the abortion option - national abortion federation · . why this publication was developed the...

A Values Clarification Guide

for Health Care Professionals

the abortion option

The National Abortion Federation (NAF) is the professional association of abortion providersin the United States and Canada. We are grateful to Alix Hirabayashi and Lisa Butel whorevised, expanded, and updated this publication. We acknowledge Laureen Tews, MPH whoprovided feedback and guidance, and who developed and wrote with Terry Beresford the 1998publication on which this guide was based. We additionally acknowledge Annie Baker, JoanGarrity, and Pat Anderson who provided expert feedback on the original 1998 publication andEducational Foundation of America, The Richard and Rhoda Goldman Fund, The John MerckFund, Open Society Institute, and The David and Lucile Packard Foundation whose generoussupport of NAF’s Access Initiative Project and programs to educate health care professionalsmade this work possible.

© 2005 National Abortion Federation1755 Massachusetts Avenue NW, Suite 600

Washington, DC 20036202/667-5881

www.prochoice.org

Why this publication was developed

The exercises in this publication are designedto help you examine your beliefs aboutabortion so that you may be better able tocare for women considering this option.Because one’s beliefs about abortion arelinked to one’s thoughts about sexuality,pregnancy prevention, parenting, andadoption among other issues, some exercisesexamine these topics as well. While someexercises are geared specifically towardproviders who are making decisions aboutwhether or not to obtain abortion trainingand ultimately to be involved in providingabortion services to their patients, themajority of exercises are appropriate for thewide range of health care professionals whoprovide care to women. As a health careprovider, your responsibility to assess yourfeelings about abortion and providingabortion care is greater than that of people inother professions, because your decisions willultimately determine whether or not womenreceive accurate information about theirreproductive health care options, areempowered to make the health care decisionsthat are best for them, and are able to obtainhigh quality, supportive, respectful abortionservices if they choose abortion. Further,because information about abortion is notincluded as a routine component of mostmedical school or nursing curricula, and

abortion training is not incorporated intomany residency programs, most health careproviders will need to decide for themselveshow important it is to learn about abortionand/or to obtain abortion training.

The following exercises are designed to helpyou critically examine the factors that mightinfluence your beliefs about parenting,adoption, and abortion and, for some, yourchoice to become trained and to provideabortion services. They are also intended toillustrate the possible consequences of yourchoice to provide or not provide service. It isfor these reasons that the National AbortionFederation developed this publication.

How to use this publication

The legal and historical overviews in Part Iprovide background information about thecontext in which abortion services arecurrently provided and the personal andpublic health implications of restrictions onwomen’s access to abortion. This baselineinformation can help set the stage for healthcare professionals as they proceed with thevalues clarification exercises.

Many exercises that follow in Part II and PartIII can be used either individually (Part II) orin a group setting (Part III). Ideally, bothformats will be used so that you will have an

iThe Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF

THE ABORTION OPTION: A VALUES CLARIFICATION

GUIDE FOR HEALTH CARE PROFESSIONALS

© 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care Professionalsii

opportunity for personal reflection, free ofpeer pressure, as well as the benefit of hearingother people’s viewpoints and testing yourbeliefs against possible challenges from othersin your group.

Further, each of the exercises is designed tostand on its own and, thus, instructors orothers using this publication, particularly in agroup setting, can choose to use only one ortwo exercises that suit their particularobjectives. Certainly all the exercises havevalue, but given time constraints and otherconsiderations, the publication is designed togive flexibility to those who use it.

We have arranged the exercises in sections tohelp guide users through the various sourcesof influence that affect one’s values. We havealso included graphics in the upper corners ofthe pages that can serve to orient users to thebroad categories addressed by the exercises inthis publication.

Why it is important for health care

professionals to examine our values

In spite of our efforts at objectivity, we allhold personal values that can influence howwe respond to our clients. Sometimes thesevalues are very clear to us and are easilyarticulated. Others exist at a deeper level, sothat we don’t necessarily recognize theinfluence they have on our behavior andjudgments as health care providers. Further,one’s values may change in response to lifeexperiences and your encounters with clientsand colleagues may influence your beliefswithout your having much of a chance toreflect on these changes.

The exercises presented here are intended tohelp you clarify for yourself your presentpersonal values about pregnancy options,abortion, and abortion training, and to helpyou think about those values in the context ofprofessional judgments you may be calledupon to make.

The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF iii

Table of Contents

Part I – Historical Overview of Laws, Regulations, and

Consequences of Limited Access to Abortion Services...................................1

Legal Issues in the United States and Canada ............................................................................1Overview of Abortion Laws and Policies in the U.S. ......................................................1Overview of Abortion Laws and Polices in Canada ........................................................2

Consequences of Limited Access to Abortion Services...............................................................4Examples in the U.S. during the 1950’s and 1960’s .........................................................4Examples in the U.S. after Roe v. Wade ...........................................................................5

Part II – Tools for Clarifying Our Values ..............................................................................7

Introduction – Individual Exercises for Values Clarification .......................................................7

Section A: The Role of External Influences in the Formation of Our Values............................7A.1 – Family and Social Group .......................................................................................7A.2 – Spiritual Beliefs ......................................................................................................9A.3 – Life Stage .............................................................................................................10

Section B: The Influences of Our Personal Experiences in the Formation Our Values ...........10B.1 – Sexual Intimacy and Risk-Taking ........................................................................10B.2 – Parenting, Adoption, Abortion, and Pregnancy Prevention.................................12

Section C: Self-Evaluation of Our Objectivity When Considering aWoman’s Pregnancy Circumstances and Her Options ...........................................16

C.1 – Examining Our Comfort Level with Gestational Age ........................................16C.2 – Examining Our Comfort Level with Circumstances...........................................17

of Each Woman’s Abortion DecisionC.3 – Individual Cases: Examining Our Potential Biases ............................................18C.4 – Pregnancy Options Decision Making ..................................................................20C.5 – Parenting and Adoption: Examining Our Potential Biases ................................22

Section D: Providing Abortion Care: Professional Values Clarification Exercises ..................24D.1 – Views about the Role of the Health Care Provider .............................................24D.2 – Personal Assessment of Professional Obligations ................................................24D.3 – The Decision to Provide Abortion Care:

Motivations and Obstacles to Practice ................................................................25D.4 – Overcoming Obstacles to Providing Abortion Care: A Self Evaluation ............26

Part III – Additional Instructions for Using Selected

Exercises from the Guide in a Group Setting ................................................31

The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF

Past and Present – Historical Overview of Laws, Regulations, and Consequences

1

Legal Issues in the United States

and Canada

Given that your professional judgments, andperhaps your personal values as well, areinfluenced in part by legal limits andregulations that govern the medicalprofession, it is appropriate to give a briefoverview of the regulations and laws thatrelate to abortion. These overviews are by nomeans meant to serve as a comprehensivereview, but will provide a basis forunderstanding where the law sets limits onthe provision of abortion as opposed to whereindividual practitioners or hospitals might setpersonal or institutional limits.

