- Email: [email protected]
Beyond the clinic: preferences, motivations, and experiences with alternative abortion care in North America
398
Abstracts / Contraception 94 (2016) 387–434
P19 “I DON'T RECOMMEND IT FOR THE WEAK OF HEART”: RESILIENCE AMONG PROVIDERS INITIATING SECOND-TRIMESTER INPATIENT ABORTION SERVICES Holmquist S University of Chicago, Chicago, IL, USA Newton S, Hebert L Objectives: We aimed to describe attitudes characteristic of resilience both employed by and suggested by physicians initiating second-trimester inpatient abortion services. Methods: Semistructured in-depth interviews were conducted with physicians who initiated or attempted to initiate second-trimester inpatient abortion services at US hospitals. Interviews explored participants' motivation for implementing services, implementation logistics, barriers encountered and methods they used to overcome them. Participants were asked what personal characteristics and attitudes were helpful to them and which they would suggest to other physicians hoping to initiate these services. Interviews were transcribed, coded and analyzed to identify common themes. Results: A geographically diverse sample of 21 physicians was interviewed. Participants articulated several personal characteristics and attitudes that were helpful in overcoming barriers to service initiation, including optimism, a sense of humor, patience, perseverance, determination and commitment to the mission. Participants' attitudes mapped closely to characteristics of resilience and ego strength: the ability to maintain one's identity and cope in the face of adversity and stress. Common themes included having positive views of themselves and their abilities, sticking to plans, maintaining an internal locus of control, having good communication skills, identifying as a fighter not a victim, being mission driven and drawing from a strong support network. Further, participants described lending their ego strength to coworkers to facilitate service provision. Conclusions: Providers initiating second-trimester surgical abortion services in the inpatient setting articulate characteristics of ego strength and resilience. Fostering these attitudes in providers wishing to initiate these services may protect them against stigma and help them overcome barriers inherent in abortion provision.
themes included: emotional distress about the injection directly ending the pregnancy; discomfort carrying a deceased fetus; and physical discomfort and anxiety regarding the injection. Another theme that emerged was confusion about why the injection was part of the procedure. Conclusions: Experiences with digoxin before D&E are polarized. While there was little confusion about digoxin's effect, there was much confusion about the reason for its use. Patient preferences should be considered in decisions to administer digoxin before D&E. http://dx.doi.org/10.1016/j.contraception.2016.07.060
P21 NEGOTIATING MASCULINITIES IN THE EXPERIENCES OF MALE PARTNERS ACCOMPANYING WOMEN AT THE TIME OF ABORTION: RESULTS FROM A QUALITATIVE STUDY Newton S University of Chicago, Chicago, IL, USA Hebert L, Nguyen B, Reid V III, Gilliam M University of Chicago, Chicago, IL, USA
PATIENT EXPERIENCES WITH DIGOXIN INJECTION BEFORE DILATION AND EVACUATION: A QUALITATIVE STUDY
Objectives: Though women remain the focal point of abortion care, supportive male partners often accompany women to their appointments. This study uses Connell's (1995) hierarchy of masculinities framework to better understand how male partners determine and negotiate their role in their partner's abortion. Methods: We conducted 27 in-depth interviews between April and August 2015 with male partners of women obtaining an abortion at a communitybased abortion clinic or at a university-based abortion clinic. Transcripts were double coded using deductive and inductive methods, and emergent themes were analyzed using a thematic content approach. Results: The interviews generally reflected male partners' struggles to adopt characteristics typical of hegemonic masculinity (e.g., power, stoicism, competence, and status) in order to “be a man” in the abortion setting. In an environment where women's needs were prioritized, some male partners expressed distress about their unfamiliarity with the procedure, their limited ability to participate and uncertainty about how to care for their partners at the time of the abortion. Other male partners identified with alternative expressions of masculinity, voicing a duty to take responsibility and to provide instrumental and social or emotional support during their partner's decision making and abortion experience. Conclusions: Male partners who accompany women to their abortion may desire to behave according to the expectations of hegemonic masculinity. Doing so may be difficult in a space where women are prioritized, which may lead some male partners to reexamine their concept of masculinity.
