Abortion referral-making in the United States: findings and recommendations from the abortion referrals learning community.

In recent years, reproductive health researchers and practitioners have increased their focus on abortion referrals as an overlooked component of access. March 2019 proposed changes to the regulation of publicly funded family planning services that severely restrict abortion referrals have heightened public attention. In October 2017, Provide, Inc. convened researchers and practitioners to assess our knowledge of abortion referral and make recommendations for future research. We found that existing literature on abortion referral is limited and may overlook important outcomes as well as variations in patient experiences by age, race, income, and other attributes. Recommendations include more robust attention to patient experiences and research that assesses a broad range of referral-making practices and outcomes, with specific attention to vulnerable populations and to referral quality and the distinction between appropriate and inappropriate referral.

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

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.

Women's Pathways to Abortion Care in South Carolina: A Qualitative Study of Obstacles and Supports.

CONTEXT: Women seeking timely and affordable abortion care may face myriad challenges, including high out-of-pocket costs, transportation demands, scheduling difficulties and stigma. State-level regulations may exacerbate these burdens and impede women's access to a full range of care. Women's reports of their experiences can inform efforts to improve pathways to abortion care. METHODS: In 2014, semistructured qualitative interviews were conducted with 45 women obtaining abortions in South Carolina, which has a restrictive abortion environment. Interviews elicited information about women's pathways to abortion, including how they learned about and obtained care, whether they received professional referrals, and the supports and obstacles they experienced. Transcripts were examined using thematic analysis to identify key themes along the pathways, and a process map was constructed to depict women's experiences. RESULTS: Twenty participants reported having had contact with a health professional or crisis pregnancy center staff for pregnancy confirmation, and seven of them received an abortion referral. Women located abortion clinics through online searches, previous experience, and friends or family. Financial strain was the most frequently cited obstacle, followed by transportation challenges. Women reported experiencing emotional strain, stress and stigma, and described the value of receiving social support. Because of financial pressures, the regulation with the greatest impact was the one prohibiting most insurance plans from covering abortion care. CONCLUSIONS: Further research on experiences of women seeking abortion services, and how these individuals are affected by evolving state policy environments, will help shape initiatives to support timely, affordable and safe abortion care in a climate of increasing restrictions.

From the outside in: a unique model for stimulating curricula reform in nursing education.

Given the current demands on nursing education, the introduction of new content into curricula can present significant challenges for nursing faculty. This is particularly true when the content being introduced is the subject of deep ethical, religious, or political controversy. This article offers a unique model for approaching curricula reform that draws on a decade-long effort to increase abortion-related content in nursing programs in New England and other regions of the United States mounted by a nonprofit organization. Strategies used and successes of the project are discussed. Faculty interested in introducing controversial topics into curricula, as well as advocacy groups that seek to stimulate curricula reform, may find this discussion to be particularly relevant and instructive to their efforts.

Abortion education in nurse practitioner, physician assistant and certified nurse-midwifery programs: a national survey.

OBJECTIVE: This study was undertaken to examine the inclusion and extent of abortion education in accredited nurse practitioner (NP), physician assistant (PA) and certified nurse-midwifery (CNM) programs in the United States. METHODS: In January 2000, a confidential survey requesting information about the curricular inclusion of eight reproductive health topics was mailed to program directors at all 486 accredited NP, PA and CNM programs in the United States. RESULTS: Two hundred two surveys were returned, with a response rate of 42%. Overall, 53% of programs reported didactic instruction on surgical abortion, manual vacuum aspiration or medication abortion and 21% reported including at least one of these three procedures in their routine clinical curriculum. CONCLUSION: Abortion education is deficient in NP, PA and CNM programs in the United States. As integral components of women's health care, abortion, pregnancy options counseling and family planning merit incorporation into routine didactic and clinical education.