An Overview of Abortion Laws and

Policies in the United States

Abortion laws differ, rather dramatically insome cases, from state to state. However, theSupreme Court has issued some keydecisions, starting with Roe v. Wade in 1973,which today serve as the basic foundation forstate abortion laws.

In the Roe decision, the Court established that:

(a) In the first third of a pregnancy (about thefirst 13 weeks), state laws and regulationsmay not interfere with a woman’s right toend a pregnancy through abortion. This

means that the decision whether or not tohave an abortion is left to a woman andher physician.

(b) During the second third of pregnancy(about 14 to 24 weeks), state laws mayregulate abortion procedures only in orderto protect the woman’s health.

(c) During the later part of pregnancy (afterabout 24 weeks), and after the fetus isviable, state laws may prohibit abortionexcept when it is necessary to preserve thelife or health of the woman. Most states(40 states and the District of Columbia)have passed laws to prohibit post-viabilityabortions under most circumstances and,in practice, there are only a small handfulof doctors nationwide who offer this careto women who need it.

For some time, the framework of Roe v. Wadeserved as the basis by which theconstitutionality of state laws related toabortion was determined. Subsequent Courtdecisions, however, particularly PlannedParenthood v. Casey in 1992, have establishedthat states can restrict pre-viability abortions,even in the first trimester and in ways that aremedically unnecessary, as long as suchrestrictions do not place an “undue burden” onwomen seeking abortion services. Thus, state

PART I: PAST AND PRESENT – HISTORICAL OVERVIEW OF

LAWS, REGULATIONS, AND CONSEQUENCES OF

LIMITED ACCESS TO ABORTION SERVICES

© 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care Professionals2


laws requiring waiting periods before a womancan have an abortion, mandatory counselingwhich promotes childbearing, reportingrequirements, and parental consent ornotification have been implemented in manystates. (Note: Some state constitutions havestronger privacy protection than the federalconstitution and thus in these states some ofthese restrictions would not be permitted.)

Additionally, in practice, individual hospitalsand practices can and do impose otherrestrictions, such as gestational limits,anesthesia requirements, and so forth, on theabortion services they provide. Thus eventhough women in the U.S have aconstitutionally protected right to obtain pre-viability abortions, these medical servicesmight not, in fact, be available or accessible.

A woman’s access to abortion services in theU.S. is influenced in part by her ability to payfor that care, either out-of-pocket or throughher private or public health insurance program.The Hyde Amendment forbids the U.S.Medicaid program from paying for abortionsexcept in cases of rape or incest, as well aswhen a pregnant woman’s life is endangered bya physical disorder, physical injury, or physicalillness, including a life-endangering physicalcondition caused by or arising from thepregnancy itself. States may use their own fundsto pay for abortions not covered by Medicaid.However, only 23 states offer additional funding.

In addition, Congress permits healthmaintenance organizations (HMOs) serving

Medicaid recipients to refuse to covercounseling or referral for services, such asabortion, which the HMO objects to onmoral or religious grounds. As a result, even instates with expanded funding, women seekingabortions may face obstacles to finding aMedicaid provider that will cover services.

Since 1996, anti-choice forces in Congresshave maintained a statutory ban on evenprivately funded abortions at all Department ofDefense facilities, including military bases.These facilities are restricted from performingmost abortions, except in cases of rape, lifeendangerment, and incest. Further, medicalinsurance for military personnel and theirdependents only covers abortion in cases of lifeendangerment. Although members of both theHouse and Senate have repeatedly attemptedto remove these restrictions they have beenunable to garner enough support to reverse it.

An Overview Abortion Laws and

Policies in Canada

(Contributed By Joyce Arthur, Director & Spokesperson,Pro-Choice Action Network, Vancouver, British Columbia,Canada) (April 2004)

Canada first liberalized its strict law againstabortion in 1969. The new law allowedabortions to be performed in hospitals with theapproval of a “therapeutic abortion committee.”A woman could get an abortion only if thecommittee decided her life or health was indanger. But the law resulted in arbitraryobstacles and unequal access for women. Dr.Henry Morgentaler, Canada’s pioneer abortionprovider and pro-choice activist, fought various



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court battles culminating in a 1988 SupremeCourt decision that threw out the entireabortion law as unconstitutional. This rulingbecame known as the Morgentaler decision.

The Supreme Court grounded the right toabortion in women’s constitutional right to“security of the person.” One judge also foundthat the abortion law violated women’s rights to“freedom of conscience” and “liberty.” Unlike inthe U.S., women’s equality rights are enshrinedin Canada’s constitution, so courts have beenvery reluctant to confer any rights on fetuses –to do so would interfere with women’sestablished constitutional right to equality.Various court rulings since 1988 have deniedfetuses any legal recognition in Canada and noabortion restrictions have ever been passed.

Although the Canadian legislature tried to re-criminalize abortion in 1990, the bill failed topass. Today, Canada’s governments, judicialsystem, and the mainstream media are largelypro-choice.

Abortion is fully funded by Medicare inCanada, except for four provinces that refuseto fully fund abortions in private clinics, eventhough they have been ordered to do so undera federal law, the Canada Health Act. Thislaw says that provinces must provide allCanadians with equal access to fully fundedhealthcare according to five basic principles:portability, accessibility, comprehensiveness,universality, and public administration.Abortion is probably the only medicallyrequired treatment that doesn’t fully measureup to any of these ideals. That is because

many provinces flout the law due to an anti-choice political bias that dismisses abortion asan “elective” and abortion clinics as privatebusinesses operating outside of Canada’suniversal healthcare system.

Clinics became legal only in 1988, but there isnot enough volume to support clinics except inthe largest cities. About two-thirds of abortionsin Canada are still performed in publichospitals. However, only about 20% of hospitalsperform abortions, which forces many womento travel long distances from their communities.Hospitals often restrict access to abortionbecause of arbitrary or anti-choice policies. Forexample, many hospitals impose restrictionssuch as quotas, gestational limits, and generalanesthesia requirements. Most hospitals requirephysician referrals and many have long waitingperiods. A few hospitals require the approval oftwo doctors, or parental consent for any surgeryon minors with no exception for abortion.Anti-choice doctors and hospital employeesoften act as gatekeepers, preventing womenfrom accessing abortion services or evenobtaining accurate information about them.Finally, the Canadian Medical Associationmaintains an old policy that essentially curtailsabortions after 20 weeks, unless they’re forcompelling health or genetic reasons.

