Department of Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
Department of Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
Contraception. 2021 May;103(5):316-321. doi: 10.1016/j.contraception.2021.01.014. Epub 2021 Feb 3.
We explored how physicians conceptualize their role in contraceptive counseling at the time of abortion, including identifying clinician attitudes that may lead to patients' perceptions of contraceptive coercion.
We conducted individual semi-structured interviews using questions based on components of the Theory of Planned Behavior. We recruited physician abortion providers using purposeful sampling to attain diversity in practice setting and geographic practice region. We analyzed transcribed interviews using initial and values coding methods.
We interviewed 39 participants across the United States, who primarily self-reported as White female obstetrician gynecologists (OB/GYNs) aged 25 to 44. Over half of participants practiced in an academic setting. Participants perceived providing patient education and taking a patient-centered approach as part of their role in contraceptive counseling. Participants also believed it was their responsibility to prevent unintended pregnancies and subsequent abortions among their patients. External motivations behind this belief included wanting patients to avoid the challenges of obtaining another abortion, particularly in states with multiple abortion restrictions. Internal motivations included valuing professional goal attainment, discomfort with abortion, and abortion stigma. When physicians counseled about contraception, many expressed preferences toward methods of long-acting reversible contraception (LARC) and an emphasis on contraception provision for adolescents and women with prior abortions.
Physicians providing abortions strive to use a patient-centered approach to contraceptive counseling. However, many continue to be motivated by the goal of avoiding a subsequent abortion which patients may perceive as coercion towards contraceptive uptake.
Considering contraceptive counseling as a means to prevent subsequent abortion may lead to coercive practices, especially with specific patient populations. Moral codes and abortion stigma influence physicians' counseling practices and physicians must examine their personal values and motivations behind recommending contraception after an abortion.
我们探讨了医生在堕胎时如何看待自己在避孕咨询中的角色，包括确定可能导致患者认为避孕受到强制的临床医生态度。
我们使用基于计划行为理论组成部分的问题进行了个体半结构化访谈。我们通过有针对性的抽样招募了堕胎医生提供者，以实现实践环境和地理实践区域的多样性。我们使用初始和价值观编码方法分析了转录的访谈。
我们在美国各地采访了 39 名参与者，他们主要自我报告为年龄在 25 至 44 岁的白人女性妇产科医生（OB/GYN）。超过一半的参与者在学术环境中执业。参与者认为提供患者教育和采取以患者为中心的方法是他们在避孕咨询中角色的一部分。参与者还认为，他们有责任防止其患者意外怀孕和随后的堕胎。这种信念背后的外部动机包括希望患者避免获得另一次堕胎的挑战，特别是在有多个堕胎限制的州。内部动机包括重视专业目标的实现、对堕胎的不适以及堕胎耻辱感。当医生咨询避孕时，许多人表示对长效可逆避孕方法（LARC）的偏好，并强调为青少年和有过堕胎史的妇女提供避孕。
提供堕胎的医生努力采用以患者为中心的避孕咨询方法。然而，许多人仍然受到避免随后堕胎的目标的激励，而患者可能会认为这是对避孕的强制。
将避孕咨询视为预防随后堕胎的一种手段可能会导致强制做法，特别是针对特定的患者群体。道德准则和堕胎耻辱感影响医生的咨询实践，医生必须检查他们在堕胎后推荐避孕的个人价值观和动机。
