Should prenatal care providers offer pregnancy options counseling?

Healthcare providers can play an important role in making sure people have everything they need to make informed decisions about pregnancy. Options counseling is an opportunity to consider, along with a provider, whether a person wants to continue a pregnancy and parent, make a plan for adoption or terminate a pregnancy.

There is little research on people’s views on pregnancy options counseling, and it hasn’t been widely explored outside of the abortion care context. Researchers from ANSIRH talked to women seeking prenatal care in Louisiana and Maryland to look at whether options counseling could be a beneficial part of early prenatal care.

As they entered prenatal care, nearly all the women interviewed said their preferred outcome for their pregnancy was to give birth and raise the child. About one-third of women had considered abortion at some point during the pregnancy. At the time of interview, 2%preferred adoption and 1% preferred abortion.

Most women were certain of their decision at the time of their prenatal visit. However, three percent of the women had low certainty, indicating that options counseling could be helpful. In addition, nine percent of women said that they would be interested in discussing their pregnancy options with their prenatal care provider. Women who preferred adoption or abortion were more likely to want to talk about options.

While most women weren’t interested in discussing their pregnancy options as they entered prenatal care, the vast majority agreed that it would be OK for their provider to ask if their pregnancy was planned (88%) and if they had considered abortion (81%). Nearly all women – more than 95% -- said they would answer honestly if their provider asked them about these topics.

Women who reported dealing with food insecurity were 3 times as likely to report uncertainty about their pregnancy decision and 5 times as likely to want options counseling. This makes clear how women’s broader circumstances play a role in pregnancy decision-making and outcomes.

The finding that most women are certain of their decision to continue pregnancy at their first prenatal care visit mirrors research showing that most women are certain when seeking abortion care. However, there is a subset of people who are uncertain and would benefit from further counseling with a provider.

Options counseling is more than explaining 3 basic options—it includes a comprehensive discussion of how to best provide support a person to reach their desired pregnancy outcome. There’s still a question of how to identify people who are most in need of support and make sure they’re connected with services. Screening tools and/or probing questions are needed to support prenatal care providers in identifying these people and ensuring unbiased, non-directed counseling on all pregnancy options.