Anti-choice protest activity is low in Canada,especially in recent years, although clinicprotests are still routine at some clinics,particularly in British Columbia, Ontario, andNew Brunswick. However, three Canadiandoctors were shot between 1994 and 1997,with American James Kopp as the leading



1Joffe C. Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade. Boston:Beacon Press, 1995

suspect. A bomb destroyed a Toronto clinic in1992, and one of the shot doctors was alsostabbed by an unknown assailant in 2000. Aprovincial bubble zone law in BritishColumbia, the Access to Abortion ServicesAct, protects two clinics and one hospitalfrom protesters. Clinics in Alberta andOntario use court injunctions to keepprotesters at bay.

As stated above, this overview should provideenough general legal information forcompleting the exercises in this publication,because the exercises focus on personal valuesclarification. It is prudent, however, for allhealth care providers in practice to be asinformed as possible about laws related to themedical care that they provide and thus wewould recommend further study of abortionrelated regulations and legislation in yourstate or province.

Consequences of Limited Access to

Abortion Services

The negative impact on public health whenabortion is illegal or otherwise inaccessible iswell documented. As a health care provider,your decision to provide women withunbiased information and appropriatereferrals, or your decision to provide or notprovide abortion services has a directinfluence, positive or negative, on theaccessibility of abortion. The followingexamples show possible consequences oflimited access to legal abortion and may helpyou determine what role you might play inaddressing decreasing access.

Examples in the United States during

the 1950’s and 1960’s

We have excerpted passages from Carole Joffe’sDoctors of Conscience1 describing the experiencesof physicians who practiced when abortion wasillegal in most states.

A doctor who was a resident in a New York Cityhospital during the 1960’s describing what hecalled the “Monday morning abortion line-up”:

What would happen is that the women would gettheir paychecks on Friday, Friday night theywould go to their abortionist and spend theirmoney on the abortion. Saturday they wouldstart being sick and they would drift in onSunday or Sunday evening, either hemorrhagingor septic, and they would be lined up outside theoperating room to be cleaned out Mondaymorning. There was a lineup of women onstretchers outside the operating room, so youknew if you were an intern or resident, when youcame in on Monday morning, that was the firstthing you were going to do. (Joffe, p.60)

Another doctor describing her residencyexperience with illegal abortion in a countyhospital:

There were two gyn wards. They were supposed tohave thirty-two beds each, but they had to havebeds all up and down the hallways. They werealways full [because of illegal abortions]. Theymust have had one hundred and forty beds in thosewards...The residents would get duties of twenty-four hour periods, and in that period, you’d get tento twelve admissions. They walked into theemergency room bleeding. The first thing the



5

doctor down there did was send them for an X-rayto see what was in their belly-to see if there wereknitting needles, hooks, catheters up theirbelly...Then when they got to the ward, the firstthing you did besides examine them was to do aculture for gas gangrene. It was a standard wehad, whether they had a fever or not, to take thisculture, because if they had gas gangrene, youreally had to take drastic measures, like surgery,heavy duty antibiotics, and all that kind of stuff.Until the suction curettage came through, theroutine was that you accumulated all the womenuntil two o’clock in the morning when all themajor surgery was done, and the last gunshotwound had been cleared out of the emergency room– then the first-year residents dragged the patientsdown to the operating room and started doing theD. & C.’s at two o’clock in the morning. That’swhen the operating room was quiet...There wouldbe two or three operating rooms going at the sametime. Between 2:00 and 6:00 AM you could get acertain number of D. & C.’s done and clean up thewomen who weren’t septic, scrape their uterusesand get them back upstairs so they could bedischarged in a day or two. (Joffe, p. 61)

A chief obstetrical resident in a public hospitalin the 1950’s describing a twenty-two year oldpatient whom he treated for septic shockfollowing an illegal abortion:

What happens there, the infection is sooverwhelming, the bacteria produce toxins thatlead to a collapse of the cardiovascular system.These patients have no blood pressure, no pulse-insome cases there is absolutely nothing you can do toreverse the situation. We gave the girl blood,cortisone, hydrocortisone – nothing was working,

she was not responsive. We finally figured the onlychance we had was to do a hysterectomy. We tookher to the O.R., but Anesthesia said, “We won’tgive her anesthesia, without getting blood pressureor a pulse. We can’t monitor where we are, and sowe might kill her with the anesthesia.” So I had todo something I don’t recommend to anybody, whichis a hysterectomy under local anesthesia. We got theuterus out – I still have a picture of it in myteaching files – it was basically a bag of pus. Wefound a coiled up catheter in there. When we wereall done, I was walking along beside her in thecorridor – they were taking her back to her bed.And one of the tragedies of this septic shock is thatpeople remain lucid until the end, and she washolding my hand, and saying, “Doctor, help me,I’m dying.” And I knew she was, and I knew therewas not a blessed other thing we could do for her,and before she got to her bed, around midnight, shedied, and I have been haunted by that girl eversince. (Joffe, p. 58).

Examples in the United States after

Roe v.Wade

While the scenarios described above occurredbefore Roe v. Wade, on a smaller scale, similarsituations sometimes still arise because safe,legal abortion is still not accessible to manywomen. A 2003 study2 found that 87% ofcounties in America do not have a singleabortion provider. Some women, particularimmigrant women, are unaware that abortion islegal in the U.S. and turn to alternativemethods for self-abortion, for instance self-administered misoprostol which has beenwidely used by women in Latin Americancountries for self-abortion and is documented

2Finer LB, Henshaw SA. Abortion incidence and services in the United States in 2000. Perspectives on Sexual andReproductive Health 2003; 34(1): 6-15.



to be quite widely available in somecommunities and urban areas in the U.S.Further, legislative restrictions, such as parentalconsent laws, mandatory biased counseling, andwaiting periods, make it difficult for women,particularly young, low-income, and ruralwomen, to obtain abortions. The following twostories are examples of the consequences ofaccess limited by financial constraints.

A) Rosie Jiminez, a 27-year-old woman livingin Texas, died on October 3, 1977 fromcomplications from an illegal abortion sheobtained in Mexico. Rosie was on Medicaidbut, because the Hyde Amendmentprohibits the use of federal Medicaid fundsto pay for abortion except in cases of rape,incest, and life endangerment, she couldnot obtain a safe legal abortion using herhealth insurance. While some argued thatRosie went to Mexico for her abortionbecause she was ashamed and wanted toprotect her privacy, the fact that she hadtwice before obtained a safe, legal abortionusing her Medicaid coverage, beforeMedicaid stopped funding abortionservices, clearly connects the cutoff ofMedicaid funding with Rosie’s decision toresort to a cheaper, although illegal,abortion in Mexico. Rosie was a singlemother of a five-year-old daughter. She wasa scholarship university student supportingherself and her child while in school withwelfare payments and her income from apart-time job. She was six months awayfrom obtaining her bachelor’s degree.

