Clinicians who want to add abortion services to their health center’s practice often wonder how to discuss this subject with staff and colleagues whose views on abortion are unknown. I have found it useful to bring up the subject in the context of a case discussion. The ideal case involves a woman well known to the staff who clearly needs an abortion – so much so that anyone but the most dogmatic "anti" would understand her need – but faces difficulty in getting the procedure done elsewhere. "If only she had been able to obtain this service from her own clinician, in the privacy of her provider’s office."
The case that hit home for my staff was a 26-year-old woman who had intermittently lost custody of her first two children because of suspected abuse and neglect. Because she had a consistently depressed affect, I had been trying for some time to get her into psychotherapy. Her husband was also our patient. He did most of the daytime childcare while she worked, and then he worked night shifts. He was clearly exhausted by this schedule. All of the staff knew the family, because they often arrived late or missed and had to be rescheduled for appointments. The children were always behind in their immunizations and were in our "children of concern" file. We had referred them to the social worker and to early intervention services. Everyone who knew them agreed that another child was the last thing this couple needed. The mother then came to us with another unplanned pregnancy, asking for an abortion. We referred her to the local Planned Parenthood and did not see her again until she returned in her sixth month of pregnancy. When I began her prenatal care, I asked her about the planned abortion. She said she just could not go to "one of those clinics." I asked if she would have been able to go through with an abortion from me, in our office. She said, "Of course. Are you going to be able to do that?" Her case helped to inspire me to provide abortion services in our family health center.
During a team meeting in the health center, this story gave everyone pause. The discussion quickly became heated, with some staff members sympathizing and others condemning this patient for having become pregnant. The conversation allowed us to use a concrete example to examine staff members’ objections. (A nurse said, "If abortion were readily available, some women might use it for birth control"; and a receptionist countered, "Well, which is preferable: another child for this family, or an abortion as birth control?") This case allowed us to discuss the importance of children being born wanted, not just as accidents of sexual activity. We talked about parenthood as a life-long responsibility, to be undertaken intentionally, not just because birth control failed.
Why should primary care clinicians offer early abortion?
- No picketers or harassment
- Patients with an unwanted pregnancy can make their health care decisions with a known health care system/health care provider
- Patients will have increased continuity of care
- Patients won’t have to travel for abortion services
- There will be decreased marginalization of women and of abortion providers as abortion is integrated into primary health care services
Staff Attitude Survey
Values Clarification Workshop
Frequently Asked Questions
