While most people feel relieved, some others might experience sadness, doubt, or a mix of emotions when they decide to have an abortion. For many people, the decision to have an abortion can be accompanied by anxiety, even when they are sure about their choice. This anxiety often stems from several factors, including exposure to misinformation and disinformation about abortion.
Societal narratives, which are often driven by various agendas, can distort facts and create an environment of fear and confusion. People may encounter inaccurate portrayals of the procedure, its effects, and its emotional or psychological impact, leading to unnecessary stress and uncertainty. These concerns might include exaggerated or entirely fabricated worries about physical health risks, future fertility, or long-term emotional well-being.
Another common reason for this anxiety is previous negative encounters with biased healthcare providers. Experiences where individuals feel judged or shamed or are given incomplete or skewed information can lead to distrust in the healthcare system. This can leave them feeling vulnerable and suspicious when seeking care from new providers, making them apprehensive about receiving compassionate and objective support. Such experiences can leave a lasting impact, making subsequent medical interactions, especially those as sensitive as an abortion, particularly anxiety-inducing.
This blog is designed for abortion providers, whether you are a medical doctor, nurse, midwife, community health extension worker, or abortion doula, to equip you with the right knowledge on what patient-centered abortion counselling should look like.
The Role of Counselling in Abortion Care
Abortion counselling is more than simply providing information before a procedure. According to the World Health Organization (WHO) clinical handbook on quality abortion, it is an interactive process where a person voluntarily receives support, information, and guidance about abortion from a trained professional. This is done in an environment that is conducive to openly sharing thoughts, feelings, and personal experiences.
The purpose of abortion counselling is not only to counteract misinformation by providing people with accurate, comprehensive, and unbiased information but also to empower them to navigate their decision-making process with clarity.
Effective counselling should go beyond just dispensing facts; it should involve:
- Clarifying Misconceptions: Directly addressing any misinformation or disinformation a person may have encountered. This includes offering evidence-based facts to debunk myths and alleviate unfounded fears.
- Presenting All Options: Ensuring the individual is fully aware of all available options, including continuing the pregnancy and adoption, without coercion or judgement. This allows for a truly autonomous decision.
- Explaining the Procedure: Providing a clear and empathetic explanation of the abortion procedure itself, including what to expect physically and emotionally, to reduce fear of the unknown.
- Discussing Potential Emotions: Acknowledging that a range of emotions—such as grief, relief, sadness, or peace—are normal and valid, both before and after an abortion. Normalising these feelings can be incredibly validating.
- Offering Emotional Support: Creating a safe and non-judgemental space where individuals feel comfortable expressing their anxieties, fears, and hopes. This includes active listening and empathetic responses.
Ultimately, by equipping individuals with accurate information and fostering an environment of trust and support, abortion counselling aims to empower them to make informed choices that align with their personal values and circumstances. This, in turn, helps mitigate anxiety and ensures the patient makes a choice that will improve their emotional well-being.
Core Principles of Effective Communication
Abortion counselling sessions, whether in-person or virtual, vary among organisations and providers. However, the main goal is to make the abortion seeker feel comfortable and informed so they can make the best decision for themselves.
To achieve this, communication should adhere to the following principles:
- Confidentiality: Establishing a secure environment is crucial, starting with confidentiality. A key reason individuals seek unsafe abortion methods is the fear of being reported. All sessions must be free from external influences, occurring solely between the patient and the provider. This ensures a safe and private setting, allowing the patient to ask questions comfortably and decide freely. To reduce anxiety, it is beneficial to provide an overview of abortion counselling, its importance, and what to expect during the session. Many people worry about being reported, so it is vital to explain that questions about health history and last menstrual periods are not for reporting, but to help the provider understand their condition and offer accurate information for informed decision-making.
- Non-judgemental Approach: Maintaining a neutral expression is essential for non-judgemental counselling. The use of non-stigmatising language is encouraged, as certain words have anti-choice origins intended to shame, reflect harmful assumptions, and are not medically accurate. Such language can instill fear and influence a patient’s decision.
- Comprehensive Question Answering: Given the abundance of misinformation surrounding abortion, it’s natural for patients to have questions. Providers must dedicate time to provide medically accurate answers and confirm that the patient understands the response. If a patient requires more information, they should be directed to reputable, medically accurate websites.
Building Empathy and Trust with Patients
People seeking an abortion face numerous challenges, including harassment from anti-choice groups, navigating abusive relationships, dealing with difficult pregnancies, and sifting through misinformation. Given these hurdles, abortion providers must offer empathetic and supportive care.
Building empathy is essential for trust. Providers should create a safe environment for patients, reassuring them of their security, as safety concerns are common among those seeking abortion.