McNamara B Yale University School of Medicine, New Haven, CT, USA
http://dx.doi.org/10.1016/j.contraception.2016.07.061
http://dx.doi.org/10.1016/j.contraception.2016.07.059
P20
Russo J, Jacobson J, Kerns J
P22 Objectives: The use of digoxin as a feticidal agent before dilation and evacuation (D&E) abortions has increased over the past decade despite a lack of evidence for its use for this purpose. We sought to qualitatively understand patients' experiences with digoxin injection as a step before D&E. Methods: We recruited English-speaking women from one abortion clinic where digoxin is routinely used before D&Es over 18 weeks. We interviewed participants 1–3 weeks after the D&E about physical and emotional experiences with digoxin and understanding of its purpose. Using grounded theory, we analyzed transcripts iteratively, identifying themes from interviews. Women were recruited until thematic saturation and were compensated US$20. Results: The 14 women interviewed were equally divided on whether the injection was worse or better than expected. Women reported both positive and negative experiences with digoxin; none had neutral experiences. Positive experience themes included: comfort knowing that fetal demise occurred before the procedure; belief that digoxin makes the procedure faster and safe; and digoxin makes the abortion decision real and final. Negative experience
BEYOND THE CLINIC: PREFERENCES, MOTIVATIONS, AND EXPERIENCES WITH ALTERNATIVE ABORTION CARE IN NORTH AMERICA Ojanen-Goldsmith A University of Washington, School of Medicine, Department of Ob/Gyn, Division of Family Planning, Seattle, WA, USA Prager S Objectives: Recent research from Texas found that self-provided and nonclinical abortions are on the rise, largely due to abortion restrictions. Anecdotal evidence from other abortion advocates suggests that some people seek alternative abortion methods for other reasons. This is the first qualitative study with a geographically diverse North American sample to describe people's preferences, motivations and experiences with alternative abortion outside the formal health care system.
Abstracts / Contraception 94 (2016) 387–434
Methods: Using community engagement and peer-to-peer sampling, researchers recruited 25 people who had recently used or provided alternative abortion methods in North America to contribute in-depth interviews. Researchers asked participants to describe specific influential, logistical and experiential factors related to seeking and providing alternative abortion care. Transcripts were coded using in vivo codes, and a community expert consulted on thematic analysis to construct a theoretical framework. Demographic data were also collected. Results: Participants were located across the United States and Canada. Participants used a combination of methods early in the first trimester, with varying degrees of success. Most participants reported a prior in-clinic abortion, and those experiences factored into their decision to seek alternative methods. The desire for privacy, control and active participation in the process were other key factors, as was gaining bodily knowledge and autonomy. Community-based abortion providers described providing safe and effective abortions and cited several barriers to obtaining an inclinic abortion as reasons people sought their services. Conclusions: People use and provide alternative abortion methods for several reasons. This research can help advocates understand these emerging trends and inform future access to safe abortion care. http://dx.doi.org/10.1016/j.contraception.2016.07.062
P23 THE WOMEN WHO SERVE: A QUALITATIVE STUDY OF ABORTION DOULAS Whaley N University of Rochester, Rochester, NY, USA Sufrin C Objectives: Abortion doulas are nonclinical volunteers who reduce women's isolation by providing emotional and physical support during an abortion. Thousands of people benefit from abortion doula care annually, yet no research on abortion doulas exists. We explore the range of shared characteristics and perspectives of abortion doulas, including their motivations, challenges and rewards of training and work and perceptions of the health care team and abortion care. Methods: We conducted in-depth, qualitative interviews with 28 abortion doulas. A national recruitment scheme included snowball sampling from regional abortion doula networks and referral from providers. The study design employed a social constructionist framework informed by feminist and social justice paradigms. Interview guides incorporated the feedback of practicing doulas. Qualitative data analysis was performed using grounded theory. Results: Abortion doulas reported meaning and satisfaction from supporting the reproductive rights of women in their role. Doulas' insight into the diversity