B) On March 27, 1994, Kawana Ashley, anineteen-year-old single mother with athree-year-old son, shot herself in thestomach during the 25th or 26th week ofher pregnancy. She was hospitalized butultimately survived her injuries. Doctorsdelivered a female infant by emergencycaesarean who died 15 days later. Ms.Ashley was a Medicaid recipient, but sinceFlorida’s Medicaid program funds abortiononly in cases of rape, incest, or lifeendangerment, she needed to find a way topay for the surgery herself. Unfortunately,by the time she got enough money together,she was into her second trimester, and thecost was higher. When she had raised theextra money she needed, she was beyond 20weeks, the cutoff point at which the clinicstopped providing abortions. Out ofdesperation to end her unwanted pregnancy,Ms. Ashley endangered her own life.

The World Health Organization has estimatedthat worldwide approximately 80,000 womeneach year die as a result of illegal or unsafeabortions.3 Additionally, hundreds ofthousands suffer wide-ranging and serioushealth consequences. Clearly, limited ornonexistent access to safe abortion hasmonumental consequences for individualwomen and their families. These figures makeclear, however, the impact on public healthwhen access to safe, legal abortion is restricted.

3Unsafe abortion: Global and regional estimates of incidence of a mortality due to unsafe abortion with a listing ofavailable country data. Third edition. Geneva, Switzerland: World Health Organization, 1997. Available athttp://www.who.int/reproductive-health/publications/MSM_97_16/MSM_97_16_abstract.en.html


Tools for Clarifying Our Values

7

Individual Exercises for Values

Clarification

Sometimes it is helpful in the course ofnarrowing down our focus to look at both theexternal and the personal influences on thedevelopment of our values. Life stage, socialculture, and our early spiritual environmentare examples of external influences on ourvalues. Individual experiences with sexualintimacy, parenting, adoption, abortion, andbirth control also have their places in theshaping of our views. The following exercisesare designed to help you identify theexperiences that may contribute to yourpresent values about both the broad andspecific aspects of abortion. Again, it is hopedthat understanding our personal beliefs aboutabortion will help us provide better care forwomen facing an unplanned pregnancy andconsidering the option of abortion. Theexercises are divided into four categories:external influences, personal experienceinfluences, and, with those in mind, a woman’slife circumstances around her abortion. Finally,we look at professional roles and responsibilities.

These exercises and questions can provide you with insights as you work through themalone. Discussing your reactions to andthoughts about them with others can alsoexpand your insights through shared anddifferent experiences.

Section A: The Role of External Influencesin the Formation of Our ValuesExternal influences on our thinking canencompass many areas. As we grow up we are introduced to values and ideas by everyonearound us while we simultaneously comparethem to our personal experiences andperceptions. We have chosen to focus on theinfluence of our culture (family/race/socialgroups), our spiritual/religious beliefs, andlife stage to connect them to our ideas aboutfamily and parenting, and consequentlypregnancy options and abortion.

Exercise A-1: Examining the Role of

Family and Social Groups on Our

Values

The family or social group (i.e. heritage, extendedfamily, adoptive family, socio-economic group)that we grow up in provides us with ourcustomary beliefs and early social values. We usethese as a backdrop when we interact with othersand form opinions as we mature. Dependingupon our personal temperament we may integratethese values automatically or challenge them atdifferent points in our lives.

The purpose of this exercise is to reflect on thesource and influence these core beliefs have onyour present ideas about parenting, abortion, andadoption.

PART II – TOOLS FOR CLARIFYING OUR VALUES



1. a) Did the family you were brought up indiscuss specific values around parenting,adoption, or abortion? ____ Yes ____ NoIf yes, describe: _________________________________________________________________________________________

b) Were there any family events thatchanged these views while you were livingwith the family? ____ Yes ____ NoIf yes, describe: _________________________________________________________________________________________

c) Describe any similarities or differencesbetween the values you presently holdabout parenting, adoption, or abortion andyour family’s values about parenting,adoption, or abortion. ____________________________________________________________________________________

2. Did your family’s values reflect your race/heritage or nationality’s values? ____ Yes ____ NoIf no, how did they differ? ________________________________________________________________________________

3. a) Did the socio-economic group you werebrought up in have any influence on yourvalues about parenting, adoption, orabortion? ____ Yes ____ NoIf yes, describe its influence:_______________________________________________________________________________

b) Does your present socio-economic groupdiffer from that of the family you werebrought up in? ____ Yes ____ NoIf yes, has this affected your views aboutparenting, adoption, or abortion? ___________________________________________________________________________

4. Which social group would you consider hasbeen the predominant influence on yourvalues on parenting, adoption, andabortion? Heritage/race ____ Socio-economic ____Family ____

5. a) Choose one of the options in eachcategory that would be the mostencouraged by your predominant socialgroup.

Number of Family Age of new children forms parents

❑ 0 child ❑ single parent ❑ Teenage parents

❑ 1 child ❑ two-parent ❑ Parents age 20-30

❑ 2 children ❑ multigenerational ❑ Parents age 30-40in household

❑ 3-4 children ❑ same-sex parents ❑ Parents age 40-50

❑ 5+ children ❑ single gay parent

b) Does this represent your present lifeexperience? ________________________In what ways, if any, has this causedconflicts with your family? ________________________________________________________________________________



9

6. a) Do your current values differ from thevalues you were brought up with in any ofthe following areas? Check any that apply.

❑ large families ❑ small families ❑ family on welfare ❑ role of women ❑ role of men ❑ mothers working❑ birth control ❑ adoption ❑ abortion ❑ daycare ❑ divorce ❑ blended families❑ sex before ❑ mixed race ❑ marrying outside

marriage parents of culture

b) If your values differ, what influenced thechange? _______________________________________________________________________________________________

7. What percentage of your current ideasabout family is culturally (family/socialgroup) influenced? ____ Influenced bypersonal experience? ____ Other? ____


Spiritual Beliefs on the Formation of

Our Values

Our spiritual or religious beliefs may be rooted inour family or arrived at independently duringdifferent points in our lives. Some people considerthese private contemplations while others share thesebeliefs openly in their everyday interactions. Themerging of political and spiritual ideals in societyhas historically been a difficult marriage. Thepurpose of these questions is for you to reflect on therole of your spiritual beliefs in your everyday life.

Take a moment to reflect on the followingquestions and take note if these raise anyother issues for you.

1. Have you held the same spiritual beliefssince childhood? ________________________________________________________________________________________

2. How often, on average, during a day, doyou consciously refer to your spiritualbeliefs before making a decision? Aftermaking a decision? ______________________________________________________________________________________

3. Have you been challenged by lifecircumstances that called on actions notsupported by your religious or spiritualbeliefs? Were you able to reconcile theseactions with your beliefs at a later date?Did you do this on your own or withsupport?_______________________________________________________________________________________________

4. Do your beliefs about any of the followingtopics that are influenced by your spiritualvalues conflict with anyone in your life atpresent?

