EXERCISES: ORIENTATION: ABORTION IN PERSPECTIVE

EXERCISE 1: Feelings about training and abortion provision

1. As you embark on this experience, consider how you might disclose this training to others. Are there parallels between the stigma that patients and providers experience?

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2. Consider this quotation on the role of conscience in abortion provision, and not just the historical focus on the refusal to participate. What are your thoughts on how this view might decrease stigma?

“[Providers] continue to offer abortion care because deeply held, core ethical beliefs compel them to do so. They see women’s reproductive autonomy as the linchpin of full personhood and self-determination, or they believe that women themselves best understand the life contexts in which childbearing decisions are made… among other reasons” (Harris 2012, “Recognizing Conscience in Abortion Provision,” NEJM).

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3. As you embark on this experience, consider the different backgrounds and identities of patients, yourself, and your trainer(s). Are there practices that can equalize power differentials and have information and feedback flow in both directions?

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EXERCISE 2: Practice environment

1. Reflect on some pros/cons patients might experience receiving abortion services in a primary care setting compared to a specialty setting.

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2. How would a one-week delay impact a patient’s care in your setting? Consider impacts of mandatory waiting periods, or changes to legislation in your area.

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EXERCISE 3: General feelings about pregnancy options

^{Adapted from The Abortion Option: A Values Clarification Guide for Health Care Professionals. (NAF 2005)}

Despite our efforts to be objective, we all hold personal values and belief systems that can influence how we respond to patients. These exercises can help you explore your values about pregnancy options in the context of professional judgments you may be called to make. In multiple global settings, participants in abortion values clarification workshops demonstrate improved knowledge, attitudes, and behavioral intentions with regards to abortion care (Turner 2018). Some of these exercises may evoke strong emotions which may require time for individual reflection prior to discussion.

EXERCISE 3.1

1. In general, how do you feel about your patients choosing abortion, adoption, or parenting in each of these situations? Are you challenged to accept a patient’s decision in the following circumstances? Were you surprised by any of your reactions? How have your life experiences contributed to these feelings? For a full set of Values Clarification Questions see A Values Clarification Guide for Health Care Professionals (NAF 2005).

• • If the pregnancy threatens their physical health or life
  • If the pregnancy involves a fetal abnormality (minor vs. incompatible with life)
  • If the patient has an active substance use disorder
  • If the patient is in a surrogacy contract
  • If you, as the provider, are pregnant

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EXERCISE 3.2: Your feelings about gestational age and abortion

1. At what gestational age do you start feeling uncomfortable about your patient choosing to have an abortion?

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2. Does it matter if you are making a referral vs. performing an abortion? Or the reason for the abortion? If so, why?

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EXERCISE 3.3: Your feelings about patients’ reasons or situation

1. How would you feel about referring or providing an abortion for a patient who:

1. 1. is ambivalent about the pregnancy but whose partner wants them to terminate
   2. wishes to obtain an abortion because they are carrying a female fetus
   3. has had a number of previous abortions
   4. indicates that they do not want any birth control method to use in the future
   5. conceived using assisted reproductive technology, but changed their mind
   6. is in a surrogacy contract and decided to end it
   7. tried unsuccessfully to end their pregnancy on their own before seeing you

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2. How might you handle your discomfort when caring for patients under these circumstances?

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