- Email: [email protected]
Beliefs about abortion risks in women returning to the clinic after their abortions: a pilot study
Contraception xx (2014) xxx – xxx
Original research article
Beliefs about abortion risks in women returning to the clinic after their abortions: a pilot study Lisa L. Littman a,⁎, Adam Jacobs a , Rennie Negron a , Tara Shochet b , Marji Gold c , Miriam Cremer d a
Icahn School of Medicine at Mount Sinai, Box 1043, New York, NY 10029-5204, USA b Consultant, Iowa City, IA c Albert Einstein College of Medicine d University of Pittsburgh Received 11 December 2012; revised 4 March 2014; accepted 5 March 2014
Abstract Background: Misinformation regarding the risks of abortion is prevalent and commonly includes medical inaccuracies about health, depression, infertility and breast cancer. This pilot study sought to assess misinformation among abortion clients as well as the origin(s) of their abortion knowledge. Study Design: Women who presented to the Mount Sinai School of Medicine Family Planning Division for postabortion follow-up were recruited for participation. Participants completed a researcher-administered survey regarding knowledge and beliefs about abortion. Results: Sixty-seven women completed the survey between 1/11/10 and 8/6/12. Common sources of abortion information included clinicians (79.1%), Web sites (70.1%), friends (50.7%) and family (40.3%). Over two thirds of women (77.6%) overestimated the health risks, and close to half (43.3%) overestimated the risk of depression after a first trimester abortion. Conclusions: Misperceptions about the health risks of abortion were prevalent among this sample. Education tools should be developed to provide accurate information about the risks of abortion. © 2014 Elsevier Inc. All rights reserved. Keywords: Abortion; Risks; Misinformation; Knowledge; Counseling
1. Introduction Inaccurate information about abortion is prevalent and often exaggerates the medical and psychological risks of the procedure [1–3]. Abortion misinformation is an important issue because all individuals deserve accurate information to make informed health decisions. Exposure to false information about abortion risk may increase women's anxiety about the procedure and influence their expectation of how well they will cope afterwards [2]. In addition, misinformation, particularly that which makes abortion seem uncommon or promotes negative stereotypes about women who have abortions, can contribute to abortion stigma [4]. From a broader
⁎ Corresponding author. Mount Sinai School of Medicine, Department of Preventive Medicine, Box 1043, New York, NY 10029–5204, USA. E-mail address: [email protected] (L.L. Littman). http://dx.doi.org/10.1016/j.contraception.2014.03.005 0010-7824/© 2014 Elsevier Inc. All rights reserved.
perspective, incorrect information about abortion in the public domain leads to public support (and politician justification) of policies that restrict access to abortion and of state-legislated mandatory physician scripts that violate the standards of informed consent [5–7]. Common types of abortion misinformation include assertions that abortion is dangerous, causes severe mental health disorders, impairs future fertility and increases the risk of breast cancer [1–3]. The evidence does not support these claims [8–14], and yet this type of incorrect material has been identified on Web sites [1,15], in abstinence-only education programs [16], in crisis pregnancy centers [1,3,17,18] and in state-legislated mandatory scripts for physicians [6,7]. Misinformation is prevalent and comes from many sources, but it is unclear what women having abortions actually believe about the service they are seeking. To the authors' best knowledge, there are no published studies from the United States
2
L.L. Littman et al. / Contraception xx (2014) xxx–xxx
regarding abortion clients and misinformation. The purpose of this study was to pilot a series of questions assessing the level of misinformation among abortion clients as well as the origin(s) of their abortion knowledge. The findings will inform a larger, cross-sectional study.
