Variation in Pregnancy Options Counseling and Referrals, And Reported Proximity to Abortion Services, Among Publicly Funded Family Planning Facilities

Hebert, Luciana E.; Fabiyi, Camille; Hasselbacher, Lee; Starr, Katherine; Gilliam, Melissa

doi:10.1363/48e8816

Cited by 23 publications

(12 citation statements)

References 21 publications

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“…These results also support others’ findings that most organizations provide a list of agencies that offer abortion, adoption services, and prenatal care, but that abortion referrals infrequently extend beyond giving women providers’ names and contact information [11,16]. However, unlike these studies, our interviews captured how abortion referrals differed from other pregnancy-related referrals, particularly prenatal care.…”

Section: Discussionsupporting

confidence: 83%

“…While respondents in our study rarely mentioned informing women about how they might cover the cost of abortion care or locations where different abortions methods were offered, they were willing to facilitate women’s access to prenatal care. This difference may reflect that providers know less about abortion than prenatal services or do not feel comfortable discussing abortion [11,16,17]. Despite none of our respondents expressing personal views opposing abortion, their perceptions of anti-abortion sentiment in the community may have contributed to staff reluctance to provide women with more information about available services.…”

Section: Discussionmentioning

confidence: 93%

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Counseling and referrals for women with unplanned pregnancies at publicly funded family planning organizations in Texas

2019

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Objectives: To compare pregnancy options counseling and referral practices at state- and Title X-funded family planning organizations in Texas after enforcement of a policy restricting abortion referrals for providers participating in state-funded programs, which differed from Title X guidelines to provide referrals for services upon request. Study design: Between November 2014 and February 2015, we conducted in-depth interviews with administrators at publicly funded family planning organizations in Texas about how they integrated primary care and family planning services, including pregnancy options counseling and referrals for unplanned pregnancies. We conducted a thematic analysis of transcripts related to organizations’ pregnancy options counseling and referral practices, and compared themes across organizations that did and did not receive Title X funding. Results: Of the 37 organizations with transcript segments on options counseling and referrals, 15 received Title X and 22 relied on state funding only. All Title X-funded organizations but only nine state-funded organizations reported offering pregnancy options counseling. Respondents at state-only-funded organizations often described directing pregnant women exclusively to prenatal care. Regardless of funding source, most organizations provided women a list of agencies offering abortion, adoption and prenatal care. However, some respondents expressed concern that providing other information about abortion would threaten their state funding. In contrast, respondents indicated staff would make appointments for prenatal care, assist with Medicaid applications and, in some instances, directly connect women with adoption-related services. Conclusions: Pregnancy options counseling varied by organizations’ funding guidelines. Additionally, abortion referrals were less common than referrals for other pregnancy-related care. Implications: Programmatic guidelines restricting information on abortion counseling and referrals may adversely affect care for pregnant women at publicly funded family planning organizations.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 93%

Counseling and referrals for women with unplanned pregnancies at publicly funded family planning organizations in Texas

2019

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“…OB/GYNs especially, whom many women perceive to be a key source of information on reproductive-related health issues, are uniquely wellpositioned to provide unbiased and accurate resources and referrals for abortion care. However, referrals from staff at publicly funded family planning clinics are an important complement to physician referrals, especially in rural areas [23]. Referrals can fall along a spectrum from taking on a passive role to an active, caring one, but a key tenet undergirding best practices in referral behavior is the provision of information in an unbiased manner [24].…”

Section: Discussionmentioning

confidence: 99%

“It's not something you talk about really”: information barriers encountered by women who travel long distances for abortion care

