Exploring the clinicians’ self-perceived role in contraceptive counseling at the time of abortion
Abortion, Contraception
Awarded 2018
Complex Family Planning Fellowship Research
Rachel Cannon, MD
Boston Medical Center

Background: Contraceptive counseling at the time of abortion is a typical practice for many abortion providers due to the perception that women are highly motivated to use contraception at this time. When asked, nearly 2/3 of women do not want to discuss birth control at the time of abortion. In addition, some women perceive pressure to choose contraception as. Given women’s varying preferences at the time of abortion with regards to counseling and the concerning findings that some women perceive pressure from their providers during counseling at the time of abortion, it is imperative to determine how providers themselves fit into this scenario. We conducted a  study  to explore how abortion providers conceptualize their role in contraceptive counseling at the time of abortion and identify clinician behaviors that may lead to patients’ perceptions of coercion.
Methodology: We performed one on one  interviews with physicians. Interview questions asked about attitudes and practices during contraceptive counseling at the time of abortion. All interviews were recorded and analyzed by two researchers. Ideas reported by participants were categorized into themes.
Important Findings: We interviewed 39 participants across the US, who primarily self-reported as white females, aged 25-44, and practicing OBGYN. Just over half of participants practiced in an academic setting and had Family Planning Fellowship training. Participants defined their role in contraceptive counseling as clarifying medical information, reviewing all contraceptive options, and taking a patient-centered approach. These roles contradicted participants’ disclosure of  a goal to reduce a subsequent abortion.  We identified multiple motivations behind this goal. Some participants who worked in hostile abortion states did not want their patients to undergo the challenges of obtaining an abortion, let alone multiple times.  Other participants, despite their stated efforts to remain patient-centered, continue to have discomfort with abortion and would like to prevent a repeat abortion in their patients via contraception uptake. Prevention of repeat abortion manifested as a preference toward the most effective birth control methods (IUD and implant) when counseling about contraception, and a particular focus on contraception provision for women with prior abortions and adolescents.
Summary Statement : Abortion providers want to take a patient-centered approach to contraceptive counseling at the time of abortion. However, many abortion providers continue to be motivated by the goal of reducing unintended pregnancy and subsequent abortion. This contradicts their stated goal of respecting a patient’s choice whether or not use contraception, and may perpetuate abortion stigma. Recognizing this that biases and sigma may lead to coercive practices; abortion providers must examine their own practices and motivations as well as employ less coercive counseling strategies.