2. Materials and methods This was a hypothesis generating pilot study that utilized a researcher-administered survey to assess knowledge and beliefs about abortion and the types of services that could be offered to women around the time of abortion. A convenience sample of women who presented for a surgical abortion follow-up visit at the research site (Mount Sinai School of Medicine Family Planning Division, New York, NY) was invited to participate. Patients receiving abortions there are routinely scheduled for postoperative visits 2–3 weeks after their procedure. Eligibility criteria included being between the ages of 14–50, speaking English and being present on a day when a research team member was available for enrollment. Exclusion criteria included having had a termination procedure for a spontaneous or incomplete abortion. Those expressing interest met privately with one of the investigators where they were provided details about the study. Informed consent was obtained, for women wanting to participate, using a consent form in which no signature was required to ensure anonymity. The principal investigator administered the survey orally. Eligible women who declined participation were asked to complete a nonparticipant sheet, which included only demographic information. The study received Institutional Review Board (IRB) approval from the Mount Sinai Institutional Review Board. Prior to embarking on this pilot study, we tested recruitment feasibility at both abortion preoperative and postoperative visits using a similar survey instrument. We found that very few women agreed to participate at their preoperative visit, even when we shortened the survey to 15 min. We understand that women returning for their postoperative visits may not be representative of all patients receiving abortions; however, due to our low numbers of potential subjects overall as well as difficulty recruiting at preoperative visits, we decided to focus on postoperative patients in order to achieve a meaningful enrollment rate. The survey contained 25 dichotomous, multiple choice, Likert scale and short answer questions that included topics on common myths about abortion (4 questions), sources of abortion information (1 question), abortion support services (5 question), an educational opportunity question (1 question) and participant demographics (14 questions). The questions regarding common abortion myths and the educational opportunity question are included in Appendix 1. Although the survey questions were not piloted specifically for the literacy levels of our population, the authors felt that administering the survey orally and providing op-
portunities for participants to ask for clarification could overcome literacy limitations. In addition, efforts were made to avoid bias in the common myth questions. The question regarding awareness of groups that provide inaccurate abortion information was inserted as an educational opportunity, to be addressed after answers to the myth questions were reviewed. The survey took approximately 15–25 min to complete. Following completion of the common myths, sources of information and educational opportunity questions, participants were given a fact sheet with evidence-based answers to the myth questions. The researcher then reviewed the evidence-based answers with the participant, especially the questions that were answered incorrectly, and discussed potential sources of abortion information and misinformation. Data were collected by the survey administrator and then entered into Excel 2010 (Microsoft Corporation, Redmond, WA, USA). Analyses were conducted using STATA version 11 (StataCorp, College Station, TX, USA); survey responses are presented by frequency and/or means. Fischer's Exact tests were used to compare demographic data between correct and incorrect answers for the four common myth questions.
3. Results Of the 79 potential participants who were offered participation in the study, 67 (84.8%) agreed to complete the survey between 1/11/10 and 8/6/12. Participant characteristics are presented in Table 1. The collected demographics of the nonparticipants were comparable to those of the study participants (not shown). A large majority of women (79.1%; 53/67) reported getting information about abortion from their doctor or nurse (Table 2). In addition, many women obtained information from Web sites (70.1%; 47/ 67), friends (50.7%; 34/67) and/or family members (40.3%; 27/67). Fewer reported getting information from the media (31.3%; 21/67) or from their partner (10.4%; 7/67). Over two thirds of all participants (77.6%; 52/67) overestimated the health risks of a first trimester abortion compared to the risks of continuing a pregnancy and giving birth (see Table 3). Close to half of participants (43.3%; 29/ 67) overestimated the risk of depression after a single first trimester abortion compared to the risk of depression after continuing an unplanned pregnancy. In addition, more than 2 in 10 women (22.4%; 15/67) erroneously believed that abortion impairs future fertility and 6.0%; 4/67 incorrectly answered that abortion is associated with an increased risk for breast cancer. Older women and women with children were more likely to answer the infertility question correctly (Fischer's Exact test = .001 and .036, respectively); women with less education were more likely to answer the depression question correctly (Fischer's Exact test = .007); and compared to non-Black women, Black women are more
L.L. Littman et al. / Contraception xx (2014) xxx–xxx Table 1 Participants' characteristics: % (n)
Table 2 Sources for abortion information (n=67) Participants n= 67