Beliefs about family? ___ Yes ___ No Beliefs about social roles? ___ Yes ___ NoBeliefs about sex? ___ Yes ___ NoBeliefs about birth control? ___ Yes ___ NoBeliefs about abortion? ___ Yes ___ No

If yes, how have you reconciled thesedifferences? ____________________________________________________________________________________________




Life Stage on the Formation of Our

Current Views

Our age influences our reactions to life andchange. Youth provides us with optimism, easyaccess to childhood memories, and endlesspossibilities but it can also limit our broaderunderstanding of the impact of our decisions.Additional years bring us the perspectiveprovided by an accumulation of experiences butthe depth of this perspective is dependent upontheir range and the personal insights we haveabout these experiences. The purpose of thesequestions is to remind us to pay attention to theinfluence of our age on our understanding of ourclients’ dilemmas and the fluid nature of ourperspectives throughout our lives.

1. How did you feel about romanticrelationships when you were 16? 25? 35?45? Describe the differences: ________________________________________________________________________________________________________________

2. What do you think would be the ideal agefor a woman to have her first child? Haveyour views changed about this since youwere 18? Since you were 30? 40? 50? Whatinfluenced these changes? ___________________________________________________________________________________________________________________

3. What did you think of teenage pregnancy,adoption, single parenting, and abortion

when you were 18? Describe how yourviews have changed since that time.___________________________________________________________________________________________________________

4. Have your views about the choice of nothaving or having children changed sinceyou were 18? Describe: _____________________________________________________________________________________________________________________

5. How does your present age affect yourperspectives when discussing pregnancyoptions with a patient? ___________________________________________________________________________________

Section B: The Role of Our PersonalExperiences in the Formation of Our ValuesWe have raised questions about the externalinfluence of family and social culture, age, andspiritual values on the formation of our values. Inthe following exercises we explore how our ownexperiences (and those of our intimate others)with sexual intimacy, and our histories withpregnancy, fertility, infertility, adoption, abortion,and parenting can also influence our perspective.

Exercise B-1: Examining Our Own

Experiences with Sexual Intimacy and

Risk-Taking.

Because the need for an abortion always begins withthe act of sex, it is important to be aware of ourunderlying attitudes about this topic. Dependingupon our own personalities, our sexual identity andexperiences are often deeply personal and not often



11

discussed with others. We gather information throughour own experiences, what we read and see in themedia and literature, and from stories gleaned fromour social circle. Take a moment to reflect on thefollowing questions and ask yourself if any of theseexperiences affect how you would consider a patient’ssexual history and its role in her pregnancy.

1. Was your first sexual intimacy well plannedor spontaneous? Was birth control an issue?Given your present perspective, is thereanything you would change about thatexperience? If yes, describe. _________________________________________________________________________________________________________________

2. How healthy is your own sex life atpresent? Is there anything you would liketo be different? If you are unable to makeany changes, how has this affected your lifeat present? Describe:_______________________________________________________________________________________________________________________

3. Have you always had a sexual partnerduring your adult years? If not, what wasthe longest period of time you wentwithout sexual intimacy? Describe anyeffects it had on your life at the time. ___________________________________________________________________________________________________________________________________________

4. Which of the following have had animpact on your sexual or intimaterelationships:

Sexual abuse or sexual assault _______Coerced sex _______Sexual infidelity _______(yours, partner’s, parents’)

Infertility or fear of infertility _______Sexually transmitted disease _______One night stand _______Unplanned pregnancy _______Abortion _______Drugs or alcohol _______

5. Which of the topics listed in #4 abovewould you feel the most comfortablediscussing with a client having a similarexperience in her own life? ______ Theleast comfortable? ______

6. Describe how your experiences (or lack of )influence your discussions with clients in apositive way. ___________________________________________________________________________________________

7. Describe how your experiences (or lack of )influence your discussions with clients in anegative way. ____________________________________________________________________________________________________________________________

8. What strategies would you use to improveyour comfort level with these topics if theyimpacted the life of one of your clients?________________________________________________________________________________________________________



Exercise B-2: Examining Our Own

Experiences with and Views about

Parenting, Adoption, Abortion, and

Pregnancy Prevention

Not all of us become parents, but many of us havehad experiences and/or risks with pregnancy. Ourexperiences often affect how we see others insimilar situations. Think about your responses tothese questions and your present ideas about thechallenges of parenting, adoption, abortion, andpregnancy prevention.

ParentingOur experiences with parenting color the way wesee it as an option for women. It is important toacknowledge our own experiences to help us beaware of our biases.

1. If you do not have children, which of thefollowing statements would apply to you?(check all that apply)

Do not want to have children _______Not ready to have children _______Infertility/difficulty conceiving _______Lack of opportunity _______Do not want to be a single parent_______Financial reasons _______Health reasons _______Career goals _______Placed a child for adoption _______Loss of a child _______Undecided _______Other _______

If any of the above reasons have created stressin your life, describe how you have coped.________________________________________________________________________

Have any of these experiences complicated orassisted in your ability to understand yourclients’ choices? If yes, describe: __________________________________________________________________________________

2. Which, if any, of the following have you hadpersonal experience with in the role of childor family member? (check all that apply)

Welfare _______Mental health problems _______Drugs and alcohol abuse _______Prenatal health risk by mother _______Single parenting _______Divorce/blended families _______

Was your experience as a parent or childcompromised in any way by these issues?Describe: ____________________________________________________________________________________________________

How have you coped with these experiences?________________________________________________________________________


3. Would you or others view your parents/family as the “perfect” family? ______ If yes, describe the impact on your presentviews on parenting and family. _____________________________________________________________________________



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4. If you are a parent, have you experiencedany of the following with your child(children)? (check all that apply)

Health challenges _______Mental health issues _______Drug addictions _______Financial challenges _______Single parenting _______Divorce _______Death of a child _______

How have you coped with these experiences?________________________________________________________________________


AdoptionFewer of us have personal experience with adoptionthan we do with parenting. As with parenting, it isimportant to acknowledge how our experiences orlack thereof may influence our views of this option.

1. If you have a personal experience withadoption, which of the following apply?(check all that apply)

I am adopted _______Family member/friend is adopted_______Placed a child for adoption _______Family/friend placed _______

child for adoptionTrying or tried to adopt _______Family member/friend _______

adopted a child

Considered adoption when _______I or my partner became pregnant

Work(ed) in the adoption field _______

How have these experiences affected yourpersonal life? _____________________________________________________________

Have any of these experiences challenged orassisted in your objectivity as a healthprofessional when counseling a woman aboutpregnancy options? If yes, describe: _______________________________________________________________________________

2. If you have no personal experience withadoption, has your objectivity beenchallenged as a health professional whencounseling a woman about pregnancyoptions? If yes, describe: __________________________________________________________________________________

AbortionOur experiences with abortion vary. It isimportant to assess where our experiences arederived from and the influences they may have onour objective understanding of other women’schoices.

