Abortion Decision-Making - Revision history

Barb: /* General Background Studies */

2020-12-21T15:35:09Z

General Background Studies

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	:This article by the former national director of the National Abortion Federation describes conflicts with partner, ambivalence, guilt, anger, fear of pain and concern about suitable birth control as major themes which consistently appear in counseling. ( Ed Note: This article is frank and revealing.)		:This article by the former national director of the National Abortion Federation describes conflicts with partner, ambivalence, guilt, anger, fear of pain and concern about suitable birth control as major themes which consistently appear in counseling. ( Ed Note: This article is frank and revealing.)

			:Uta Landy, a former executive director of the National Abortion Federation, encourages counselors to be aware of the fact that
			::Some women’s feelings about their pregnancy are not simply ambivalent but deeply confused. This confusion is not necessarily expressed in a straightforward manner, but can hide behind such outward behavior as: (1) being uncommunicative, (2) being extremely self assured, (3) being impatient (how long is this going to take, I have other important things to do), (4) being
			hostile (this is an awful place; you are an awful doctor, counselor, nurse; I hate being here).

			:Landy defines four types of defective decision-making observed in abortion clinics. She calls the first defective process the “spontaneous approach,” in which the decision is made too quickly, without taking sufficient time to resolve internal conflicts or explore options. A second defective decision-making process is the “rational-analytical approach,” which focuses on the practical reasons for terminating the pregnancy (financial problems, single parenthood, etc.) without consideration of emotional needs (attachment to the pregnancy, maternal desires, etc.). A third defective process is the “denying-procrastinating” approach, which is typical of women who have delayed deciding precisely because of the many conflicting feelings they have about keeping the baby. When such a “denying-procrastinator” finally agrees to an abortion, it is likely that she has still not resolved her internal conflicts, but is submitting to the abortion only because she has “run out of time.” Fourth, there is the “no-decision-making approach” in which a woman refuses to make her own decision but allows others, such as her male partner, parents, counselors, or physician, to decide for her.



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Barb: /* Prior Knowledge & Beliefs About Abortion */

2017-01-17T21:55:56Z

Prior Knowledge & Beliefs About Abortion

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	:Implications: The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.		:Implications: The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.

	Notes: ~~Participation and followup rates are not reported~~ in the abstract. The authors fail to recommend that if these scales are reliable, they should be used to identify women who need additional counseling. Also, the study appears to presume that women already have all the information they need to know before actually receiving abortion counseling and that the counseling they receive fully discloses all risk factors, risks, and options. In other words, just because a woman believes here decision is the right one based on false or incorrect information does not mean she would believe it is the right one once she was given accurate and complete information.		Notes: Based on the highly flawed [[Turn Away Study]] sample, the authors have failed to identify in the abstract that the participation rate of this self-selected sample was extremely low. The authors conclusions also fail to recommend that if these scales are reliable, they should be used to identify women who need additional counseling. Also, the study appears to presume that women already have all the information they need to know before actually receiving abortion counseling and that the counseling they receive fully discloses all risk factors, risks, and options. In other words, just because a woman believes here decision is the right one based on false or incorrect information does not mean she would believe it is the right one once she was given accurate and complete information.

Barb: /* Prior Knowledge & Beliefs About Abortion */

2016-10-17T17:55:19Z

Prior Knowledge & Beliefs About Abortion

← Older revision		Revision as of 12:55, 17 October 2016
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	== Prior Knowledge & Beliefs About Abortion ==		== Prior Knowledge & Beliefs About Abortion ==
			[http://www.contraceptionjournal.org/article/S0010-7824(16)30410-3/abstract Measuring decisional certainty among women seeking abortion] Ralph LJ, Foster DG, Kimport K, Turok D, Roberts SCM (2016) Contraception vol. 73 (2) p. 211-3

			:Objective: Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft–Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy.

			:Methods: Eligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews 3 weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at follow-up.

			:Results: Five hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=.93 and .72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses.

			:Conclusion: The DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care. Comparing scores on the DCS in this population to other studies of decision making suggests that the level of uncertainty in abortion decision making is comparable to or lower than other health decisions.

			:Implications: The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.

			Notes: Participation and followup rates are not reported in the abstract. The authors fail to recommend that if these scales are reliable, they should be used to identify women who need additional counseling. Also, the study appears to presume that women already have all the information they need to know before actually receiving abortion counseling and that the counseling they receive fully discloses all risk factors, risks, and options. In other words, just because a woman believes here decision is the right one based on false or incorrect information does not mean she would believe it is the right one once she was given accurate and complete information.