Age in years b20 20–24 25–29 30–34 35 + Relationship status In a relationship, not married In a relationship, married Not currently in a relationship Race/Ethnicity Latina/Hispanic African American/Black Mixed race White Other Education level completed: % (n) Eleventh grade or less High school diploma or General Educational Development (GED) Assoc degree/trade school/tech degree Some college College degree or greater Importance of religion in participant's life Somewhat or very important Not important Not applicable/don't know Frequency of attending religious institution At least once per week One to three times per month Less than once per month Never Refused/Do not know Health insurance Medicaid Private Military None Has one or more children Had one or more prior abortions Weeks gestation: mean±SD (range) Weeks since abortion: mean±SD (range)
3
10.4 (7) 35.8 (24) 31.3 (21) 13.4 (9) 9.0 (6) 74.6 (50) 10.4 (7) 14.9 (10) 41.8 (28) 38.8 (26) 9.0 (6) 7.5 (5) 3.0 (2) 15.6 (10) 42.2 (27) 14.1 (9) 20.3 (13) 7.8 (5) 89.6 (60) 7.5 (5) 3.0 (2) 14.9 (10) 29.9 (20) 22.4 (15) 31.3 (21) 1.5 (1) 83.6 (56) 7.5 (5) 1.5 (1) 7.5 (5) 68.7 (46) 58.2 (39) 10.8±4.9 (3.5–23) 2.6±1.1 (1.5–8)
likely to answer the depression question correctly (Fischer's Exact test = .046) (data not shown). 4. Discussion Misperceptions about the health risks of abortion and the risk of depression after abortion were prevalent among this sample of women. Given the potential impact of misinformation on coping ability, these findings raise concerns about abortion clients who may be unnecessarily worried about the effect of abortion on their physical and emotional health. As a counter measure, public health campaigns as well as inclinic education tools need to be developed to provide women with accurate information about the safety and risks of abortion as well as to minimize abortion-related stigma.
% (n) a
Where participant got information about abortion Clinician Web site(s) Friend(s) Family member(s) Media Partner Other Participant was aware that there are groups that give out incorrect information about abortion Yes No a
79.1 (53) 70.1 (47) 50.7 (34) 40.3 (27) 31.3 (21) 10.4 (7) 13.4 (9)
53.7 (36) 46.3 (31)
Totals add up to N100% as multiple answers were allowed.
Although the majority of women in this study reported having received information about abortion from a medical professional, incorrect knowledge about abortion was highly prevalent. However, most participants obtained information from multiple sources, and it is not known how each source was valued. Qualitative research is needed to better understand the complexity of abortion knowledge: where the various pieces of information are obtained, how women determine which sources are trustworthy, and which “facts” are believed. An educational component was added to this pilot study because the authors did not want to inadvertently raise concerns about abortion risk or leave participants susceptible to sources of abortion misinformation in the future. More than half of the women surveyed (53.7%; 36/67) were not aware that there are groups that provide inaccurate information about abortion. The educational component Table 3 Perceptions of health risks related to abortion (n=67) % (n) Which has lower health risk? Abortion in first trimester⁎ Continuing the pregnancy and having the baby Risk is the same Do not know Do women who have an abortion in the first trimester for an unplanned pregnancy have a higher risk of depression than women who continue the pregnancy? Yes No⁎ Don't know Do women who have an abortion in the first trimester have a higher risk of future infertility than women who continue the pregnancy? Yes No⁎ Don't know Is having an abortion associated with an increased risk of breast cancer? Yes No⁎ Don't know ⁎ The evidence-based correct answer.
20.9 (14) 23.9 (16) 53.7 (36) 1.5 (1)
43.3 (29) 49.3 (33) 7.5 (5)
22.4 (15) 74.6 (50) 3.0 (2)
6.0 (4) 89.6 (60) 4.5 (3)
4
L.L. Littman et al. / Contraception xx (2014) xxx–xxx
included providing participants with the evidence-based answers for the abortion risk questions and providing information about which sources are most likely to provide accurate (or inaccurate information) about abortion. One limitation of this study is that it was small with a narrow client base and thus may not be generalizable to the national population of abortion clients. In addition, recruitment was limited due to small patient volume, low rate of postabortion return visits and scheduling limitations of personnel. Women who return for follow-up visits after abortion may differ from women who do not, and this could potentially skew the results. Women who do not have concerns after abortion might decide not to return because they feel that they do not need another visit. These women might have fewer misperceptions about abortion risk, and results would be skewed in the direction of surveyed women having higher levels of misinformation than abortion patients who do not return for follow-up. Finally, this survey did not capture women who were not eligible to participate or those who may have been dissuaded by misinformation and opted against abortion. This was a pilot study aimed at generating hypotheses. Hypotheses to explore further are “A high proportion of abortion clients may be misinformed about the risks associated with abortion” and “Women who receive information regarding abortion from physicians may still have high levels of misinformation regarding the risks associated with abortion.” Despite the limitations of this pilot, the findings here do provide preliminary insights into the problem of misinformation and will help inform further exploration into this potentially harmful issue. All women deserve accurate information for health care decision making. When abortion clients are purposely provided with false information it may serve only to intimidate them, to cause emotional stress and/or to further the stigma surrounding abortion care. Evidence-based education interventions must be developed to ensure that all women seeking abortion know the true risks involved and are not encumbered by false ones. Supplementary data to this article can be found online at http://dx.doi.org/10.1016/j.contraception.2014.03.005.