1. If you have experience with abortion,which of the following apply? (check allthat apply)

My partner or I have had an abortion ____I have accompanied a family member ____I have accompanied a friend ____I am aware that a family member and/

or close friend has had an abortion ____



My partner or I have considered abortion because of pregnancy ____

I work in the abortion field ____My family or I picket at

abortion clinics ____

Which of the above (if any) have had themost impact on your views on abortion?________________________________________________________________________

Have any of these experiences challenged or assisted your objectivity as a health careprofessional when counseling a woman abouther pregnancy options? If yes, describe:________________________________________________________________________

2. If you or your partner has had an abortion,describe the most difficult aspects of thisdecision. ____________________________________________________________

Describe the positive aspects of this decision.________________________________________________________________________

If you could, what would you have changedabout the experience? ______________________________________________________

Have any of these experiences challenged orassisted your objectivity as a health careprofessional when counseling a woman abouther pregnancy options? If yes, describe: ____________________________________________________________________________

3. If you have no personal experience withabortion, has this had any effect on your role asa health care professional counseling a womanabout her pregnancy options? If yes, describe:____________________________________________________________________

Pregnancy PreventionOur attitudes about abortion sometimes havelinks to our views on the preventative side ofpregnancy. Birth control failure, absence, ormisuse is a complex topic too often simplified ifwe do not address the complexity of individualpersonalities, the power dynamics of relationships,cultural differences, and women’s experiences withthe side effects of medications. Take a moment toreflect on your own experiences and evaluatethese in relation to your views on pregnancyprevention.

1. Considering your own experiences withbirth control methods, have youexperienced any of the following? (check allthat apply)

Difficulty accessing birth control _______Parental disapproval _______Partner conflict _______Financial difficulties _______Misinformation _______Compliance difficulties _______Lack of preparation _______Failure of method _______Medical contraindication _______Use influenced by drugs or alcohol_______Assumed partner was using _______Cultural difference _______



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If yes, how did you solve these problems?________________________________________________________________________

If you have been pregnant, how many of yourpregnancies are the result of any of the abovedifficulties with birth control? _______

2. Have you or your partner experienced anyof the following side effects from a birthcontrol method? (check all that apply)

Allergic reaction _______Weight gain _______Mood changes _______Irregular bleeding _______Nausea _______Pain _______Change in sexual performance _______Acne _______Change in sexual pleasure _______Change in libido _______

If yes, how many times have you changedyour method? _______

Has this caused stress in your life? If yes,describe: ____________________________________________________________________________________________________

3. Would you describe yourself as a risk takerin general? ____ Yes ____ NoDo you take risks with your health? ___ Yes ___ No Smoker? _______Overweight? _______No exercise? _______Seatbelts? _______Sunscreen? _______Drive too fast? _______Always practice safe sex? _______Safe oral sex? _______Regular pap or other

routine tests? _______Ask potential partner about STD’s

before sex? _______Have you taken risks with

birth control? ____ Often? _______Have you discussed this with a health

professional? _______

Do you follow the same birth control advice yougive to clients you counsel? ___ Yes ___ No

If no, why not? _______________________________________________________________________________________________

Have your experiences strained or assistedyour objectivity when you discuss birthcontrol and pregnancies with clients? If yes,describe: ____________________________________________________________________________________________________



Section C: Self-Evaluation of OurObjectivity When Considering a Woman’sPregnancy Circumstances and Her OptionsWhen a woman presents with a pregnancy andis examining her options, her circumstances willplay a role in her decision. It is natural for ahealth care provider to be evaluating her choicealong with her in order to provide objective andrespectful professional care. It is important toexamine our own comfort level with her choiceand consider our reactions when our neutralityis challenged. We will begin by looking at theoption of abortion and our personal responsesto issues such as gestational age, and thenfollow with the circumstances of the individualwoman who is making this decision.

Exercise C-1: Examining Our Comfort

Level with Gestational Age

For some people the acceptability of a patient’sabortion decision is dependent on the stage ofpregnancy at which the abortion might take place.This exercise is designed to help you examine yourown feelings about this very personal questionand its possible influence on the exercises to follow.

1. Does gestational age affect how you feelabout your patient’s abortion decision? ____ Yes ____ No

2. If gestational age does affect your response,at what point do you feel uncomfortablewith your patient’s abortion decision?

At conception _____At implantation _____At the end of the first trimester _____At quickening (i.e. point of

fetal movement) _____

At viability _____At the end of the second trimester _____At some point in the third trimester_____It depends on the reason for

the abortion _____

3. Now consider this list again as it relates toyour comfort level with three varyingdegrees of your professional involvement inabortion. At what point do you feeluncomfortable with:

a) making abortion referrals for patients

b) assisting with the provision of abortionservices

c) providing abortions

Write your reasons for feeling this way aboutgestational age. How long have you felt thisway?________________________________________________________________________________________________________

If you had different cutoff points dependingon the level of your involvement in providingservices, what are the reasons for thesedifferences? If your feelings were consistentacross the different levels of involvement,what are the reasons for this? ____________________________________________________________________________________



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Level with Circumstances of Each

Woman’s Abortion Decision

Sometimes we are comfortable with one woman’sabortion decision, but are challenged by thecircumstances surrounding another woman’s decision.This exercise is designed for you to reflect on yourpersonal responses to the following situations. It alsoillustrates the wide range of circumstances that mayinfluence a woman to decide to have an abortion.

___ I can accept a woman’s abortion decisionin any circumstance when she has madean informed and voluntary choice forabortion.

___ I can accept a woman’s abortion decisionin certain circumstances including: (checkall that apply)

___ to end a pregnancy that threatenedher life

___ to end a pregnancy that threatenedher physical health

___ to end a pregnancy that threatenedher mental health

___ to end a pregnancy involvingsignificant fetal abnormality

___ to end a pregnancy resulting fromrape or incest

___ to end a pregnancy resulting frombirth control failure

___ to end a pregnancy if the woman isunmarried

___ to end a pregnancy if the woman isin an unstable relationship or is notin a relationship

___ to end a pregnancy if the womandoes not want any more children

___ to end a pregnancy if the woman isnot financially able to care for achild

___ to end a pregnancy if the womanfeels she is not ready for theresponsibility of having a child

___ to end a pregnancy if a child wouldinterfere with educational or careergoals

___ to end a pregnancy if the woman isunready for how a child couldchange her life

___ to end a pregnancy if the woman isvery young

___ to end a pregnancy if the woman hasnot had a previous abortion

___ to end a pregnancy because of gender

___ other(s): _____________________________________________________________________________________

___ I find abortion unacceptable undervirtually any circumstances.

What are the reasons for your beliefs? Howlong have you held these beliefs? _________________________________________________________________________________________________________________________________________________________



Exercise C-3: Individual Cases:

Examining Our Potential Biases

Parts 1 and 2 of this exercise individualize thecircumstances of a woman’s abortion decision byproviding more details to expose the complexity ofthe decision. By putting yourself into the role of thehealth care professional responsible for providingaccess to abortion to only one of the followingwomen, you are challenged to examine yourpersonal views and to experience the difficultiesassociated with limited access on the healthprofessional as well as the patient. This exercisealso illustrates the difficulty with comparing onepatient’s circumstance with another. Until we areput in this position we may assume thatdetermining a hierarchy of needs would be difficultbut not impossible. Pay attention to your reactionsto this challenge when putting yourself in the roleof the decision-maker. Part 3 helps us identify ourpersonal discomfort, if any, when faced with thecircumstances of some women’s abortion decision.

