Patient-reported experience with discussion of all options during pregnancy options counseling in the US South

Nobel, Kristin; Ahrens, Katherine A.; Handler, Amy; Holt, Kelsey

doi:10.1016/j.contraception.2021.08.010

Cited by 7 publications

(9 citation statements)

References 28 publications

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“…Although the stigma of not intending to pursue parenthood can prevent patients from disclosing that intention, 36–38 available research indicates that patients are open to discussing their pregnancy intentions with their provider 16 and would answer honestly if asked 8 . Discussion of all options during pregnancy options counseling was associated with a more positive patient experience in prior research 23 . However, unpublished program evaluation data indicates that many providers prefer not to discuss alternatives to parenting unless a patient “expresses despair” about pregnancy.…”

Section: Discussionmentioning

confidence: 98%

“…Studies suggest that non‐comprehensive pregnancy options counseling favors counseling around continuing pregnancy over abortion counseling. 22 , 23 Such pregnancy options counseling bias can coerce patients into continuing pregnancy, and may in turn lead them to face downstream maternal and infant mortality risks. 21 , 24 , 25 Inadequate counseling at the point of initial pregnancy confirmation may also play a role in further reducing patients' trust in medical systems, with implications for pregnancy care and beyond.…”

Section: Introductionmentioning

confidence: 99%

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Racial disparities in pregnancy options counseling and referral in the US South

Nobel¹,

Luke

Rice

2022

Health Services Research

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Objective: The objective of this study is to examine racial variation in receipt of counseling and referral for pregnancy options (abortion, adoption, and parenting) following pregnancy confirmation. Equitable offering of such information is a professional and ethical obligation and an opportunity to prevent racial disparities in maternal and child health.Data Source: Primary data from patients at southern United States publicly funded family planning clinics, October 2018-June 2019.Study Design: Patients at 14 clinics completed a survey about their experiences with pregnancy options counseling and referral following a positive pregnancy test. The primary predictor variable was patients' self-reported racial identity. Outcomes included discussion of pregnancy options, referral for those options, and for support services.Data Collection: Data from eligible patients with non-missing information for key variables (n = 313) were analyzed using descriptive statistics, χ 2 tests, and multivariable logistic regression.Principal Findings: Patients were largely Black (58%), uninsured (64%), and 18-29 years of age (80%). Intention to continue pregnancy and receipt of prenatal care referral did not differ significantly among Black as compared to non-Black patients.However, Black patients had a higher likelihood of wanting an abortion or adoption referral and not receiving one (abortion: marginal effect [ME] = 7.68%, p = 0.037; adjusted ME [aME] = 9.02%, p = 0.015; adoption: ME = 7.06%, p = 0.031; aME = 8.42%, p = 0.011). Black patients intending to end their pregnancies had a lower probability of receiving an abortion referral than non-Black patients (ME = À22.37%, p = 0.004; aME = À19.69%, p = 0.023). In the fully adjusted model, Black patients also had a higher probability of wanting access to care resources (including transportation, childcare, and financial support) and not receiving them (aME = 5.38%, p = 0.019).Conclusions: Clinical interactions surrounding pregnancy confirmation provide critical opportunities to discuss options, coordinate care, and mitigate risk, yet are susceptible to systemic bias. These findings add to limited evidence around pregnancy

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Racial disparities in pregnancy options counseling and referral in the US South

Nobel¹,

Luke

Rice

2022

Health Services Research

Self Cite

View full text Add to dashboard Cite

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“…Patient preferences for pregnancy options counseling do not always match the provider's perspective and the counseling provided [6 ▪ ]. This is evident in studies showing that many providers refer their patients only to prenatal care [20] and often do not discuss or refer for abortion services [15,21].…”