of ways abortion is experienced by women — including relief, sadness, pain, shame and ambivalence — and aids their ability to provide personalized care during an abortion. Their observation of the power imbalance in the provider–patient relationship is an unexpected finding that highlights areas for improved patientcentered communication and care as part of abortion services. Conclusions: Abortion doulas' perspectives provide valuable insight into the provision of abortion from a novel vantage point. Abortion doulas view their role as validating the abortion experience for women and view themselves as reproductive rights activists. They play an important role in the abortion experience, and their continued work should be supported by the abortion provider community. http://dx.doi.org/10.1016/j.contraception.2016.07.063
P24 TWEETING PP: AN ANALYSIS OF THE 2015–2016 PLANNED PARENTHOOD CONTROVERSY ON TWITTER Han L University of California, Santa Barbara, Santa Barbara, CA, USA Rodriguez M, Han L
399
Objectives: We analyzed Twitter data to provide geographic, temporal and contextual insight into the use of social media related to the Planned Parenthood video controversy. Methods: We randomly sampled the Twitter Firehose using Crimson Hexagon. We analyzed tweets from 30,000 users containing the phrase “planned parenthood” as well as group-defining hashtags “#defundpp” and “#standwithpp”. Demographic content and contextual data were used to generate charts, maps and timeline visualizations. Chi-square and t tests were used to compare differences in content, statistical references and rhetorical strategies. Results: From July 14, 2015 to January 30, 2016, some 1,364,131 and 795,791 tweets contained “#defundpp” and “#standwithpp,” respectively. Geographically, #defundpp and #standwithpp were disproportionally localized to the US South and West, respectively. Word analysis found that early tweets predominantly used “sensational” words, and the proportion of political and “call to action” tweets increased over time. Scatterplots revealed that #standwithpp tweets were more clustered and episodic than #defundpp tweets. #standwithpp users were more likely to be female (OR, 2.2; 95% CI, 2.0–2.4) and have fewer followers (mean 3682 vs. 7500, pb.0001). In statistical posts, the usage of #standwithpp versus #defundpp did not differ significantly. However, #defundpp users were more likely to link to Web sites (OR, 1.8; 95% CI, 1.7–1.9) and crosslink to other threads (mean: 3.3 vs. 2.0, pb.0001). Conclusions: Social media plays an important role in information dissemination, amplification and reflection of public sentiment in medical controversy. Further research is needed to understand how these tools are being used, in order to disseminate accurate, viral, medical information to the public. http://dx.doi.org/10.1016/j.contraception.2016.07.064
P25 “REGRET,” “RISK,” AND “MURDER”: AN ANALYSIS OF ABORTION STIGMA IN THE NEWS Nixon L Berkeley Media Studies Group, Berkeley, CA, USA Mejia P, Arbatman L, Seklir L, Woodruff K, Cockrill K, Harold S, Himiak L, Dorfman L Objectives: Abortion regularly makes headlines — but do those headlines help or hurt efforts to destigmatize the issue? Berkeley Media Studies Group is partnering with The Sea Change Program to analyze and identify abortion stigma in the media and develop strategies to address it. Methods: We conducted an ethnographic content analysis of major US newspapers and selected online news sources from 2014 to 2015. Our analysis focused on the use of stigmatizing language and frames about abortion. We searched for articles that mentioned any variant of “abortion,” “unborn child,” “pro-life,” “pro-choice,” or “fetus” at least three times. Results: We analyzed 285 news articles and opinion pieces from 17 major US news sources, both print and online. Results suggest that abortion coverage could reinforce stigma through the limited range of speakers cited in coverage and the use of language that associated abortion with selfishness, regret, mental and physical harm and irresponsibility. Pro- and antiabortion arguments were not presented with equal weight, and stories of personal experiences with abortion were rarely included in news articles. Abortion was frequently framed as a political issue, rather than as a medical procedure that affects women's health. Conclusions: These findings suggest that news coverage offers an inaccurate picture of abortion in the United States and may reinforce abortion stigma. Recommendations are needed for journalists, health practitioners and advocates on how to improve news coverage of abortion to address stigma and provide more accurate portrayals of the issue to inform policymakers and the public. http://dx.doi.org/10.1016/j.contraception.2016.07.065
