Administrative, counseling and medical practices in National Abortion Federation facilities.

A survey of members of the National Abortion Federation (NAF), most of them non-hospital facilities, responsible for performing almost half of the abortions in the United States, was carried out by the NAF in 1981. Among the principal findings were the following: Fifty-three percent of the NAF facilities are freestanding clinics operated for profit. Fifty-one percent are open more than 50 hours per week, and 77 percent are open six days a week; 86 percent are open on Saturdays. Seventy-five percent of the physicians performing abortions in these facilities are gynecologists. Counseling provided by specially trained abortion counselors is a unique contribution of abortion facilities to health-care delivery. Virtually all facilities employ counselors who are neither doctors nor nurses. Most NAF facilities have more counselors than nurses and more nurses than doctors. Counseling in virtually all facilities includes providing written as well as verbal information about the nature of the procedure and its medical risks; such information is given to the patient so that she can give informed consent for the abortion. Almost all facilities include information about contraception and about the options available to a woman with a problem pregnancy. Most offer counseling to the male, as well as the female partner, on the patient's request. Twenty-eight percent of facilities generally provide both individual and group counseling. Where only one type of counseling is provided, it is usually individual counseling.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: A survey of members of the National Abortion Federation (NAF), most of them nonhospital, and responsible for performing almost half of the abortions in the United States, was carried out by the NAF in 1981. Findings show that 53% operate for profit, they are open 5 days or more per week, and 75 percent of physicians in the clinics are gynecologists. There are more counselors than nurses and more nurses than doctors. Counseling is written and verbal; there is individual and group counseling. Minors are encouraged to involve parents but most facilities do not require the minors to do so. Pregnancy tests are usually required and most facilities do not require appointments or referrals. Abortions take place within a week of the pregnancy test. 20 to 25% of nonhospital facilities offer abortion in the second trimester but 83% of clinics and 62% of physicians performing abortion in their offices do so. Facilities use metal dilators (89%), laminara (15%), for 1st trimester abortions, for 2nd trimester D&E procedures, laminaria was used as often or more often. Contraceptive services are made available and followup visits are recommended. There is 24 hour contact in case of emergencies. NAF nonhospital clinics are more likely than nonmember clinics to provide abortion services primarily.

D & E midtrimester abortion: a medical innovation.

PIP: With the advent of legalized abortion in the US in 1973, the innovation, adoption and dissemination of new and improved medical procedures for the voluntary termination of pregnancy became an important objective. 3 principal techniques were introduced: suction curettage, instillation procedures using saline solution or prostaglandin, and dilatation and evacuation (D and E). Suction curettage in the 1st trimester was readily adopted because the procedure was less traumatic than the traditional dilatation and curettage. Instillation procedures for abortions in the 2nd trimester were also readily adopted. Physicians preferred them to surgical procedures, were familiar with the delivery simulation, and were comfortable with the hospital setting in which the procedure was performed. D and E, an extension of the suction procedure to abortions in the 2nd trimester has lower complication rates than instillation procedures and can be performed early in the midtrimester. A 1981 membership survey conducted by the National Abortion Federation found that about 1/3 of the members performed D and E midtrimester abortions, a wider acceptance than was expected. In 1978, of the 2nd trimester abortions, 85% of the early midtrimester and 25% of the 16 weeks gestation or later abortions were done by D and E. Acceptance in some other countries is also increasing. A study of the relationship of a history of 2nd trimester abortions and subsequent adverse pregnancy outcomes was unable to identify any statistically significant relationship with the possible exception of low birth weight infants. According to a 1976 survey of teaching hospitals, less than 1/4 require their residents to perform midtrimester abortions. Very few medical schools include D and E procedures in their residency training programs. Residents should use the D and E technique only under supervision and after becoming experienced in 1st trimester suction curettage. A survey reported that D and E techniques can be learned by all gynecologists, can be safer than instillation procedures and can be safely performed in nonhospital settings. Ultrasound can be helpful during the procedure to diagnose pelvic pathology, guide instruments and manipulate fetal and placental tissue with more precision. Local anesthesia is associated with fewer complications than general anesthesia. An increasing number of physicians are using laminaria tents to dilate the cervix which reduces the risk of perforation and cervical injury, and the cervix returns to normal within a shorter period of time than with metal dilators. Laminaria have been successfully used on a outpatient basis. A questionnaire survey found both positive and negative staff reactions in facilities which had instituted 2nd trimester D and E procedures. Training for staff before initiating the new procedure and at periodic intervals thereafter is essential and should include factual information on the procedure, sonography, laminaria, fetal development, as well as the opportunity to share reactions, reassess attitudes and resensitize staff to patient needs. D and E procedures shift the psychological burden from nurses and patients to the physicians.^ieng

Mortality and fertility control.

The authors present a continuation of the thesis suggesting that the most rational procedure for regulating fertility is a perfectly safe, even though not completely effective, contraceptive method combined with safe methods for terminating pregnancy when the contraceptive fails. This analysis demonstrates that, compared with the risk of death from pregnancy and childbirth, major reversible methods of fertility control--the pill, IUDs, condoms, and diaphragms--and abortion are associated with very low levels of mortality. The exception to this statement is pill use after age 40 by women who smoke. This analysis also confirms the very low mortality associated with using the condom and diaphragm with early induced abortion as a backup to terminate pregnancies resulting from contraceptive failures.

Sterilization associated with induced abortion: JPSA findings.

PIP: The data on sterilizations performed in concurrence with induced abortions as obtained by the Joint Program for the Study of Abortion is reviewed. The survey included 72,988 legal abortions performed in 1970-1971 at 60 hospitals and clinics across the country. 3.7% of all of the women in this study and 15.8% of those with preexisting health problems chose a concurrent sterilization. Of these 2725 patients, 813 had hysterectomies and 1912 had tubal sterilizations. The incidence of concurrent elective sterilization increased sharply with age and parity of the patient, indicating that these patients were more likely to seek permanent family limitation. Women on nonprivate medical service and nonwhite women had more frequent concurrent sterilizations at a younger age and lower parity than women on private service or white women even when age and parity were held constant. This phenomenon is not readily explained. Ever-married women who had no prior births were sterilized from 2-3 times as frequently as never-married women in the same age groups. The concurrent sterilization rates found in this study are well below those found in other countries.^ieng