	'''[http://www.ncbi.nlm.nih.gov/pubmed/?term=Connecting+Knowledge+about+Abortion+and+Sexual+and+Reproductive+Health+to+Belief+about+Abortion+Restrictions%3A+Findings+from+an+Online+Survey Connecting knowledge about abortion and sexual and reproductive health to belief about abortion restrictions: findings from an online survey.] Kavanaugh ML1, Bessett D, Littman LL, Norris A. Womens Health Issues. 2013 Jul-Aug;23(4):e239-47. doi: 10.1016/j.whi.2013.04.003.'''		'''[http://www.ncbi.nlm.nih.gov/pubmed/?term=Connecting+Knowledge+about+Abortion+and+Sexual+and+Reproductive+Health+to+Belief+about+Abortion+Restrictions%3A+Findings+from+an+Online+Survey Connecting knowledge about abortion and sexual and reproductive health to belief about abortion restrictions: findings from an online survey.] Kavanaugh ML1, Bessett D, Littman LL, Norris A. Womens Health Issues. 2013 Jul-Aug;23(4):e239-47. doi: 10.1016/j.whi.2013.04.003.'''

Barb: /* General Background Studies */

2016-08-05T20:52:39Z

General Background Studies

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	== General Background Studies ==		== General Background Studies ==
			'''[http://scholarship.law.cornell.edu/cgi/viewcontent.cgi?article=1731&context=facpub The Uncertain Psychological Case for Paternalism], JJ Rachlinski - Nw. UL Rev., 2002 Northwestern University Law Review 2002. Vol. 97, No. 3'''
			:Research shows that there are situations in which people are prone to making decisions harmful to themselves for which the benefits "paternalistic" interventions may exceed the costs.



	'''[http://www.americanthinker.com/2013/02/a_new_understanding_of_the_trauma_of_abortion.html#ixzz2LeVKXYQr A New Understanding of the Trauma of Abortion]. Charles T. Kenny, Ph.D. and Paul Swope. New American Thinker. Feb 22, 2013'''		'''[http://www.americanthinker.com/2013/02/a_new_understanding_of_the_trauma_of_abortion.html#ixzz2LeVKXYQr A New Understanding of the Trauma of Abortion]. Charles T. Kenny, Ph.D. and Paul Swope. New American Thinker. Feb 22, 2013'''

Barb: /* Prior Knowledge & Beliefs About Abortion */

2016-07-07T21:50:13Z

Prior Knowledge & Beliefs About Abortion

← Older revision		Revision as of 16:50, 7 July 2016
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	== Prior Knowledge & Beliefs About Abortion ==		== Prior Knowledge & Beliefs About Abortion ==

	[http://www.ncbi.nlm.nih.gov/pubmed/?term=Connecting+Knowledge+about+Abortion+and+Sexual+and+Reproductive+Health+to+Belief+about+Abortion+Restrictions%3A+Findings+from+an+Online+Survey Connecting knowledge about abortion and sexual and reproductive health to belief about abortion restrictions: findings from an online survey.] Kavanaugh ML1, Bessett D, Littman LL, Norris A. Womens Health Issues. 2013 Jul-Aug;23(4):e239-47. doi: 10.1016/j.whi.2013.04.003.		'''[http://www.ncbi.nlm.nih.gov/pubmed/?term=Connecting+Knowledge+about+Abortion+and+Sexual+and+Reproductive+Health+to+Belief+about+Abortion+Restrictions%3A+Findings+from+an+Online+Survey Connecting knowledge about abortion and sexual and reproductive health to belief about abortion restrictions: findings from an online survey.] Kavanaugh ML1, Bessett D, Littman LL, Norris A. Womens Health Issues. 2013 Jul-Aug;23(4):e239-47. doi: 10.1016/j.whi.2013.04.003.'''

	:BACKGROUND: The objective of this research was to examine individuals' knowledge about abortion in the context of their knowledge about other sexual and reproductive health (SRH) issues, including contraception, abortion, pregnancy, and birth.		:BACKGROUND: The objective of this research was to examine individuals' knowledge about abortion in the context of their knowledge about other sexual and reproductive health (SRH) issues, including contraception, abortion, pregnancy, and birth.
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	:CONCLUSIONS: Women and men are not well-informed about the relative safety and consequences of SRH-related experiences. Many overestimate their knowledge, and personal beliefs about abortion restrictions may influence their knowledge about the safety and consequences of abortion and contraception. Providers of SRH services should provide comprehensive evidence-based information about the risks and consequences of SRH matters during consultations, particularly in the case of abortion providers serving women who hold more restrictive abortion beliefs.		:CONCLUSIONS: Women and men are not well-informed about the relative safety and consequences of SRH-related experiences. Many overestimate their knowledge, and personal beliefs about abortion restrictions may influence their knowledge about the safety and consequences of abortion and contraception. Providers of SRH services should provide comprehensive evidence-based information about the risks and consequences of SRH matters during consultations, particularly in the case of abortion providers serving women who hold more restrictive abortion beliefs.

