By Kristin Nobel, MPH
She already suspected the news I was bringing, though she hoped somehow the test in our office would put her fears to rest. I had to say the words that would confirm them: Your pregnancy test result is positive. She was quiet and expressionless. After giving her some time to absorb the news, I asked her how she was feeling. “This couldn’t come at a worse time,” she admitted. When she looked at me, I knew she was waiting. How I responded in the next moment would determine whether or not she would tell me she didn’t want to continue her pregnancy. The pain of being judged for her choice would be worse than having to go it alone, so she waited to hear not just the word, but also how I said it. “You have three options,” I began, and when I mentioned “abortion,” she nodded, seemingly relieved that I had been the one to say it first. In doing so, I opened the door to that conversation, and signaled I was willing to walk through it with her.
It has been 20 years since I worked as a medical assistant and counselor, but I still vividly remember what it felt like to sit in that vulnerable moment, trying to shift the client’s fear of judgment to an experience of compassionate listening and empowerment. Now my role is to analyze rows of data, but I never forget that each one is a client or provider with their own situation and story.
In 2017, our team had the opportunity to analyze data from individual client interactions at a large state-based Title X (Family Planning) organization. During the study period there were 35 clients who expressed interest in abortion and received a referral to an abortion provider, but there were almost again as many (28) who received an abortion referral who hadn’t initially expressed interest. In 89% of these cases, abortion only came up because the provider mentioned it as an option. If the provider hadn’t done so, around 40% of the total clients who wanted an abortion referral might have been “missed,” leaving the clinic without the information they needed to obtain a safe and timely procedure.
Following Provide’s Referrals Training, the rate at which the 28 providers in our study discussed abortion as an option more than tripled (from 11% to 35%). Probably as a result of mentioning abortion more often as an option, the rate of referral for abortion services rose from 6% to 10%, coming much closer to the rate at which clients in that state actually receive abortion care (19% of all pregnancies). When providers felt more comfortable mentioning abortion as an option, fewer clients were “missed”, and more were able to receive support and information from their provider instead of having to rely on outside sources.
A nurse we interviewed recently in North Carolina related,
“I would talk to people and they would have to just come out and say, ‘You know, I don’t think I want to have this baby’ and I wasn’t doing what I really felt like I was supposed to do. But now I will say, ‘Okay, you can have the baby, do adoption, or terminate the pregnancy.’ It makes it a better experience for them because people come in here and you don’t know if they’re stressed, or they just don’t know. What if they run into a situation later on in their pregnancy and something happens? They know they can come back to me and I’m going to be there regardless.”
It may not always be obvious when a client is interested in abortion. Our recent data indicates that nearly half of all clients do not bring it up on their own. But by offering clients all their options – in the courageous act of naming each of those choices out loud – providers empower their clients to express their true preference and take charge of their health care.