2019

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For individuals traveling significant distances for time-sensitive abortion care, accurate information about service options and locations is critical, but little is known regarding information barriers that individuals may encounter and strategies for circumventing these barriers. Study design: In early 2015, we conducted in-depth interviews with 29 patients who had traveled for abortion care at six facilities in Michigan and New Mexico. We identified information-related barriers that respondents encountered in understanding their pregnancy options and/or where to obtain an abortion between the time of pregnancy discovery, including any contact with a crisis pregnancy center, to the day of the abortion procedure through inductive and deductive analysis. Results: We identified two logistical information-related barriersa general lack of reproductive-related knowledge and unhelpfulness on the part of perceived members of the healthcare communityand one broader barrier of perceived stigma within respondents' narratives. Of the seven respondents who did not encounter a logistical information-related barrier, having previous personal or close experience with abortion and internet savviness were both identified as strategies enabling them to circumvent the barriers. Conclusion: Lack of clear, easy-to-find and accurate information about abortion services and availability represents a key barrier to obtaining an abortion; health care providers play a crucial role in ensuring pregnant patients' right to informed consent within reproductive health care delivery. Implications: Women's health care providers should provide their patients with the full spectrum of resources and referrals for pregnancy and abortion care; recent federal guidelines proposing to restrict abortion counseling and referral at Title X-funded facilities would only exacerbate the current challenges that pregnant patients encounter when seeking abortion-related information and further decrease linkages to timely, desired abortion care.

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“…A growing evidence base on abortion referral-making suggests deficiencies in clinicians’ practice (Dodge et al 2012 ; French et al 2015 ; Hebert et al 2016 ; Holt et al 2017 ; Homaifar et al 2017 ). A recent national population-based survey of almost 800 primary care physicians (PCPs) revealed that 43% of family medicine and general internal medicine physicians reported seeing women seeking abortion (Holt et al 2017 ).…”

Section: Introductionmentioning

confidence: 99%

“…Another study found that, when prompted for a referral by a mystery client over the phone, only about half of staff working in reproductive health facilities that do not provide abortion provided a direct referral (defined as providing the name or telephone number of a facility that provided abortion services) (Dodge et al 2012 ). A survey of publicly-funded family planning services in 16 states found that significantly fewer providers offer abortion referrals compared to adoption referrals (Hebert et al 2016 ) and a survey in Nebraska of family medicine physicians and other clinicians found that providers were much less likely to say they would provide abortion referrals compared to other pregnancy related services (French et al 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Training for Health and Social Service Providers on Abortion Referral-Making

O'Donnell¹,

Holt

Nobel³

et al. 2018

Matern Child Health J

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Purpose Engaging trusted care providers and empowering them with information and skills about abortion is a critical opportunity to improve coordination of care for women seeking abortion, if and when these services are needed. Description Provide, a nonprofit that works in partnership with health and social service providers to build a health system that is equipped to respond to women’s health care needs around abortion, launched a referrals training program in 2013. To assess the effectiveness of this training program, we conducted an evaluation of satisfaction with training and the impact of the intervention on provider knowledge of safety of abortion, self-efficacy to provide abortion referrals, and intention to provide pregnancy options counseling and referrals in the future. Assessment Approximately 90% of participants were “very satisfied” with their training experience. Results show significant increase in intention to provide non-judgmental pregnancy options counseling and referrals for abortion care after participants went through training. Post-training, significantly more reported that they would present all pregnancy options without judgment or bias (94 vs. 82%, p < .0001), provide a referral for abortion care if needed (80 vs. 50%, p < .0001), and follow-up with the client (71 vs. 39%, p < .0001). Further, more also reported they would refer a client for prenatal care if the client requested it (78 vs. 67%, p < .0001). Conclusion Our results suggest that abortion referrals training hold potential to build the capacity of health and social service providers’ ability to meet client needs related to pregnancy and could be implemented at a larger scale.

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Variation in Pregnancy Options Counseling and Referrals, And Reported Proximity to Abortion Services, Among Publicly Funded Family Planning Facilities

Abstract: A better understanding of disparities in provision of pregnancy options counseling and referrals at publicly funded family planning clinics is needed to ensure that women get timely care.

Cited by 23 publications

References 21 publications

Counseling and referrals for women with unplanned pregnancies at publicly funded family planning organizations in Texas

Counseling and referrals for women with unplanned pregnancies at publicly funded family planning organizations in Texas

“It's not something you talk about really”: information barriers encountered by women who travel long distances for abortion care

Evaluation of a Training for Health and Social Service Providers on Abortion Referral-Making

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