Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study

PurposeThis paper examines how Utah's two-visit requirement and 72-hour waiting period influence women's certainty about their decision to have an abortion.ProceduresThis study uses data from a prospective cohort study of 500 women who presented at an abortion information visit at four Utah family planning facilities. At the information visit, participants completed a baseline survey; 3 weeks later, they completed telephone interviews that assessed their pregnancy outcome, change in certainty, and factors affecting changes in certainty.Main findingsOverall, 63% reported no change in certainty owing to the information visit and 74% reported no change in certainty owing to the waiting period. Changes in certainty were primarily in the direction of increased certainty, with more women reporting an increase (29%) than a decrease (8%) in certainty owing to the visit and more women reporting an increase (17%) than a decrease (8%) owing to waiting. Changes in certainty in either direction were concentrated among the minority (8%) who were conflicted about their decision at baseline. Learning about the procedure, meeting staff, and discovering that the facility was a safe medical environment were main contributors to increased certainty.ConclusionMost women were certain of their decision to have an abortion when they presented for their abortion information visit and their certainty remained unchanged despite the information visit and 72-hour waiting period. Changes in certainty were largely concentrated in the minority of women who expressed uncertainty about their decision before the beginning of the information visit. Thus, individualized counseling for the minority who are conflicted when they first present for care seems more appropriate than universal requirements

Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study.

PurposeThis paper examines how Utah's two-visit requirement and 72-hour waiting period influence women's certainty about their decision to have an abortion.ProceduresThis study uses data from a prospective cohort study of 500 women who presented at an abortion information visit at four Utah family planning facilities. At the information visit, participants completed a baseline survey; 3 weeks later, they completed telephone interviews that assessed their pregnancy outcome, change in certainty, and factors affecting changes in certainty.Main findingsOverall, 63% reported no change in certainty owing to the information visit and 74% reported no change in certainty owing to the waiting period. Changes in certainty were primarily in the direction of increased certainty, with more women reporting an increase (29%) than a decrease (8%) in certainty owing to the visit and more women reporting an increase (17%) than a decrease (8%) owing to waiting. Changes in certainty in either direction were concentrated among the minority (8%) who were conflicted about their decision at baseline. Learning about the procedure, meeting staff, and discovering that the facility was a safe medical environment were main contributors to increased certainty.ConclusionMost women were certain of their decision to have an abortion when they presented for their abortion information visit and their certainty remained unchanged despite the information visit and 72-hour waiting period. Changes in certainty were largely concentrated in the minority of women who expressed uncertainty about their decision before the beginning of the information visit. Thus, individualized counseling for the minority who are conflicted when they first present for care seems more appropriate than universal requirements

Admitting privileges and hospital-based care after presenting for abortion: A retrospective case series.

ObjectiveTo examine the pathways of care for abortion patients transferred or referred to emergency departments (EDs) or hospitals before and after abortion-providing physicians obtained hospital admitting privileges.Data sourcesThis case series was based on retrospective chart review at three abortion clinics in which physicians had obtained admitting privileges in the previous 5 years.Study designWe identified patients who were transferred or referred to a hospital or ED. Patients were grouped according to the pathway by which their care was transferred or referred to the ED/hospital.Principal findingsBoth before and after admitting privileges, the majority of patients were referred to a hospital before the abortion was attempted and most were for suspected ectopic pregnancy or to perform the abortion in a hospital. Direct ambulance transfer from the facility to the ED/hospital was the least common pathway. We observed few changes in practice from before to after admitting privileges. Preexisting mechanisms of coordination and communication facilitated care that was tailored for the specific patient.ConclusionsWe did not find evidence that physician admitting privileges influenced the pathways through which abortion patients obtain hospital-based care, as existing mechanisms of collaboration between hospitals and abortion facilities allowed for management of patients who sought hospital-based care

The Impact of a Parental Notification Requirement on Illinois Minors' Access to and Decision-Making Around Abortion.

PURPOSE:This study aims to examine the impact of a parental notification (PN) requirement on the frequency, timing, and out-of-state travel of minors seeking abortion, as well as changes in who minors involve in their decision, support received, and decision certainty. METHODS:We analyzed administrative and medical records of 1,577 women obtaining an abortion before and after implementation of a PN requirement at one Illinois facility. Using multivariate regression within a difference-in-differences framework, we quantified changes in the number and timing of women seeking care, frequency of parental awareness and support, travel from out-of-state, decision certainty, and anticipated coping among minors 17 years and below compared with young adults (YAs) aged 18-20 years. RESULTS:A smaller proportion of abortions to women ages 20 years and under post-law were among minors (39%-33%, p = .017). Compared with YAs, minors experienced a larger increase in parental awareness (71%-93% [minors] vs. 53%-58% [YAs], p < .000]; however, parents' support for the decision was unchanged. The proportion of minors certain of their decision went from 77% pre-law to 71% post-law (p = .099) compared with 82% pre- and post-law among YAs (p = .798). Compared with YAs, a larger proportion of minors obtained second trimester care post-law if coming from another state (21%-31% [minors] vs. 23%-16% [YAs], p = .022). CONCLUSIONS:Illinois' PN requirement was associated with a decrease in the number of abortions among minors, delayed care for those from out-of-state, increased parental awareness of the pregnancy, and no change in parents' support

Conceptual model.

<p>Conceptual model.</p

Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study

<div><p>Background</p><p>Since mid-2013, Wisconsin abortion providers have been legally required to display and describe pre-abortion ultrasound images. We aimed to understand the impact of this law.</p><p>Methods</p><p>We used a mixed-methods study design at an abortion facility in Wisconsin. We abstracted data from medical charts one year before the law to one year after and used multivariable models, mediation/moderation analysis, and interrupted time series to assess the impact of the law, viewing, and decision certainty on likelihood of continuing the pregnancy. We conducted in-depth interviews with women in the post-law period about their ultrasound experience and analyzed them using elaborative and modified grounded theory.</p><p>Results</p><p>A total of 5342 charts were abstracted; 8.7% continued their pregnancies pre-law and 11.2% post-law (p = 0.002). A multivariable model confirmed the law was associated with higher odds of continuing pregnancy (aOR = 1.23, 95% CI: 1.01–1.50). Decision certainty (aOR = 6.39, 95% CI: 4.72–8.64) and having to pay fully out of pocket (aOR = 4.98, 95% CI: 3.86–6.41) were most strongly associated with continuing pregnancy. Ultrasound viewing fully mediated the relationship between the law and continuing pregnancy. Interrupted time series analyses found no significant effect of the law but may have been underpowered to detect such a small effect.</p><p>Nineteen of twenty-three women interviewed viewed their ultrasound image. Most reported no impact on their abortion decision; five reported a temporary emotional impact or increased certainty about choosing abortion. Two women reported that viewing helped them decide to continue the pregnancy; both also described preexisting decision uncertainty.</p><p>Conclusions</p><p>This law caused an increase in viewing rates and a statistically significant but small increase in continuing pregnancy rates. However, the majority of women were certain of their abortion decision and the law did not change their decision. Other factors were more significant in women’s decision-making, suggesting evaluations of restrictive laws should take account of the broader social environment.</p></div

Adjusted monthly rate of continuing pregnancy, predicted value of segmented regression with covariates.

<p>Adjusted monthly rate of continuing pregnancy, predicted value of segmented regression with covariates.</p

Time period, viewing ultrasound, decision certainty and their associations with continuing pregnancy, n = 5,158.

<p>Time period, viewing ultrasound, decision certainty and their associations with continuing pregnancy, n = 5,158.</p