References [1] Di Mauro D, Joffe C. The religious right and the reshaping of sexual policy: an examination of reproductive rights and sexuality education. Sex Res Soc Policy [serial online] 2007;4(1):67–92 Available from: http://www.longviewinstitute.org/research/joffe/ religiousrightandsexuality Accessed 3/30/12. [2] Russo NF, Denious JE. Controlling birth: science, politics, and public policy. J Soc Issues 2005 Mar;61(1):181–91. [3] Kulczycki A. Ethics, ideology, and reproductive health policy in the United States. Stud Fam Plann 2007;38(4):333–51. [4] Kumar A, Hessini L, Mitchell EM. Conceptualising abortion stigma. Cult Health Sex 2009;11(6):625–39. [5] Gold RB, Nash E. State abortion counseling policies and the fundamental principles of informed consent. Guttmacher Pol Rev 2007;10:6–3. [6] Curfman GD, Morrissey S, Greene MF, Drazen JM. Physicians and the first amendment. N Engl J Med 2008 Dec 4;359(23):2484–5. [7] Lazzarini Z. South dakota's abortion script–threatening the physician-patient relationship. N Engl J Med 2008 Nov 20;359(21):2189–91. [8] Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol 2012;119 (2 Pt 1):215–9. [9] Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C. Abortion and mental health: evaluating the evidence. Am Psychol 2009;64(9):863–90. [10] Charles VE, Polis CB, Sridhara SK, Blum RW. Abortion and longterm mental health outcomes: a systematic review of the evidence. Contraception 2008;78(6):436–50. [11] Committee on Gynecologic Practice. ACOG committee opinion no. 434: induced abortion and breast cancer risk. Obstet Gynecol 2009;113 (6):1417–8. [12] National Cancer Institute Summary Report: early reproductive events and breast cancer workshop. Issues Law Med 2005;21(2):161–5. [13] Beral V, Bull D, Doll R, Peto R, Reeves G. Collaborative group on hormonal factors in breast cancer. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries. Lancet 2004 Mar 27;363(9414):1007–16. [14] Hogue CJ. Impact of abortion on subsequent fecundity. Clin Obstet Gynaecol 1986;13(1):95–03. [15] Donohoe M. Increase in obstacles to abortion: the American perspective in 2004. J Am Med Womens Assoc 2005;60(1):16–25. [16] Ott MA, Santelli JS. Abstinence and abstinence-only education. Curr Opin Obstet Gynecol 2007;19(5):446–52. [17] Rosen JD. The public health risks of crisis pregnancy centers. Perspect Sex Reprod Health 2012;44(3):201–5. [18] Bryant AG, Levi EE. Abortion misinformation from crisis pregnancy centers in North Carolina. Contraception 2012;86(6):752–6.
