, [4][5][6] where patients express appreciation for the option to view, regardless of whether they end up viewing or not. Abortion providers in this study elaborated that PCV options promote access to information, freedom of choice, and the exercising of rights, which aligns with independent clinics' historic patient-centred and stigma-fighting frameworks.…”

Section: Discussionmentioning

confidence: 92%

“…Some (31%) of the clinics that provide PCV specified that offering this service benefits staff. Patientoriented staff benefits include honouring requests and being able to assure the patient that the By patient request 5 (31) No answer 1 (6) abortion is complete; provider-centred benefits include connecting staff with the reality of abortion care, strengthening their commitment to abortion work, and helping them practice empathy for patients. Half of the administrators mentioned barriers to facilitating PCV, including the resources needed to appropriately train staff, concern about adverse patient emotions, staff discomfort with tissue, and some staff not understanding why a patient would request to view tissue.…”

Section: Staff Training and Comfortmentioning

confidence: 99%

“…This connects with administrators' survey responses where benefits of PCV included honouring patient requests and assuring the patient that the abortion is complete. Emma contextualised tissue viewing and abortion as on a continuum of pregnancy experiences: Multiple support outlets 2 (13) No policy 2 (13) No answer 1 (6) "Many women don't get to have closure around their abortion experience. It's the same as women who have miscarriages, they need to have closure.…”

Section: Interviewsmentioning

confidence: 99%

“…Studies that have explored patient preferences for viewing fetal images in pre-abortion ultrasounds found that patients appreciate the choice to see their ultrasounds in non-mandated settings and that viewing could help with decision-making and satisfying curiosity. [4][5][6] In pregnancy loss *Embryonic and fetal tissues are often referred to as "products of conception" (POC) in medical settings. 1 Language used to refer to POC varies by provider as well as scholar.…”

Section: Introductionmentioning

confidence: 99%

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The option to look: patient-centred pregnancy tissue viewing at independent abortion clinics in the United States

Hann

Becker

2020

Sexual and Reproductive Health Matters

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Abortion providers' approaches to patient-centred pregnancy tissue viewing (PCV)when a patient requests to see their products of conceptionis understudied in abortion care. This mixed-method study aimed to identify: (1) if, when, and how PCV is facilitated at US independent abortion clinics; (2) how staff are trained to offer viewing; and (3) provider experiences facilitating PCV. We surveyed administrators from 22 independent abortion clinics affiliated with the Abortion Care Network about their PCV practices and then completed in-depth semi-structured interviews with 25 providers to better understand their experiences facilitating PCV. Results indicate that most of the clinics that provide PCV do so by patient request. A variety of providers facilitate viewing, including counsellors, educators, physicians, nurses, and medical assistants. Timing, viewing location, and staff training vary by facility. Benefits of and barriers to PCV emerged through three themes: (1) patient-centred care;(2) misinformation about fetal tissue; and (3) personal navigations as providers. Providers and administrators report PCV aligns with their patient-centred clinic missions and offers patients opportunities for choice, closure, and access to information. Yet, anti-abortion misinformation about fetal tissue impacts the ways providers must navigate complex conversations about PCV professionally and personally. Clinic resources and concern about adverse patient reactions to identifiable fetal parts present barriers to offering viewing. Understanding providers' experiences and approaches to PCV is an important first step to developing quality practices that can be shared across clinics. The findings of this study support the need for more research and training on PCV in abortion care.

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Women's experiences of facility-based abortion care: A WHO qualitative evidence synthesis

Ganatra,

Sorhaindo,

Cleeve

et al. 2025

Social Science & Medicine

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A Qualitative Study of Women's Decision to View or Not View an Ultrasound Image Before Early Medication Abortion

Cited by 6 publications

References 8 publications

Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study

Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study

The option to look: patient-centred pregnancy tissue viewing at independent abortion clinics in the United States

Women's experiences of facility-based abortion care: A WHO qualitative evidence synthesis

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