			'''Predictors of abortion counseling receipt and helpfulness in the United States. Gould H, Foster DG, Perrucci AC, Barar RE, Roberts SC. Womens Health Issues. 2013 Jul-Aug;23(4):e249-55. doi: 10.1016/j.whi.2013.05.003.'''

			:BACKGROUND: Little is known about women's expectations, needs, and experiences with abortion counseling and the factors that influence their experiences.

			:METHODS: This study sought to investigate individual- and facility-level factors that influenced women's reports of receiving abortion counseling and the helpfulness of counseling. Data were drawn from quantitative interviews with 718 patients recruited from 30 abortion facilities, and 27 interviews with facility informants in the United States.

			:FINDINGS: Sixty-eight percent of participants reported receiving counseling; reports varied by facility. Almost all participants who reported receiving counseling described counseling as helpful: 40% extremely, 28% quite, 17% moderately, 10% a little, and 4% not at all. Nearly all (99%) reported that their counselor communicated support for whatever decision they made. No individual-level factors predicted counseling receipt or helpfulness. Facility informant reports that it is their role to counsel patients about emotional issues was positively associated with women's reports of counseling receipt (p < .001). Women at facilities subject to laws requiring provision of specific information and/or state-approved, written materials had lesser odds of finding counseling helpful, compared with women at facilities not subject to such laws (p < .01).

			:CONCLUSIONS: Legal mandates that regulate abortion counseling do not seem to be helpful to women. More research is needed to understand the effects of abortion counseling and whether policies regulating counseling have a deleterious effect on women.

	== Abortion Decision Making - Role of Males ==		== Abortion Decision Making - Role of Males ==

Barb: /* Abortion Decision Making - Role of Males */

2016-07-01T16:06:44Z

Abortion Decision Making - Role of Males

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	Unplanned pregnancies and abortion counseling.Some thoughts on unconscious motivations, B Loader, ''Psychodyn Couns. 1(3):363-376, 1995''		Unplanned pregnancies and abortion counseling.Some thoughts on unconscious motivations, B Loader, ''Psychodyn Couns. 1(3):363-376, 1995''
	:Many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism for self-harm.		:Many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism for self-harm.

			== Prior Knowledge & Beliefs About Abortion ==

			[http://www.ncbi.nlm.nih.gov/pubmed/?term=Connecting+Knowledge+about+Abortion+and+Sexual+and+Reproductive+Health+to+Belief+about+Abortion+Restrictions%3A+Findings+from+an+Online+Survey Connecting knowledge about abortion and sexual and reproductive health to belief about abortion restrictions: findings from an online survey.] Kavanaugh ML1, Bessett D, Littman LL, Norris A. Womens Health Issues. 2013 Jul-Aug;23(4):e239-47. doi: 10.1016/j.whi.2013.04.003.

			:BACKGROUND: The objective of this research was to examine individuals' knowledge about abortion in the context of their knowledge about other sexual and reproductive health (SRH) issues, including contraception, abortion, pregnancy, and birth.

			:METHODS: During August 2012, we administered an online questionnaire to a randomly selected sample of 639 men and women of reproductive age (18-44 years) in the United States.

			:FINDINGS: Respondents reported the highest levels of perceived knowledge about SRH in general (81%), followed by pregnancy and birth (53%), contraception (48%), and abortion (35%); knowledge of specific items within each of these areas paralleled this pattern. Respondents who believe that abortion should be allowed in at least some circumstances were more likely to be correct regarding the safety and consequences of contraception and abortion. Characteristics associated with higher levels of knowledge regarding abortion-related issues included having higher levels of knowledge about non-abortion-related SRH issues and having less restrictive abortion beliefs.

			:CONCLUSIONS: Women and men are not well-informed about the relative safety and consequences of SRH-related experiences. Many overestimate their knowledge, and personal beliefs about abortion restrictions may influence their knowledge about the safety and consequences of abortion and contraception. Providers of SRH services should provide comprehensive evidence-based information about the risks and consequences of SRH matters during consultations, particularly in the case of abortion providers serving women who hold more restrictive abortion beliefs.


