Valerie French1, Renaisa Anthony2, Chelsea Souder3, Christine Geistkemper4, Eleanor Drey5, Jody Steinauer6. 1. Bixby Center for Global Reproductive Health, San Francisco, CA, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: valerie.french@ucsf.edu. 2. College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: renaisa.anthony@unmc.edu. 3. College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: chelsea.souder@gmail.com. 4. College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: christine.geistkemper@gmail.com. 5. Bixby Center for Global Reproductive Health, San Francisco, CA, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: edrey@ucsf.edu. 6. Bixby Center for Global Reproductive Health, San Francisco, CA, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: jody.steinauer@ucsf.edu.
Abstract
OBJECTIVE: To assess the association of clinician referral with decision-to-abortion time. STUDY DESIGN: We conducted a cross-sectional survey of women seeking abortion at all three Nebraska abortion clinics. We defined referral as direct (information for an abortion clinic), inappropriate (information for a clinic that does not provide abortions) or no referral. Women reported when they recognized their pregnancy, decided to seek abortion and contacted a clinician. The primary outcome - decision-to-abortion time - was time from certain decision to abortion. We used multivariate linear regression analysis, controlling for potential confounders. RESULTS: Participants (n=356) were a mean of 26.8±5.3years old, primarily white (62%), unmarried (88%) and urban (87%), with a mean gestational duration of 8(2/7)weeks (S.D.±20days). Forty-six percent (164) had contacted a clinician and 30% (104) had discussed abortion with one before their abortion. Of those, 30% received a direct referral, 6% received an inappropriate referral and 64% received no referral. Decision-to-abortion time did not vary by referral type [mean difference compared with direct referral: inappropriate referral, 1.1days, 95% confidence interval (CI) -13.4 to 15.6, p=.88; no referral, -0.4days, 95% CI -7.0 to 6.3]. The most common reasons cited for delay in obtaining an abortion were an inability to get an earlier appointment (105/263, 40%) and time needed to raise money to pay for the abortion (73/263, 28%). CONCLUSION: While neither occurrence of referral nor type was associated with decision-to-abortion times, women in Nebraska continue to face barriers to timely abortion care. IMPLICATIONS: Additional research is needed to explore whether quality clinician referral improves abortion access and whether increased resources should be dedicated to improving referral patterns.
OBJECTIVE: To assess the association of clinician referral with decision-to-abortion time. STUDY DESIGN: We conducted a cross-sectional survey of women seeking abortion at all three Nebraska abortion clinics. We defined referral as direct (information for an abortion clinic), inappropriate (information for a clinic that does not provide abortions) or no referral. Women reported when they recognized their pregnancy, decided to seek abortion and contacted a clinician. The primary outcome - decision-to-abortion time - was time from certain decision to abortion. We used multivariate linear regression analysis, controlling for potential confounders. RESULTS:Participants (n=356) were a mean of 26.8±5.3years old, primarily white (62%), unmarried (88%) and urban (87%), with a mean gestational duration of 8(2/7)weeks (S.D.±20days). Forty-six percent (164) had contacted a clinician and 30% (104) had discussed abortion with one before their abortion. Of those, 30% received a direct referral, 6% received an inappropriate referral and 64% received no referral. Decision-to-abortion time did not vary by referral type [mean difference compared with direct referral: inappropriate referral, 1.1days, 95% confidence interval (CI) -13.4 to 15.6, p=.88; no referral, -0.4days, 95% CI -7.0 to 6.3]. The most common reasons cited for delay in obtaining an abortion were an inability to get an earlier appointment (105/263, 40%) and time needed to raise money to pay for the abortion (73/263, 28%). CONCLUSION: While neither occurrence of referral nor type was associated with decision-to-abortion times, women in Nebraska continue to face barriers to timely abortion care. IMPLICATIONS: Additional research is needed to explore whether quality clinician referral improves abortion access and whether increased resources should be dedicated to improving referral patterns.
Authors: Alice F Cartwright; Mihiri Karunaratne; Jill Barr-Walker; Nicole E Johns; Ushma D Upadhyay Journal: J Med Internet Res Date: 2018-05-14 Impact factor: 5.428