Abstracts / Contraception 94 (2016) 387–434
P19 “I DON'T RECOMMEND IT FOR THE WEAK OF HEART”: RESILIENCE AMONG PROVIDERS INITIATING SECOND-TRIMESTER INPATIENT ABORTION SERVICES Holmquist S University of Chicago, Chicago, IL, USA Newton S, Hebert L Objectives: We aimed to describe attitudes characteristic of resilience both employed by and suggested by physicians initiating second-trimester inpatient abortion services. Methods: Semistructured in-depth interviews were conducted with physicians who initiated or attempted to initiate second-trimester inpatient abortion services at US hospitals. Interviews explored participants' motivation for implementing services, implementation logistics, barriers encountered and methods they used to overcome them. Participants were asked what personal characteristics and attitudes were helpful to them and which they would suggest to other physicians hoping to initiate these services. Interviews were transcribed, coded and analyzed to identify common themes. Results: A geographically diverse sample of 21 physicians was interviewed. Participants articulated several personal characteristics and attitudes that were helpful in overcoming barriers to service initiation, including optimism, a sense of humor, patience, perseverance, determination and commitment to the mission. Participants' attitudes mapped closely to characteristics of resilience and ego strength: the ability to maintain one's identity and cope in the face of adversity and stress. Common themes included having positive views of themselves and their abilities, sticking to plans, maintaining an internal locus of control, having good communication skills, identifying as a fighter not a victim, being mission driven and drawing from a strong support network. Further, participants described lending their ego strength to coworkers to facilitate service provision. Conclusions: Providers initiating second-trimester surgical abortion services in the inpatient setting articulate characteristics of ego strength and resilience. Fostering these attitudes in providers wishing to initiate these services may protect them against stigma and help them overcome barriers inherent in abortion provision.
themes included: emotional distress about the injection directly ending the pregnancy; discomfort carrying a deceased fetus; and physical discomfort and anxiety regarding the injection. Another theme that emerged was confusion about why the injection was part of the procedure. Conclusions: Experiences with digoxin before D&E are polarized. While there was little confusion about digoxin's effect, there was much confusion about the reason for its use. Patient preferences should be considered in decisions to administer digoxin before D&E. http://dx.doi.org/10.1016/j.contraception.2016.07.060
P21 NEGOTIATING MASCULINITIES IN THE EXPERIENCES OF MALE PARTNERS ACCOMPANYING WOMEN AT THE TIME OF ABORTION: RESULTS FROM A QUALITATIVE STUDY Newton S University of Chicago, Chicago, IL, USA Hebert L, Nguyen B, Reid V III, Gilliam M University of Chicago, Chicago, IL, USA
PATIENT EXPERIENCES WITH DIGOXIN INJECTION BEFORE DILATION AND EVACUATION: A QUALITATIVE STUDY
Objectives: Though women remain the focal point of abortion care, supportive male partners often accompany women to their appointments. This study uses Connell's (1995) hierarchy of masculinities framework to better understand how male partners determine and negotiate their role in their partner's abortion. Methods: We conducted 27 in-depth interviews between April and August 2015 with male partners of women obtaining an abortion at a communitybased abortion clinic or at a university-based abortion clinic. Transcripts were double coded using deductive and inductive methods, and emergent themes were analyzed using a thematic content approach. Results: The interviews generally reflected male partners' struggles to adopt characteristics typical of hegemonic masculinity (e.g., power, stoicism, competence, and status) in order to “be a man” in the abortion setting. In an environment where women's needs were prioritized, some male partners expressed distress about their unfamiliarity with the procedure, their limited ability to participate and uncertainty about how to care for their partners at the time of the abortion. Other male partners identified with alternative expressions of masculinity, voicing a duty to take responsibility and to provide instrumental and social or emotional support during their partner's decision making and abortion experience. Conclusions: Male partners who accompany women to their abortion may desire to behave according to the expectations of hegemonic masculinity. Doing so may be difficult in a space where women are prioritized, which may lead some male partners to reexamine their concept of masculinity.