	== Abortion Decision Making - Role of Males ==		== Abortion Decision Making - Role of Males ==
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	:In a study of 74 adolescent males in Ontario, Canada of their attitudes toward adolescent pregnancy and fatherhood, all males wished to be told if a pregnancy occurred, whether or not they were in a casual or serious dating relationship. Male attitudes toward abortion were markedly different depending on the type of relationship. Some 32% of the casual daters believed the desired pregnancy outcome should be abortion compared to only 13% of the serious daters. Most males wished to be included in the decision-making process and receive emotional and social support during this time. When not included they felt confused and neglected. Males were a factor in the decision-making process even when ignored by professionals. The study concluded, "In regard to teenage pregnancy, it seems appropriate for professionals to recognize the male sexual partner as part of the problem as well as part of the solution."		:In a study of 74 adolescent males in Ontario, Canada of their attitudes toward adolescent pregnancy and fatherhood, all males wished to be told if a pregnancy occurred, whether or not they were in a casual or serious dating relationship. Male attitudes toward abortion were markedly different depending on the type of relationship. Some 32% of the casual daters believed the desired pregnancy outcome should be abortion compared to only 13% of the serious daters. Most males wished to be included in the decision-making process and receive emotional and social support during this time. When not included they felt confused and neglected. Males were a factor in the decision-making process even when ignored by professionals. The study concluded, "In regard to teenage pregnancy, it seems appropriate for professionals to recognize the male sexual partner as part of the problem as well as part of the solution."

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	== Adoption as An Option ==		== Adoption as An Option ==

Barb: /* Attitude Toward Pregnancy */

2013-09-13T15:41:19Z

Attitude Toward Pregnancy

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 ''Unplanned pregnancies and abortion counseling.Some thoughts on unconscious motivations, B Loader, Psychodyn Couns. 1(3):363-376, 1995''
 :Many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism for self-harm.
 == Attitudes of Doctors and Counselors ==

Barb: /* Characteristics of Women Having Induced Abortion */

2013-06-21T14:42:49Z

Characteristics of Women Having Induced Abortion

← Older revision		Revision as of 09:42, 21 June 2013
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	== Characteristics of Women Having Induced Abortion ==		== Characteristics of Women Having Induced Abortion ==

			''[http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0043462 Live and non-live pregnancy outcomes among women with depression and anxiety: a population-based study.] Ban L, Tata LJ, West J, Fiaschi L, Gibson JE. PLoS One; 2012;7(8):e43462.''
			:Conclusion: Women with depression or anxiety have higher risks of miscarriage, perinatal death and decisions to terminate a pregnancy if prescribed psychotropic medication during early pregnancy than if not. Although underlying disease severity could also play a role, avoiding or reducing use of these drugs during early pregnancy may be advisable.


	''[http://www.jogc.com/abstracts/full/200705_womenshealth_1.pdf The prevalence of intimate partner violence among women and teenagers seeking abortion compared with those continuing pregnancy.] Bourassa D, Berube J. J Obstet Gynaecol Can 2007;29:415–23.''		''[http://www.jogc.com/abstracts/full/200705_womenshealth_1.pdf The prevalence of intimate partner violence among women and teenagers seeking abortion compared with those continuing pregnancy.] Bourassa D, Berube J. J Obstet Gynaecol Can 2007;29:415–23.''

Barb: /* Pregnancy Reactions/Unwanted Pregnancy */

2013-05-06T18:14:49Z

Pregnancy Reactions/Unwanted Pregnancy

← Older revision		Revision as of 13:14, 6 May 2013
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	=== Pregnancy Reactions/Unwanted Pregnancy ===		=== Pregnancy Reactions/Unwanted Pregnancy ===

			''The intendedness of pregnancy: a concept in transition, LV Klerman, Maternal and Child Health Journal 4(3):155-162, 2000.''
			:The terms, "intended", "unintended", "mistimed", "wanted", "unwanted" and "planned" are often used without significant attention being paid to their meaning or how they were derived from survey questions. There is a particular need to distinguish between terms that define attitudes and those that define behaviors.


			''Unintended pregnancy in a commercially insured population, DC Green et al, Maternal and Child Health Journal 6(3):181-187, 2002.''

			Women who reported that the partner did not want the pregnancy were 7.4 times more likely than women whose partner wanted the pregnancy to regard the pregnancy as unintended. Only 40% of the women with an unintended birth used birth control, and 64% of those used less effective methods such as condoms and diaphragms.



	''“ Cultural practices and social support of pregnant women in a northern New Mexico community”,'' EW Domian, J Nursing Scholarship 33(4):331-336, 2001		''“ Cultural practices and social support of pregnant women in a northern New Mexico community”,'' EW Domian, J Nursing Scholarship 33(4):331-336, 2001

Barb: /* Characteristics of Women Having Induced Abortion */

2013-05-06T18:13:09Z

Characteristics of Women Having Induced Abortion

← Older revision		Revision as of 13:13, 6 May 2013
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	:Women with previous induced abortions were more likely to be unmarried, black, regular drinkers and smokers.		:Women with previous induced abortions were more likely to be unmarried, black, regular drinkers and smokers.

			Unplanned pregnancies and abortion counseling.Some thoughts on unconscious motivations, B Loader, ''Psychodyn Couns. 1(3):363-376, 1995''
			:Many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism for self-harm.

	== Abortion Decision Making - Role of Males ==		== Abortion Decision Making - Role of Males ==