By Kristin Nobel, MPH
Senior Director of Program Evaluation
For years, providers have been telling us, “My clients don’t want to talk about abortion,” or “I only offer that option when I can tell the client is in despair about her pregnancy.” We understood from interviewing providers that they didn’t want to offend their clients by bringing up options that would make their clients uncomfortable. But what did clients really want? Other than a few small qualitative studies, no one had really asked them. Entire policies had been made about what providers could or couldn’t say to clients about their pregnancy options without anyone ever studying what actually made clients more satisfied.
In 2017, we conducted a research study at randomly selected, publicly-funded family planning clinics in the deep South. We selected half at random to train and left the other half untrained. Then the staff at both sets of clinics began offering clients the option to complete an anonymous survey on an iPad after they received pregnancy options counseling. We ended with over 300 completed surveys and 37 client interviews and to ensure a rigorous analysis, we asked a public health university faculty member with whom we had no prior relationship to analyze our data. Our Client Experience Study found that:
- Provide’s Abortion Referrals Training approximately tripled the rate at which providers discussed abortion with clients and doubled the rate of abortion referral.
- Clients were significantly more satisfied with their care when abortion was included or when all options were discussed.
- Clients were 80% more likely to rate their provider as “excellent” on all measures when their provider had discussed all pregnancy options with them.
These quantitative findings were validated and explained by what clients told us in interviews. Clients said that they felt more respected and viewed their providers as more professional when they offered all options in a neutral way and didn’t assume or judge what the clients wanted. One client related, “I would prefer them to offer discussing it with me. If you’re looking at abortion for instance, you’re able to discuss it with somebody that doesn’t make you feel judgment.”
Even clients who planned to continue their pregnancies were more satisfied when they were offered all options. In interviews, nearly all clients who intended to parent indicated that they felt comfortable declining options they weren’t interested in as long as the provider approached the options in a neutral way. Another client explained, “I told her, I’m gonna keep it, but I think they did amazing. I really liked the way that she came at me with things. She explained each one—like “these are your options and this is what you can do.”
This month, a rigorous, peer-reviewed article on our findings – the first of their kind – will be published in the respected journal Contraception. We hope that our findings will give providers the confidence that naming all options for clients in a way that signals a willingness to discuss any or all of them without judgment will ultimately create a more positive experience for clients and ensure that their needs are met. Saying the words “abortion, adoption, or parenting” takes courage when you don’t know how your client will respond, but we now have evidence that doing so is a best practice that ultimately benefits and creates a more positive experience for clients.