McNamara B Yale University School of Medicine, New Haven, CT, USA
http://dx.doi.org/10.1016/j.contraception.2016.07.061
http://dx.doi.org/10.1016/j.contraception.2016.07.059
P20
Russo J, Jacobson J, Kerns J
P22 Objectives: The use of digoxin as a feticidal agent before dilation and evacuation (D&E) abortions has increased over the past decade despite a lack of evidence for its use for this purpose. We sought to qualitatively understand patients' experiences with digoxin injection as a step before D&E. Methods: We recruited English-speaking women from one abortion clinic where digoxin is routinely used before D&Es over 18 weeks. We interviewed participants 1–3 weeks after the D&E about physical and emotional experiences with digoxin and understanding of its purpose. Using grounded theory, we analyzed transcripts iteratively, identifying themes from interviews. Women were recruited until thematic saturation and were compensated US$20. Results: The 14 women interviewed were equally divided on whether the injection was worse or better than expected. Women reported both positive and negative experiences with digoxin; none had neutral experiences. Positive experience themes included: comfort knowing that fetal demise occurred before the procedure; belief that digoxin makes the procedure faster and safe; and digoxin makes the abortion decision real and final. Negative experience
BEYOND THE CLINIC: PREFERENCES, MOTIVATIONS, AND EXPERIENCES WITH ALTERNATIVE ABORTION CARE IN NORTH AMERICA Ojanen-Goldsmith A University of Washington, School of Medicine, Department of Ob/Gyn, Division of Family Planning, Seattle, WA, USA Prager S Objectives: Recent research from Texas found that self-provided and nonclinical abortions are on the rise, largely due to abortion restrictions. Anecdotal evidence from other abortion advocates suggests that some people seek alternative abortion methods for other reasons. This is the first qualitative study with a geographically diverse North American sample to describe people's preferences, motivations and experiences with alternative abortion outside the formal health care system.
Abstracts / Contraception 94 (2016) 387–434
Methods: Using community engagement and peer-to-peer sampling, researchers recruited 25 people who had recently used or provided alternative abortion methods in North America to contribute in-depth interviews. Researchers asked participants to describe specific influential, logistical and experiential factors related to seeking and providing alternative abortion care. Transcripts were coded using in vivo codes, and a community expert consulted on thematic analysis to construct a theoretical framework. Demographic data were also collected. Results: Participants were located across the United States and Canada. Participants used a combination of methods early in the first trimester, with varying degrees of success. Most participants reported a prior in-clinic abortion, and those experiences factored into their decision to seek alternative methods. The desire for privacy, control and active participation in the process were other key factors, as was gaining bodily knowledge and autonomy. Community-based abortion providers described providing safe and effective abortions and cited several barriers to obtaining an inclinic abortion as reasons people sought their services. Conclusions: People use and provide alternative abortion methods for several reasons. This research can help advocates understand these emerging trends and inform future access to safe abortion care. http://dx.doi.org/10.1016/j.contraception.2016.07.062
P23 THE WOMEN WHO SERVE: A QUALITATIVE STUDY OF ABORTION DOULAS Whaley N University of Rochester, Rochester, NY, USA Sufrin C Objectives: Abortion doulas are nonclinical volunteers who reduce women's isolation by providing emotional and physical support during an abortion. Thousands of people benefit from abortion doula care annually, yet no research on abortion doulas exists. We explore the range of shared characteristics and perspectives of abortion doulas, including their motivations, challenges and rewards of training and work and perceptions of the health care team and abortion care. Methods: We conducted in-depth, qualitative interviews with 28 abortion doulas. A national recruitment scheme included snowball sampling from regional abortion doula networks and referral from providers. The study design employed a social constructionist framework informed by feminist and social justice paradigms. Interview guides incorporated the feedback of practicing doulas. Qualitative data analysis was performed using grounded theory. Results: Abortion doulas reported meaning and satisfaction from supporting the reproductive rights of women in their role. Doulas' insight into the