Original research article
Beliefs about abortion risks in women returning to the clinic after their abortions: a pilot study Lisa L. Littman a,⁎, Adam Jacobs a , Rennie Negron a , Tara Shochet b , Marji Gold c , Miriam Cremer d a
Icahn School of Medicine at Mount Sinai, Box 1043, New York, NY 10029-5204, USA b Consultant, Iowa City, IA c Albert Einstein College of Medicine d University of Pittsburgh Received 11 December 2012; revised 4 March 2014; accepted 5 March 2014
Abstract Background: Misinformation regarding the risks of abortion is prevalent and commonly includes medical inaccuracies about health, depression, infertility and breast cancer. This pilot study sought to assess misinformation among abortion clients as well as the origin(s) of their abortion knowledge. Study Design: Women who presented to the Mount Sinai School of Medicine Family Planning Division for postabortion follow-up were recruited for participation. Participants completed a researcher-administered survey regarding knowledge and beliefs about abortion. Results: Sixty-seven women completed the survey between 1/11/10 and 8/6/12. Common sources of abortion information included clinicians (79.1%), Web sites (70.1%), friends (50.7%) and family (40.3%). Over two thirds of women (77.6%) overestimated the health risks, and close to half (43.3%) overestimated the risk of depression after a first trimester abortion. Conclusions: Misperceptions about the health risks of abortion were prevalent among this sample. Education tools should be developed to provide accurate information about the risks of abortion. © 2014 Elsevier Inc. All rights reserved. Keywords: Abortion; Risks; Misinformation; Knowledge; Counseling
1. Introduction Inaccurate information about abortion is prevalent and often exaggerates the medical and psychological risks of the procedure [1–3]. Abortion misinformation is an important issue because all individuals deserve accurate information to make informed health decisions. Exposure to false information about abortion risk may increase women's anxiety about the procedure and influence their expectation of how well they will cope afterwards [2]. In addition, misinformation, particularly that which makes abortion seem uncommon or promotes negative stereotypes about women who have abortions, can contribute to abortion stigma [4]. From a broader
⁎ Corresponding author. Mount Sinai School of Medicine, Department of Preventive Medicine, Box 1043, New York, NY 10029–5204, USA. E-mail address: [email protected] (L.L. Littman). http://dx.doi.org/10.1016/j.contraception.2014.03.005 0010-7824/© 2014 Elsevier Inc. All rights reserved.
perspective, incorrect information about abortion in the public domain leads to public support (and politician justification) of policies that restrict access to abortion and of state-legislated mandatory physician scripts that violate the standards of informed consent [5–7]. Common types of abortion misinformation include assertions that abortion is dangerous, causes severe mental health disorders, impairs future fertility and increases the risk of breast cancer [1–3]. The evidence does not support these claims [8–14], and yet this type of incorrect material has been identified on Web sites [1,15], in abstinence-only education programs [16], in crisis pregnancy centers [1,3,17,18] and in state-legislated mandatory scripts for physicians [6,7]. Misinformation is prevalent and comes from many sources, but it is unclear what women having abortions actually believe about the service they are seeking. To the authors' best knowledge, there are no published studies from the United States
2
L.L. Littman et al. / Contraception xx (2014) xxx–xxx
regarding abortion clients and misinformation. The purpose of this study was to pilot a series of questions assessing the level of misinformation among abortion clients as well as the origin(s) of their abortion knowledge. The findings will inform a larger, cross-sectional study.
2. Materials and methods This was a hypothesis generating pilot study that utilized a researcher-administered survey to assess knowledge and beliefs about abortion and the types of services that could be offered to women around the time of abortion. A convenience sample of women who presented for a surgical abortion follow-up visit at the research site (Mount Sinai School of Medicine Family Planning Division, New York, NY) was invited to participate. Patients receiving abortions there are routinely scheduled for postoperative visits 2–3 weeks after their procedure. Eligibility criteria included being between the ages of 14–50, speaking English and being present on a day when a research team member was available for enrollment. Exclusion criteria included having had a termination procedure for a spontaneous or incomplete abortion. Those expressing interest met privately with one of the investigators where they were provided details about the study. Informed consent was obtained, for women wanting to participate, using a consent form in which no signature was required to ensure anonymity. The principal investigator administered the survey orally. Eligible women who declined participation were asked to complete a nonparticipant sheet, which included only demographic information. The study received Institutional Review Board (IRB) approval from the Mount Sinai Institutional Review Board. Prior to embarking on this pilot study, we tested recruitment feasibility at both abortion preoperative and postoperative visits using a similar survey instrument. We found that very few women agreed to participate at their preoperative visit, even when we shortened the survey to 15 min. We understand that women returning for their postoperative visits may not be representative of