Section: The Patient Perspcectivementioning

confidence: 99%

“…In a study looking at patient experiences with pregnancy options counseling, 10% of patients reported that their provider discussed all options, which included abortion, adoption, and parenting. Providers who discussed all options were more likely to have received options counseling training [6 ▪ ]. Implementation of pregnancy options counseling education and training sessions could improve pregnancy options counseling and increase the frequency of abortion referrals amongst providers who were previously reluctant or opposed to this counseling.…”

Section: Variations In Pregnancy Options Counselingmentioning

confidence: 99%

“…The lack of appropriate pregnancy options counseling has also been shown to effect patient's healthcare experiences. A study conducted in the US south aimed to evaluate the association between comprehensive pregnancy options counseling, which includes a discussion of abortion, adoption, and parenting, and patient reported experience with counseling [6 ▪ ]. Patients expressed a desire for supportive and nondirective counseling on all pregnancy options.…”

Section: The Patient Perspcectivementioning

confidence: 99%

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Pregnancy options counseling

Owens¹,

Shorter²

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of ReviewThis article reviews key aspects of pregnancy options counseling, and highlights how inappropriate counseling can create barriers to timely and safe abortion care.Recent FindingsAccess to safe abortion services in the United States is increasingly constrained. One way to combat this hostile environment is to ensure that individuals presenting for care early in pregnancy have access to comprehensive and unbiased pregnancy options counseling. There are unfortunately many barriers to individuals receiving adequate pregnancy options counseling, and marginalized groups experience disproportionate effects of inappropriate counseling. Research shows that individuals desire appropriate pregnancy options counseling when seeking early pregnancy care, and that providers often serve as a barrier to this care. Provider miseducation and opposition to pregnancy options counseling, particularly as it concerns abortion care, creates challenges and delays for people seeking abortion services. Crisis Pregnancy Centers use misinformation to further these barriers to appropriate care.SummaryNondirective and patient-centered pregnancy options counseling is standard of care. People seeking pregnancy options counseling desire and deserve comprehensive and accurate information. Providers must not serve as barriers to safe and appropriate care. Increasing nondirective pregnancy options counseling research, education, and training is crucial to ensuring access to safe and appropriate abortion care.

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Neighborhood deprivation is not associated with abortion consideration or completion in patients with fetal myelomeningocele

Papastefan,

Bian,

Singh

et al. 2024

Prenatal Diagnosis

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ObjectiveThe objective of this study was to evaluate whether patient‐level neighborhood deprivation index (NDI) was associated with termination of pregnancy consideration and completion in patients presenting with fetal myelomeningocele.MethodsThis was a retrospective cohort analysis of patients with fetal myelomeningocele presenting to a fetal treatment center (FTC) in Illinois between 2018 and 2024. The exposure was NDI calculated from patient zip codes. The NDI was analyzed as both a dichotomous and ordinal exposure. The co‐primary outcomes were abortion consideration prior to FTC consultation, ascertained by nurse intake, and abortion completion after consultation. Bivariate and log‐binomial regression analyses were performed. Covariates were selected based on p < 0.10 on bivariate analyses. Otherwise, p < 0.05 indicated statistical significance.ResultsA total of 157 participants were included. Evaluation of neighborhood deprivation as a dichotomous exposure revealed no association with abortion consideration or completion. AdditionallLy, no association was found on log binomial modeling after controlling for gestational age at presentation to the FTC and maternal race or ethnicity for abortion consideration (aRR 0.87, 95% CI 0.59–1.28) or completion (aRR 0.86, 95% CI 0.59–1.28). These results were similar when treating the NDI as an ordinal exposure.ConclusionsContrary to our hypothesis, NDI is not associated with abortion consideration or completion in patients with fetal myelomeningocele.

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Patient-reported experience with discussion of all options during pregnancy options counseling in the US South

Cited by 7 publications

References 28 publications

Racial disparities in pregnancy options counseling and referral in the US South

Racial disparities in pregnancy options counseling and referral in the US South

Pregnancy options counseling

Neighborhood deprivation is not associated with abortion consideration or completion in patients with fetal myelomeningocele

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