diversity of ways abortion is experienced by women — including relief, sadness, pain, shame and ambivalence — and aids their ability to provide personalized care during an abortion. Their observation of the power imbalance in the provider–patient relationship is an unexpected finding that highlights areas for improved patientcentered communication and care as part of abortion services. Conclusions: Abortion doulas' perspectives provide valuable insight into the provision of abortion from a novel vantage point. Abortion doulas view their role as validating the abortion experience for women and view themselves as reproductive rights activists. They play an important role in the abortion experience, and their continued work should be supported by the abortion provider community. http://dx.doi.org/10.1016/j.contraception.2016.07.063
P24 TWEETING PP: AN ANALYSIS OF THE 2015–2016 PLANNED PARENTHOOD CONTROVERSY ON TWITTER Han L University of California, Santa Barbara, Santa Barbara, CA, USA Rodriguez M, Han L
399
Objectives: We analyzed Twitter data to provide geographic, temporal and contextual insight into the use of social media related to the Planned Parenthood video controversy. Methods: We randomly sampled the Twitter Firehose using Crimson Hexagon. We analyzed tweets from 30,000 users containing the phrase “planned parenthood” as well as group-defining hashtags “#defundpp” and “#standwithpp”. Demographic content and contextual data were used to generate charts, maps and timeline visualizations. Chi-square and t tests were used to compare differences in content, statistical references and rhetorical strategies. Results: From July 14, 2015 to January 30, 2016, some 1,364,131 and 795,791 tweets contained “#defundpp” and “#standwithpp,” respectively. Geographically, #defundpp and #standwithpp were disproportionally localized to the US South and West, respectively. Word analysis found that early tweets predominantly used “sensational” words, and the proportion of political and “call to action” tweets increased over time. Scatterplots revealed that #standwithpp tweets were more clustered and episodic than #defundpp tweets. #standwithpp users were more likely to be female (OR, 2.2; 95% CI, 2.0–2.4) and have fewer followers (mean 3682 vs. 7500, pb.0001). In statistical posts, the usage of #standwithpp versus #defundpp did not differ significantly. However, #defundpp users were more likely to link to Web sites (OR, 1.8; 95% CI, 1.7–1.9) and crosslink to other threads (mean: 3.3 vs. 2.0, pb.0001). Conclusions: Social media plays an important role in information dissemination, amplification and reflection of public sentiment in medical controversy. Further research is needed to understand how these tools are being used, in order to disseminate accurate, viral, medical information to the public. http://dx.doi.org/10.1016/j.contraception.2016.07.064
P25 “REGRET,” “RISK,” AND “MURDER”: AN ANALYSIS OF ABORTION STIGMA IN THE NEWS Nixon L Berkeley Media Studies Group, Berkeley, CA, USA Mejia P, Arbatman L, Seklir L, Woodruff K, Cockrill K, Harold S, Himiak L, Dorfman L Objectives: Abortion regularly makes headlines — but do those headlines help or hurt efforts to destigmatize the issue? Berkeley Media Studies Group is partnering with The Sea Change Program to analyze and identify abortion stigma in the media and develop strategies to address it. Methods: We conducted an ethnographic content analysis of major US newspapers and selected online news sources from 2014 to 2015. Our analysis focused on the use of stigmatizing language and frames about abortion. We searched for articles that mentioned any variant of “abortion,” “unborn child,” “pro-life,” “pro-choice,” or “fetus” at least three times. Results: We analyzed 285 news articles and opinion pieces from 17 major US news sources, both print and online. Results suggest that abortion coverage could reinforce stigma through the limited range of speakers cited in coverage and the use of language that associated abortion with selfishness, regret, mental and physical harm and irresponsibility. Pro- and antiabortion arguments were not presented with equal weight, and stories of personal experiences with abortion were rarely included in news articles. Abortion was frequently framed as a political issue, rather than as a medical procedure that affects women's health. Conclusions: These findings suggest that news coverage offers an inaccurate picture of abortion in the United States and may reinforce abortion stigma. Recommendations are needed for journalists, health practitioners and advocates on how to improve news coverage of abortion to address stigma and provide more accurate portrayals of the issue to inform policymakers and the public. http://dx.doi.org/10.1016/j.contraception.2016.07.065