Insights: Options Counseling in Restricted Abortion Access States

Written by Stephanie Mischell

The current legal landscape of abortion care is varied and hostile. As more states ban or restrict abortion access, patients are facing more stigma and misinformation when navigating abortion care than ever. As clinicians, it is our duty to advocate for patients by providing nonjudgmental and compassionate options counseling, and accurate information, not only about the safety of abortion but the ever-changing legal and political landscape of abortion access.

Values-based, person-centered options counseling is a key skill for all clinicians, nurses, and health educators. Facets of good options counseling include centering the pregnant person’s values, avoiding assumptions about their feelings or wishes, and honoring their goals when it comes to abortion and pregnancy/parenting. Clinicians can use the Best Practice Guide for All-Options Pregnancy Counseling from Provide as a guide when providing options counseling. Misinformation regarding abortion care is ubiquitous and patients may rely on clinicians to be a source of accurate clinical information. These tenets must not change in restricted access states; patients navigating access barriers deserve just as compassionate, nonjudgmental, and accurate care as those in more supportive states. To date, there is no precedent to challenge the legality of presenting all options and giving medically accurate information and support. And the abortion bans in place currently target the provision of abortion care, not patients seeking or traveling for care. However, legal, financial, and geographic barriers to care will undoubtedly impact patients’ decision-making.

Patients in restricted access states seeking abortion care can find clinics and telehealth options in nearby states at or Clinicians can support their patients by helping to confirm gestational age, ensuring they schedule appointments at abortion clinics and not crisis pregnancy centers (CPCs), and offering to be a source for follow-up care if needed. For many, the barriers to care go beyond merely finding a clinic—travel, time off work, and extended childcare can be prohibitively costly. Patients can be referred to the National Abortion Hotline, the National Network of Abortion Funds, and/or Apiary for Practical Support for any financial assistance or logistical support needs.

These resources cannot replace community-based care, and abortion clinics will not be accessible to all patients. States with abortion bans have higher rates of self-managed abortion, also known as SMA.¹ SMA is a safe option, but patients may run the risk of criminalization. Clinicians can support patients self-sourcing by providing accurate resources, symptom management, and careful documentation to avoid patient criminalization.

RHAP Resources:

Pregnancy Options Counseling Model

Approach to Patients Undergoing Self-Managed Medication Abortion

Non-RHAP Resources:

Know Your State’s Abortion Laws: Guides for Medical Providers


1. Abigail R. A. Aiken, Jennifer E. Starling, Alexandra van der Wal, Sascha van der Vliet, Kathleen Broussard, Dana M. Johnson, Elisa Padron, Rebecca Gomperts, and James G. Scott, 2020: Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States. American Journal of Public Health 110, 90_97,

2. Goodman S, Flaxman G, and the TEACH Trainers Collaborative Working Group.* TEACH Early Abortion Training Workbook, Fifth Edition. UCSF Bixby Center for Global Reproductive Health: San Francisco, CA (2016).

3. Increasing access to abortion. ACOG Committee Opinion No. 815. American College of Obstetricians and Gynecologists. Obstet Gynecol 2020;136:e107–15.

4. Prager S, Carlisle S, Chaiten L, et al. 2020 Clinical Policy Guidelines for Abortion Care. 2020.

5. Best practice guide for all-options pregnancy counseling. Provide. Published October 2022. Accessed October 19, 2022.

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 Insights is unbiased, based on science alone.