Women who choose abortion are certain of the decision

Female doctor explaining diagnosis to her female patient (javi_indy)

Women seeking an abortion tend to be more certain of their choice, even after the procedure, than people making other healthcare decisions, according to a new U.S. study.

Some state laws require waiting periods, ultrasounds or counseling before abortions are provided, ostensibly to give women more time to make up their minds.

But the results suggest that women who choose an abortion have very little uncertainty by the time they arrive at the clinic seeking information, researchers say.

"Levels of certainty about the decision to have an abortion were comparable to, and often higher than, levels of certainty found in other studies of men and women making other health care decisions like whether to have a mastectomy after a breast cancer diagnosis, undergo prenatal testing after infertility, or have reconstructive knee surgery," said lead author Lauren J. Ralph of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco.

"Our finding directly challenges the idea that decision-making on abortion is somehow exceptional and requires additional protection, such as state laws that mandate waiting periods or targeted counseling and whose stated purpose is to prevent women from making an unconsidered decision," Ralph told Reuters Health by email.

In the recent debate between vice presidential candidates Democratic Virginia senator Tim Kaine and Republican Indiana governor Mike Pence, the appropriateness of abortion restrictions came up and Kaine said his ticket "trusts" women to make the decision for themselves.

The new study assessed decisional certainty among 500 women seeking abortion care at four family planning facilities in Utah. All completed baseline surveys and two-thirds answered follow-up questions by phone three weeks later.

Utah requires that women seeking an abortion visit the clinic and hear a face-to-face "information script" from their provider at least three days before actually receiving an abortion. During this first visit, the women participating in the study completed a survey rating 20 items designed to assess how informed, certain or conflicted they were about their decision.

On average the women were 25 years old, most were white and half had never had any children. Most were employed or in school and most were in a relationship with or married to the man involved in the pregnancy.

More than half of women strongly agreed with every item on the certainty scale, including, "I know which options are available to me" and "I expect to stick to my decision." The one exception was the item: "this decision is easy for me to make."

The results of the decisional conflict scales, scored from 1 to 100 with higher scores representing higher conflict or uncertainty, showed the women overall to be very sure of their choice. Mean scores were 15.5/100 and 12.4/100.

According to the follow-up phone interviews, 267 women, or 89 percent of the group, did return to the clinic for an abortion. The 11 percent who were still pregnant at that point had scored higher on the uncertainty scale when surveyed at the clinic, with a mean uncertainty score of 28.5, compared to a mean of 13.5 among women who went through with an abortion.

That indicates the tests were accurate in gauging decisional certainty, the study team writes in the journal Contraception.

To those who work in the abortion area, and who are familiar with how women handle an unplanned pregnancy and the decisions surrounding it, the new study's results are not surprising, said Louise Keogh of the Melbourne School of Population and Global Health at The University of Melbourne in Australia, who was not part of the new study.

"But it is fantastic to have confirmation of the fact that women are able to make the decision to end a pregnancy with a high level of certainty," Keogh told Reuters Health by email.

The results confirm that forcing women to wait or view an ultrasound before going through with an abortion is inappropriate practice, she said.

"I think they support the model we have in Victoria, Australia, where women are assumed to be capable of making the decision, and of accessing the support they need to do so," she said.

"Laws aimed at preventing women from making an unconsidered decision about abortion - including mandatory waiting periods and information scripts, ultrasound review requirements, and parental involvement requirements - are common in the U.S.," Ralph said.

"These laws presuppose that most women are conflicted in their decision about abortion, and need additional time and information to make a decision," she said.