How patients feel about discussing abortion during contraceptive counseling

Abortions are a very common health experience in the United States, with about one in four women experiencing abortion in their lifetime. However, abortion is set apart from the rest of health care in several ways—often physically separate from where people get other gynecological care—and is highly stigmatized. This stigmatization can impact whether people can access high quality information about abortion. One way to reduce stigmatization is to integrate the topic of abortion into other reproductive health visits, such as contraceptive counseling.

New research from Bixby members sought to understand how such conversations might destigmatize abortion and improve patient experiences. Researchers interviewed women about their attitudes towards discussing abortion during contraceptive counseling appointments in primary care offices. The women interviewed were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. 

A majority of women reported that having abortion mentioned during contraceptive counseling would be acceptable and even helpful. This didn’t depend on their opinions on the legality of abortion. Women who believed abortion should be illegal also felt that providers should talk to their patients about all options. As a whole, the women interviewed felt that it is important and helpful to receive accurate information about abortion from healthcare providers. They also felt that mentioning abortion normalizes healthcare conversations about abortion. One participant noted that, “it would make people more comfortable in the topic…stating that abortion is in there, it releases more tension towards that term.” The few women who found it unacceptable to mention abortion during contraceptive counseling said that the topic was irrelevant or unnecessary.

The majority of those interviewed also stressed the importance of non-judgmental and non-directive communication in such counseling practices. The counseling approaches found to be the most acceptable and helpful did the following:

  • Included discussion of abortion as an option if contraception were to fail,
  • Described that some women consider their feelings about pregnancy management options when considering contraceptive method effectiveness, and
  • First addressed contraceptive options rather than pregnancy management options, in order to center the patient’s presenting needs.

While these counseling methods may reduce abortion stigma and help contraceptive decision-making for some patients, there is also a concern that they could introduce coercion toward the most highly effective methods because of the emphasis on potential method failure. The concern for coercion must be considered in light of policies and provider practices in the United States that have violated the autonomy of women of color and poor women and devalued their desire to parent. Providers must pay careful attention to their communication style and phrasing as well as their implicit biases.

Creating standardized practices may help to reduce biases that could otherwise promote coercion and inequity in these counseling dialogues; however, flexibility is also needed to best incorporate patients’ particular needs.