1. Before Roe v. Wade legalized all firsttrimester abortions in the U.S., somehospitals provided a very limited number of“special case” legal abortions. Hospitaltherapeutic abortion committees had thetask of determining which cases wereworthy of being granted a safe, legalabortion. You are on that committee andmust determine which ONE of thefollowing patients, all of whom arerequesting an abortion, will be granted theone remaining legal abortion left in youryearly quota.

___ 12 year old incest victim

___ 15 year old rape victim

___ 22 year old carrying a fetus with severe deformity

___ 24 year old heroin addict who alreadyhas three children in state custody

___ 26 year old single mother who has ayoung child with leukemia

___ 30 year old with 2 children whosehusband died recently in a car crash

What factors influenced your choice? Howdid it feel to have to make this choice?________________________________________________________________________

2. The six women described below have cometo you requesting a referral for abortion.Due to circumstances beyond your control,only one more abortion can be done andyou must choose which one of your sixpatients is to receive the last abortion.Rank the cases from 1 (most want to referfor an abortion) to 6 (least want to refer).

__ Gloria is 14 years old, unsure aboutwhat to do. She has supportive parents.

__ Louise is 19 years old, has two childrenand has had two previous abortions.

__ Selma is 24 years old, a student inmedical school and engaged to bemarried. She wants to begin her careerbefore starting her family.

__ Eileen is 29 years old, single andpregnant with an IUD in place.

__ Margaret is 35 years old, divorced,pregnant from a one-night encounter,her first sexual experience following herdivorce.



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__ Dorothy is 45 years old, married withthree grown children. Neither she norher husband wants any more children.

What guided your choice for number 1?________________________________________________________________________

What guided your choice for number 6?________________________________________________________________________

Was making your choices difficult or easy foryou? Explain._________________________________________________________________________________________________

Below are some of the arguments often madefor each of the women. In each case, if youneeded to argue for your choice, how wouldyou respond to or refute these arguments forthe women you did not choose?

Gloria: She’s just beginning her life andshould have a chance to enjoy her childhood.She will have few coping skills and the childmight suffer. At her age, childbearing couldbe damaging to her health.

Response: ___________________________________________________________________________________________________

Louise: She has her hands full with twochildren at such a young age. Her previoustwo abortions indicate she is clear about notwanting another child.

Response: ___________________________________________________________________________________________________

Selma: She is clear that she wants toconcentrate on her career and her newmarriage before starting a family.

Response: ___________________________________________________________________________________________________

Eileen: Her IUD failed and she is now facedwith an unplanned pregnancy. She is alsosingle and may not have the support sheneeds to raise a child.

Response: ___________________________________________________________________________________________________

Margaret: She is already coping with a highlevel of stress because of her divorce. To havea child without the emotional and financialsupport of a partner would be very difficult.She is clear that she does not want to have achild under these circumstances.

Response: ___________________________________________________________________________________________________

Dorothy: She and her husband are bothclear they do not want another child and feeltheir family is complete with their threegrown children. Additionally, at her age, thepregnancy is high risk.

Response: ___________________________________________________________________________________________________



As a health care professional, how do youthink you would react to having to makechoices like these? What unique qualificationsdo you have to make such choices? _______________________________________________________________________________

3. Even health care providers who self-identifyas pro-choice and are supportive of theirpatients’ decision-making autonomy can befaced with circumstances that ‘push theirbuttons’ and challenge them personally andprofessionally. This exercise helps to identifythe areas where you area most challenged.

I would feel most uncomfortable referring orproviding an abortion for a woman who:

___ is ambivalent about having an abortionbut whose partner wants her to terminatethe pregnancy

___ wishes to obtain an abortion because sheis carrying a female fetus

___ has had what I consider too manyprevious abortions

___ shows little emotion about becomingpregnant and choosing abortion

___ has indicated that she does not want anybirth control method to use in the future

___ is a regular protestor at abortion clinics butfeels her circumstances are different fromthose of other women seeking abortion.

___ is nearing the end of her second trimester

What factors influenced your choice? How did itfeel to make this choice? How might you handleyour discomfort in dealing with this patient?________________________________________________________________________________________________________________________________________________

Exercise C-4: Pregnancy Options

Decision Making

Each woman with a pregnancy decision to makehas to consider her obligations to herself, the impactof her decision on her family, partner and thechildren she already may have. This exercise isdesigned to involve you in the intricacies ofbalancing priorities in the decision-making processof a woman examining her options. The effort ofprioritizing and selecting options forces us to exposeour internal biases and challenge our neutrality.

You have been given the authority to decidethe outcomes of the following six pregnancies.Only two of the women can carry theirpregnancies to term and become parents, onlytwo can make arrangements for adoption, andonly two can obtain abortions. You must makethese decisions and be able to justify them.

Jane is 17 years old and is 10 weeks pregnant.She comes from a supportive, working classfamily with strong ties to the anti-abortionmovement. She has been accepted on anathletic scholarship to the University ofPennsylvania and is due to start her firstsemester there in two months. Her boyfriendwants them to get married and have the baby.



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Mary is a 26-year-old lawyer and is 6 weekspregnant. She and her boyfriend are planningto get married in a few years. She has highaspirations for her career and is uncertainwhether she wants children at all.

Ruth is 34 years old, married with 3 children.She had just ended a month long affair andhad committed herself to her marriage whenshe discovered she was pregnant. She isunsure with which man she became pregnant.Her husband is very loving and supportivebut is unaware of his wife’s involvement withanother man.

Leslie is 21 years old and is midway throughthe first semester of her last year of college.She is working 2 jobs to pay for her tuitionand expenses and is just barely getting byfinancially. She has been with her partner for2 months and is not sure where therelationship is going. Before she found outshe was pregnant, she was thinking aboutbreaking things off.

Sue is 37 years old and married. She and herhusband had been trying to get pregnant for3 years. She just got back the results of heramniocentesis and they indicate that the babyhas a severe genetic abnormality. She is 16weeks pregnant.

Tina is 14 years old. Although she wasn’treally planning to get pregnant, she wasexcited when the test came back positive. Shehasn’t told her parents yet because she knowsthat they will be angry and will not think she

is ready to be a mother. She and herboyfriend, who is 17, have been together for 8months. His parents are not very happy thattheir son is with Tina.

