Abortion opponents love to claim that abortion clinics and even abortions themselves hurt women. They invoke these evidence-free beliefs when proposing anti-abortion laws designed to “protect” women from themselves, clinics, and the supposed ramifications of the procedure. Pro-choice advocates are quick to point out study after study showing abortion is safe, and that the best science of the last several decades proves that abortion does not cause any mental health problems. This is accurate and useful data, but it turns out that we actually know little about what contributes to a positive abortion experience from an abortion patient’s perspective. Knowing what patients value and need from a clinic at the time of their abortion can help us make sure that abortion care is not only safe, but also patient-centered and provided in a compassionate manner.
Dr. Diana Taylor and her colleagues at the University of California, San Francisco recently published findings from a prospective, observational study to identify which patient experiences are associated with positive or negative clinic experiences. They also investigated if patient experiences were influenced by having a different type of health professional perform the abortion, such as nurse practitioners, nurse midwives, and physician assistants, in addition to physicians. Dr. Taylor and her colleagues recruited over 9,000 patients from 22 different abortion clinics in California to participate in the study, and asked them to complete a post-procedure patient experience survey.
What they found is pretty astounding: Nearly three-quarters of participants reported that their abortion experience was better than they expected. This speaks to both the high quality of care at abortion clinics and also to the stigmatization of abortion. Other studies show that patients may believe that abortion clinics are unsafe medical establishments, which may be why they rate their quality of care so highly—they were expecting to receive low-quality care.
Dr. Taylor and her team also found that more than 80 percent of participants rated their treatment by both clinicians and clinic staff as excellent, and found that there was not a statistically significant difference in patient satisfaction depending on the type of clinician who performed the procedure. Some demographic factors contributed to patient satisfaction—compared to 20- to 24-year-olds, 16- to 19-year-olds were less likely to report an excellent experience at a clinic, while women age 35 and over were more likely to report an excellent experience. Black and Hispanic women and those with multiple ethnic identities were more likely to report an excellent experience than non-Hispanic white women.
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These socio-demographic data might suggest that it may be possible to anticipate patient experiences of abortion care based on certain patient characteristics, but actually, clinic-level factors have a much bigger impact on a patient’s experience. We need more qualitative data to understand why certain kinds of patients have slightly better experiences than others.
What’s amazing about this study is that it is the first one to identify these clinic-level factors that contribute to a positive abortion experience. The researchers discovered that the main contributors to women’s rating of their abortion care experience were treatment by the clinician performing the abortion, treatment by clinic staff, timeliness of care, and levels of pain during the abortion procedure. These are not issues that are unique to abortion care—improving these factors across the board in various health-care settings would likely improve patient satisfaction with their experience of health care. They also found that women’s satisfaction ratings did not change based on the type of clinician providing the abortion. This supports the growing body of evidence that physicians aren’t the only types of clinicians that can and should be performing abortion procedures.
With the mounting legislative regulation of abortion, it’s difficult to imagine a world in which we are working to improve abortion care quality instead of fighting to keep clinics open. But these concerns shouldn’t be prioritized one over the other. Roughly 1.2 million abortions occur in the United States every year, and we should do everything we can to maintain quality, which includes not just safety, but also patient-centered care.