Insights: How All Clinicians Can Support People Who Need Abortion
Written by Jasmine Chan, M.D. and Navjot Narula, MD
As restrictive laws increasingly limit patients’ access to abortion care, clinicians must maximize their support for patients seeking abortions. Even if your organization does not provide abortions, there are still many ways you can support patients seeking abortion care. These recommendations may fall in a legally gray area for those working in certain states or in Title-X funded clinics. For legal advice on your role in supporting abortion care, contact the Abortion Defense Network.
Options Counseling
Clinicians should be able to provide competent and compassionate options counseling on abortion and other pregnancy-related decisions for their patients. In all states, clinicians have the right to inform their patients of their options. Options counseling should be patient-centered first and foremost. To follow the “All-Options Counseling Approach,” the clinician should aim to have a conversation where patients feel safe to explore all their pregnancy decisions, feelings, and experiences without an agenda. This approach involves affirming the complexity of this decision, creating an open, non-judgmental environment, validating and normalizing the multiple and complex feelings around pregnancy, active listening, clarifying the facts, and reassuring the patient that you will support them with any decision.
Local Resources
Important to your practice is being aware of the existing resources in your community. Familiarize yourself with your local trusted abortion providers, clinics, and abortion support networks to refer your patients to. Start with INeedAnA for abortion access options local to your practice. Ensure that you are also aware of the crisis pregnancy centers in your area so that patients are not going to fake clinics that do not provide evidence-based information. In states and practice settings without significant legal barriers to care, it can be helpful to confirm a patient’s gestational age and medical history to confirm their eligibility for medication abortions or procedural abortions. If needed, clinicians can aid the patient in attaining ultrasounds to confirm dates and intrauterine pregnancy. More specific counseling and provision of ultrasound may not be applicable in all states or practices. To check if your state allows insurance coverage of abortions, you can use this resource by AllAboveAll. Unfortunately, many insurers do not cover abortion. Local abortion funds are crucial components of access for many patients with financial constraints. They can provide financial resources to support costs related to travel, lodging, and the appointment. The National Network of Abortion Funds is a good, but not exhaustive, place to start exploring your community’s local abortion funds.
For clinicians in states with more restricted access, patients may need to travel out of state or have a self-managed abortion (SMA).
Self-Managed Abortions
SMAs are a safe and effective option for patients.1 Even in restricted states, clinicians are able to provide information on SMAs. Share trusted resources with your patients, like Plan C Pills which provides information on how patients can obtain abortion pills, If/When/How’s guide for providers and patients on confidentiality and legal helpline, and the M+A hotline which is an invaluable resource for patients to be able to speak with a trusted clinician about SMA or managing a miscarriage. The hotline can also be used by providers who need guidance in helping their patient who has had an SMA.
Post-Abortion Care
While routine in-person follow-up is not generally required for medication or procedural abortions,2 it is helpful for clinicians to have knowledge of abortion outcomes and aftercare. Educate yourself on the rare complications that may occur with abortions to be able to counsel and advise patients, especially those who have experienced a SMA or for patients who have traveled back to your community from abortion clinics out of state. The National Abortion Federation has a resource for post-abortion triage guidelines for providers. If your clinic has the capabilities, it is beneficial to offer point-of-care ultrasounds for patients who are unsure of the completion of their abortion or for those who have continued bleeding.
Legal
With the ever-changing legal landscape, clinicians may feel overwhelmed trying to stay on top of the laws in the country and even in the state where they practice. There are resources to help keep one up to date, like the Center for Reproductive Rights’ state-by-state guide and Abortion Defense Network’s state-specific guides for healthcare workers. It is important to highlight that, to date, giving accurate medical information is legal in all 50 states.
RHAP Resources:
Pregnancy Options Counseling Model
How to Spot and Avoid Fake Abortion Clinics
Approach to Patients Undergoing Self-managed Medication Abortion
Sources:
Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.
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