The experiences and adaptations of abortion providers practicing under a new TRAP law: a qualitative study

Abstract

OBJECTIVE Abortion laws are proliferating in the United States, but little is known about their impact on abortion providers. In 2011, North Carolina instituted the Woman’s Right to Know (WRTK) Act, which mandates a 24-hour waiting period and counseling with state-prescribed information prior to abortion. We performed a qualitative study to explore the experiences of abortion providers practicing under this law. STUDY DESIGN We conducted semi-structured interviews with 31 abortion providers (17 physicians, 9 nurses, 1 physician assistant, 1 counselor, and 3 clinic administrators) in North Carolina. Interviews were audio-recorded and transcribed. Interview transcripts were analyzed using a grounded theory approach. We identified emergent themes, coded all transcripts, and developed a thematic framework. RESULTS Two major themes define provider experiences with the WRTK law: provider objections / challenges and provider adaptations. Most providers described the law in negative terms, though providers varied in the extent to which they were affected. Many providers described extensive alterations in clinic practices to balance compliance with minimization of burdens for patients. Providers indicated that biased language and inappropriate content in counseling can negatively impact the patient-physician relationship by interfering with trust and rapport. Most providers developed verbal strategies to mitigate the emotional impacts for patients. CONCLUSIONS Abortion providers in North Carolina perceive WRTK to have a negative impact on their clinical practice. Compliance is burdensome, and providers perceive potential harm to patients. The overall impact of WRTK is shaped by interaction between the requirements of the law and the adaptations providers make in order to comply with the law while continuing to provide comprehensive abortion care.

Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States

“…While other studies have focused on evaluating the impact of one restriction of abortion care (or a group of restrictions in one local context), ours sought to capture the impact of restrictive environments more generally. For example, we did not measure the incidence or impact of traveling to obtain abortion care in order to avoid a waiting period law in a given state, but instead documented the effects of waiting periods in the context of the many other barriers that women face.…”

TRAP laws and the invisible labor of US abortion providers

“…Interviews covered topics including the provider’s professional history, current practice characteristics, personal experiences in providing care under the law, perceptions of how the law affected their patients and how their practice had adapted to comply. Our detailed methodology and a summary of our findings have been described elsewhere (Mercier et al 2015). …”

Pathways to Abortion at a Tertiary Care Hospital: Examining Obesity and Delays

“…This study did not examine the potential effects of expanding restrictions on referral patterns. Targeted regulations of abortion providers have been reported as a source of provider stress, including a sense of increased scrutiny . It is possible that this perception could lead to increased risk aversion among providers.…”