Influence of clinician referral on Nebraska women's decision-to-abortion time

Valerie French; Renaisa Anthony; Chelsea Souder; Christine Geistkemper; Eleanor Drey; Jody Steinauer

doi:10.1016/j.contraception.2015.10.005

Influence of clinician referral on Nebraska women's decision-to-abortion time

Contraception. 2016 Mar;93(3):236-43. doi: 10.1016/j.contraception.2015.10.005. Epub 2015 Nov 16.

Authors

Valerie French¹, Renaisa Anthony², Chelsea Souder³, Christine Geistkemper⁴, Eleanor Drey⁵, Jody Steinauer⁶

Affiliations

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.

PMID: 26593095
DOI: 10.1016/j.contraception.2015.10.005

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.

Keywords: Abortion; Abortion referral; Access; Delay; Referral.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Induced / economics
Abortion, Induced / statistics & numerical data*
Adult
Cross-Sectional Studies
Female
Health Care Costs
Humans
Nebraska
Pregnancy
Referral and Consultation*
Time Factors