164. Communication and Counseling Preferences of People who Chose Abortion during Adolescence

To interview people who chose abortion during adolescence about their preferences regarding abortion-related counseling and care including pre-procedure pregnancy options counseling. We conducted individual semi-structured interviews with people ages 18-35 years old who were pregnant before age 20 years old and chose abortion. We recruited participants through social media, a research registry, and flyers in healthcare facilities. We recorded and transcribed interviews. Following a thematic analysis approach, two independent coders coded all transcripts using Dedoose (9.0.17), using a consensus approach for reconciliation. We ascertained themes and selected representative quotations. Participants included 17 individuals (median 32, range 20-35 years old). Median age at time of abortion was 18 (range 14-19) years old. The sample was 58% (n=10) Caucasian and 65% (n=11) heterosexual. Satisfaction with care was largely related to effects of interpersonal interactions experienced in the abortion setting, as memories of the procedure itself were limited and unproblematic. Themes, with representative participant quotations embedded, included: 1) Endorsement of options counseling. Participants generally perceived options counseling before abortion as important and necessary, though they did not always feel they personally needed it, and wanted to make sure counseling did not feel “shoved in their faces.” 2) Desire for a gentle touch. Participants reported a perceived need for gentleness due to their adolescence, incongruent with the poor bedside manner they experienced from some nurses, physicians, and other staff. They expressed the desire to be treated personally and sensitively by providers, not just as “a job that they had to do.” 3) Avoiding judgment. Participants reported overall non-judgmental communication by center providers, including normalization of abortion care. This made them feel “comforted,” as though they were “not the only young mother that has ever came through their door.” 4) Importance of confidentiality. Participants desired privacy and confidentiality throughout their clinic appointment. They expressed concerns about limited privacy due to the logistics of their clinic. 5) Clear language. Participants appreciated medically accurate information about abortion in plain language, balancing safety and risk information, to reduce pre-procedural anxiety. They expressed that this was particularly important for adolescents in this age group with emerging but limited health literacy and for whom this interaction was often “the first gynecological experience we have of any type.” Negative experiences in abortion care facilities or with abortion clinic staff were generally not associated in the sample with decision regret or negative attitudes toward abortion. To the contrary, nearly all participants who reported such challenging experiences nevertheless remained satisfied years later with their abortion decision and supportive of abortion care for others, despite indicating areas for improvement in their clinical experience. Healthcare providers can improve care to young people considering abortion by tailoring pre-procedure options counseling to their specific level of need and interest, displaying a gentle bedside manner, normalizing abortion care, respecting desires for privacy and confidentiality, and providing medically accurate information in plain language.