Breaking the silence in the primary care office: Discussing abortion at the time of contraceptive counseling
Awarded 2017
Complex Family Planning Fellowship Research
Shokoufeh Dianat, DO
University of California, San Francisco

Background: Abortions are common health experiences in the United States, yet they are siloed from mainstream healthcare on many levels. This siloing both reflects and reproduces the stigma surrounding abortion. The practice of clinicians mentioning abortion during reproductive or preventive health visits has the potential to reduce abortion stigma and facilitate patient care. However, there is little guidance on how to integrate abortion into contraceptive counseling. 
Objective: We sought to understand patient attitudes regarding discussing abortion during contraceptive counseling.
Study design: In 2018, we completed in-depth semi-structured interviews with reproductive-aged women recruited in primary care clinics of two politically disparate regions within California. We elicited acceptability, preferences, and implications of clinicians mentioning abortion during contraceptive counseling. Using directed content analysis, we coded transcripts for inductive and deductive themes. 
Results: We achieved theoretical sufficiency after 49 interviews. Interviewees were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. Mentioning abortion during contraceptive counseling was generally viewed as acceptable, and even helpful, to patients with diverse attitudes about abortion, when delivered in a non-directive manner focused on information provision.  For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making. Careful attention to a non-judgmental communication style is critical to safeguard against potential contraceptive coercion.
Conclusions: Discussing abortion during contraceptive counseling was acceptable among this diverse population, and our findings suggest ways to best structure such counseling. Coupled with research on clinician perspectives, our findings can inform development of patient-centered contraceptive counseling approaches that integrate abortion in an attempt to facilitate patient care and reduce stigma.