all patients receiving abortions; however, due to our low numbers of potential subjects overall as well as difficulty recruiting at preoperative visits, we decided to focus on postoperative patients in order to achieve a meaningful enrollment rate. The survey contained 25 dichotomous, multiple choice, Likert scale and short answer questions that included topics on common myths about abortion (4 questions), sources of abortion information (1 question), abortion support services (5 question), an educational opportunity question (1 question) and participant demographics (14 questions). The questions regarding common abortion myths and the educational opportunity question are included in Appendix 1. Although the survey questions were not piloted specifically for the literacy levels of our population, the authors felt that administering the survey orally and providing op-
portunities for participants to ask for clarification could overcome literacy limitations. In addition, efforts were made to avoid bias in the common myth questions. The question regarding awareness of groups that provide inaccurate abortion information was inserted as an educational opportunity, to be addressed after answers to the myth questions were reviewed. The survey took approximately 15–25 min to complete. Following completion of the common myths, sources of information and educational opportunity questions, participants were given a fact sheet with evidence-based answers to the myth questions. The researcher then reviewed the evidence-based answers with the participant, especially the questions that were answered incorrectly, and discussed potential sources of abortion information and misinformation. Data were collected by the survey administrator and then entered into Excel 2010 (Microsoft Corporation, Redmond, WA, USA). Analyses were conducted using STATA version 11 (StataCorp, College Station, TX, USA); survey responses are presented by frequency and/or means. Fischer's Exact tests were used to compare demographic data between correct and incorrect answers for the four common myth questions.
3. Results Of the 79 potential participants who were offered participation in the study, 67 (84.8%) agreed to complete the survey between 1/11/10 and 8/6/12. Participant characteristics are presented in Table 1. The collected demographics of the nonparticipants were comparable to those of the study participants (not shown). A large majority of women (79.1%; 53/67) reported getting information about abortion from their doctor or nurse (Table 2). In addition, many women obtained information from Web sites (70.1%; 47/ 67), friends (50.7%; 34/67) and/or family members (40.3%; 27/67). Fewer reported getting information from the media (31.3%; 21/67) or from their partner (10.4%; 7/67). Over two thirds of all participants (77.6%; 52/67) overestimated the health risks of a first trimester abortion compared to the risks of continuing a pregnancy and giving birth (see Table 3). Close to half of participants (43.3%; 29/ 67) overestimated the risk of depression after a single first trimester abortion compared to the risk of depression after continuing an unplanned pregnancy. In addition, more than 2 in 10 women (22.4%; 15/67) erroneously believed that abortion impairs future fertility and 6.0%; 4/67 incorrectly answered that abortion is associated with an increased risk for breast cancer. Older women and women with children were more likely to answer the infertility question correctly (Fischer's Exact test = .001 and .036, respectively); women with less education were more likely to answer the depression question correctly (Fischer's Exact test = .007); and compared to non-Black women, Black women are more
L.L. Littman et al. / Contraception xx (2014) xxx–xxx Table 1 Participants' characteristics: % (n)
Table 2 Sources for abortion information (n=67) Participants n= 67
Age in years b20 20–24 25–29 30–34 35 + Relationship status In a relationship, not married In a relationship, married Not currently in a relationship Race/Ethnicity Latina/Hispanic African American/Black Mixed race White Other Education level completed: % (n) Eleventh grade or less High school diploma or General Educational Development (GED) Assoc degree/trade school/tech degree Some college College degree or greater Importance of religion in participant's life Somewhat or very important Not important Not applicable/don't know Frequency of attending religious institution At least once per week One to three times per month Less than once per month Never Refused/Do not know Health insurance Medicaid Private Military None Has one or more children Had one or more prior abortions Weeks gestation: mean±SD (range) Weeks since abortion: mean±SD (range)
3
10.4 (7) 35.8 (24) 31.3 (21) 13.4 (9) 9.0 (6) 74.6 (50) 10.4 (7) 14.9 (10) 41.8 (28) 38.8 (26) 9.0 (6) 7.5 (5) 3.0 (2) 15.6 (10) 42.2 (27) 14.1 (9) 20.3 (13) 7.8 (5) 89.6 (60) 7.5 (5) 3.0 (2) 14.9 (10) 29.9 (20) 22.4 (15) 31.3 (21) 1.5 (1) 83.6 (56) 7.5 (5) 1.5 (1) 7.5 (5) 68.7 (46) 58.2 (39) 10.8±4.9 (3.5–23) 2.6±1.1 (1.5–8)
likely to answer the depression question correctly (Fischer's Exact test = .046) (data not shown). 4. Discussion Misperceptions about the health risks of abortion and the risk of depression after abortion were prevalent among this sample of women. Given the potential impact of misinformation on coping ability, these findings raise concerns about abortion clients who may be unnecessarily worried about the effect of abortion on their physical and emotional health. As a counter measure, public health campaigns as well as inclinic education tools need to be developed to provide women with accurate information about the safety and risks of abortion as well as to minimize abortion-related stigma.