Open and honest communication about the entire process is also crucial to address any anxiety they may have. Rather than downplaying the experience by saying it’s “just a bad period,” providers should explain that pain levels vary and individuals may experience pain differently. Such transparency fosters trust, which is vital for patients to share accurate information about their situation. This, in turn, enables providers to offer the most appropriate options and guidance.
Supporting Abortion Seekers Through Decision-Making
Pregnancy can evoke a range of reactions, from shock and confusion to stress, particularly when seeking a provider. The increasing closure of clinics due to restrictive anti-reproductive laws makes this challenge even more difficult.
During abortion counselling, abortion seekers require not only comprehensive information about their options but also access to compassionate care. Guiding them to the appropriate abortion method is crucial, as denying services can lead to long-term physical and emotional harm. The majority of individuals who choose to end a pregnancy are confident in their decision.
Therefore, when a person decides to terminate a pregnancy, it is essential to explain the different methods of abortion and recommend the most suitable one. Providers should explain what to expect during the process and how to contact them with any concerns. It is important to affirm their informed decision-making and offer supportive care throughout the process.
Support continues beyond the decision to have an abortion. Post-abortion information and education are vital to ensure that services meet the needs of abortion seekers, including the provision of contraception to prevent unplanned pregnancies. Providers should also address any lingering questions abortion seekers may have after the procedure.
If a person opts for alternative choices, unbiased referrals to trusted providers offering other forms of care should be provided.
Addressing Stigma and Misinformation in Counselling
Abortion stigma is a shared understanding that abortion is morally wrong and/or socially unacceptable. This stigma can manifest in three ways:
- Perceived stigma: The anticipated negative reactions or judgements from others once they learn of an individual’s decision to have an abortion.
- Experienced stigma: Actual discrimination faced by abortion seekers from others, including healthcare providers, due to their choice.
- Internalised stigma: When abortion seekers adopt negative experiences and perceptions into their decision-making process. This often leads to shame, guilt, and delays in seeking healthcare, out of concern for others’ opinions.
This stigma can be reinforced by biased healthcare providers who impose societal expectations and stigma on patients during sessions.
Abortion providers can combat stigma by addressing its root causes, such as misinformation and disinformation. They should educate clients on the importance of asking questions, creating a safe space for inquiries, and encouraging all questions. Maintaining a neutral counselling environment by using non-stigmatising language that avoids promoting shame is also crucial.
For abortion seekers in high-stigma environments, providing a resource list of medically accurate, research-backed information can be highly beneficial. This resource can guide them on how to manage stigma and process negative information that arises, especially from internalised stigma.
Counselling in Low-Resource or High-Stigma Settings
Abortion counselling varies for each individual, particularly in high-stigma environments such as countries with restrictive laws, religious societies, and low- to middle-income nations. In these contexts, accessing safe abortion methods that include counselling is often challenging. This can also limit abortion providers, who are restricted by law.
However, counselling interventions for abortion seekers facing financial or legal barriers can still be possible through:
- Encouraging Group Discussions: Open conversations about abortion help destigmatise the process, normalising it for those involved.
- Increasing Access to Information: In countries with restrictive laws, some providers may be hesitant to openly discuss abortion. In such cases, they can direct patients to verified resources that offer information and counselling services, often at a reduced cost or for free.
Continuous Learning: Improving Counselling Skills
Misinformation and disinformation regarding abortion persist. Anti-choice tactics often involve spreading inaccurate information, such as claims that abortions can be reversed, despite numerous studies proving otherwise.
To combat this, abortion providers should prioritise platforms that offer medically accurate, science-backed information for improving abortion care and counselling skills.
The free medical abortion course for providers by howtouseabortionpill designed in partnership with International Planned Parenthood Federation (IPPF) is a recommended course for providers looking to equip themselves with the knowledge to confidently support an abortion seeker through an abortion. This course comes with a FIGO-endorsed certificate and in several languages.
The free eLearning course covers overview of abortion care, how the abortion pills work, what an abortion seeker should expect or may experience during an abortion with pills and how to support a medical abortion in just a few self-paced lessons. The medical abortion course is suitable for all types of providers, also if you are still in training.
The safe2choose counselling course is another recommended self-paced online comprehensive sexual reproductive health course. It provides high-quality training for abortion counselors and offers free certification. Available in English and Spanish, the course covers vital topics like abortion stigma, sexual and reproductive health knowledge, digital safety tools, and self-care for counsellors.
This online certification is designed to enhance knowledge of skills and resources for abortion care providers, which is essential to improve the quality of abortion counseling.