% (n) a
Where participant got information about abortion Clinician Web site(s) Friend(s) Family member(s) Media Partner Other Participant was aware that there are groups that give out incorrect information about abortion Yes No a
79.1 (53) 70.1 (47) 50.7 (34) 40.3 (27) 31.3 (21) 10.4 (7) 13.4 (9)
53.7 (36) 46.3 (31)
Totals add up to N100% as multiple answers were allowed.
Although the majority of women in this study reported having received information about abortion from a medical professional, incorrect knowledge about abortion was highly prevalent. However, most participants obtained information from multiple sources, and it is not known how each source was valued. Qualitative research is needed to better understand the complexity of abortion knowledge: where the various pieces of information are obtained, how women determine which sources are trustworthy, and which “facts” are believed. An educational component was added to this pilot study because the authors did not want to inadvertently raise concerns about abortion risk or leave participants susceptible to sources of abortion misinformation in the future. More than half of the women surveyed (53.7%; 36/67) were not aware that there are groups that provide inaccurate information about abortion. The educational component Table 3 Perceptions of health risks related to abortion (n=67) % (n) Which has lower health risk? Abortion in first trimester⁎ Continuing the pregnancy and having the baby Risk is the same Do not know Do women who have an abortion in the first trimester for an unplanned pregnancy have a higher risk of depression than women who continue the pregnancy? Yes No⁎ Don't know Do women who have an abortion in the first trimester have a higher risk of future infertility than women who continue the pregnancy? Yes No⁎ Don't know Is having an abortion associated with an increased risk of breast cancer? Yes No⁎ Don't know ⁎ The evidence-based correct answer.
20.9 (14) 23.9 (16) 53.7 (36) 1.5 (1)
43.3 (29) 49.3 (33) 7.5 (5)
22.4 (15) 74.6 (50) 3.0 (2)
6.0 (4) 89.6 (60) 4.5 (3)
4
L.L. Littman et al. / Contraception xx (2014) xxx–xxx
included providing participants with the evidence-based answers for the abortion risk questions and providing information about which sources are most likely to provide accurate (or inaccurate information) about abortion. One limitation of this study is that it was small with a narrow client base and thus may not be generalizable to the national population of abortion clients. In addition, recruitment was limited due to small patient volume, low rate of postabortion return visits and scheduling limitations of personnel. Women who return for follow-up visits after abortion may differ from women who do not, and this could potentially skew the results. Women who do not have concerns after abortion might decide not to return because they feel that they do not need another visit. These women might have fewer misperceptions about abortion risk, and results would be skewed in the direction of surveyed women having higher levels of misinformation than abortion patients who do not return for follow-up. Finally, this survey did not capture women who were not eligible to participate or those who may have been dissuaded by misinformation and opted against abortion. This was a pilot study aimed at generating hypotheses. Hypotheses to explore further are “A high proportion of abortion clients may be misinformed about the risks associated with abortion” and “Women who receive information regarding abortion from physicians may still have high levels of misinformation regarding the risks associated with abortion.” Despite the limitations of this pilot, the findings here do provide preliminary insights into the problem of misinformation and will help inform further exploration into this potentially harmful issue. All women deserve accurate information for health care decision making. When abortion clients are purposely provided with false information it may serve only to intimidate them, to cause emotional stress and/or to further the stigma surrounding abortion care. Evidence-based education interventions must be developed to ensure that all women seeking abortion know the true risks involved and are not encumbered by false ones. Supplementary data to this article can be found online at http://dx.doi.org/10.1016/j.contraception.2014.03.005.
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