Which two women would you choose tocontinue their pregnancies and become parents?____________________________________________________________________________________________________________

What factors influenced your decision?____________________________________________________________________________________________________________

Which two women would you choose tocontinue their pregnancies and makeadoption arrangements? ____________________________________________________________________________________________________________________________


Which two women would you choose toobtain abortions?______________________________________________________________________________________________




Exercise C-5: Parenting and Adoption:

Examining our Biases

Our biases about parenting and adoption can alsochallenge our neutrality when listening to thecircumstances of a woman’s pregnancy. Thisexercise is designed for you to examine your ownresponses to the following circumstances involvingthe choices of parenting and adoption to discoverareas where you are the most and least comfortable.Our awareness of these “hot buttons” allows us toreview how we would manage our feelings andresponses in a professional role with women and toensure respectful and non-judgmental care.

Indicate your first emotional responses to eachwoman described below choosing tocontinue her pregnancy and become aparent and circle the corresponding spot onthe line to identify your feelings.

Cindy is 20, has been unsuccessful in herattempts to overcome her cocaine addiction of two years. She has one child in foster care.She is on welfare and does not have a steadyboyfriend.

very very comfortable uncomfortable

Sarah is 16, living at home with her adoptiveparents. Her birth mother was 13 when shegave her up for adoption. She feels she wouldbe disloyal to her birth mother if she did notgo through with the pregnancy because hermother continued her pregnancy.


Kaiya is 36, has 3 children, all girls, ages 8, 6and 4. She has not imagined having morethan 3 children but her husband is hopefulthat this pregnancy will be a boy. She feelsher husband’s wishes are important and issympathetic to his desire for a boy. They arein a secure financial position.


Liza is 30, pregnant for the first time. She hasnot told her husband she went off birth controlbecause he says he is not ready for children andwill be ready in a year or two. She states she issure he will change his mind. She says shewould not be emotionally or financiallyprepared to single parent.


Karen is 46, broke up with long term partnerwho doesn’t want a child, will have to go onwelfare, but has always wanted a child. Shehas limited family support and has a historyof depression, although it is now controlledwith medication.




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Indicate your first emotional responses to eachwoman described below choosing tocontinue her pregnancy and make adoptionarrangements and circle the correspondingspot on the line to identify your feelings.

Jen, age 28 has just found out she is 14 weekspregnant. She was adopted at birth by anolder North American couple who broughther from South America. She is an artist, herboyfriend is a student, both are carrying largestudent loans. She feels she has aresponsibility to her birth mother to gothrough a pregnancy and place her baby foradoption. Her partner tries to remain neutralbut is visibly very upset.


Vicki, age 28, has a history of mental healthproblems but is capable of making her owndecisions. She is 15 weeks pregnant and hasnot told the man involved in the pregnancythat she is pregnant. She is canceling herabortion appointment because she has seen aTV show about women who can’t havechildren and she was very moved by theirplight. She has decided she would like toplace her baby for adoption to help infertilecouples.


Anna is a single parent of two children. Shehad sex with ex-husband who is remarried.She says she cannot afford another child anddoes not feel comfortable with abortion. Shehas not told her ex-husband about thepregnancy. She says she has decided to placethe baby for adoption to a distant relative.


Tiffany, age 15, wants to continue herpregnancy and place her baby for adoption toa loving couple she met at her friend’s church.Her parents are upset and “want to talk somesense into her.” They believe it is in Tiffany’sbest interest for her to have an abortion.Tiffany says she is not ready to be a parentand does not “believe” in abortion.


April, age 33, has recently broken up with herboyfriend. She is devastated about thepregnancy but she does not think she couldreconcile abortion with her spiritual beliefs.Her friends and family are trying to influenceher to continue the pregnancy and raise thechild with their help but she thinks she wouldnot be able to provide a life that she hasimagined for a child. She has decided to placeher baby for adoption. Her boyfriend is upsetbut does not want to become a parent.




Exercise D-1: Views about the Role of

the Health Care Provider

A physician who practiced before the 1973U.S. Supreme Court Roe v. Wade decision thatstruck down state laws prohibiting abortionsays that she occasionally lied to colleagues onthe hospital committee about a patient’smedical circumstances in order to helppatients obtain legal abortions. She states“That’s part of the practice of medicine…youdo what you feel is necessary to insure thesafety of your patients.” ( Joffe1, p. 72).

What do you think of this statement? Whatare the reasons for your position? _________________________________________________________________________________

Exercise D-2: Personal Assessment of

Professional Obligations

Building on your thoughts from Exercise D-1,what obligation do you have as a health careprovider to ensure that your patients can accesssafe abortion services? Check all that apply.

___ I have an obligation to talk my pregnantpatients out of obtaining abortion services.

1Joffe C. Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade. Boston:Beacon Press, 1995

Section D: Providing Abortion Care: Professional Values Clarification ExercisesEvaluating our professional obligations in all cases as we are presented with them can be a challenge. Itcan help if we take the time to ask ourselves some questions about the relationship between ourpersonal views and our professional role beforehand as we make decisions about providing access to safeabortion services. Providing access can include providing referrals to appropriate services or providingabortions.

As a health care provider, your decision about providing abortion services ultimately determineswhether women can access safe abortion care. As such it is important to assess your feelings aboutabortion and providing abortions in the context of your professional role and obligations. While inmany countries physicians have traditionally been the providers of legal abortion care, the availability ofmedical abortion, also referred to as medication abortion, has opened doors for other health careprofessionals, for instance nurse practitioners and midwives, to play a larger role as providers of abortioncare. Additionally, more physicians in specialties such as family medicine, primary care, and adolescentmedicine are exploring ways to incorporate abortion care into their practices. In some cases, this hasrequired practitioners to actively evaluate for the first time what it means to them to become anabortion provider. Exercises D-1 through D-4 are designed to help you critically examine the factorsthat might influence your choice to become trained and to provide abortion services. Although some ofthe exercises pertain specifically to clinicians who are deciding about becoming abortion providers, allhealth professionals, whether they are involved in abortion care specifically or provide care to women inother settings, may benefit from reviewing these questions. They are also intended to illustrate thepossible consequences of your choice to provide or not provide abortion service.



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___ I have no obligation to my patients withregard to abortion services.

___ I have no obligation to provide abortionservices for my patients as long as otherclinicians can do so.

___ I have an obligation to provide factualinformation about all pregnancy optionsto my patients.

___ I have an obligation to provide mypregnant patients with referrals for servicesI am not willing or able to provide.

___ I have an obligation to follow up onabortion referrals I make to ensure thatmy patients have been able to access safe,high quality care.

___ I have an obligation to provide whateverlegal care my patients need and that I amcompetent to provide, as long as it doesnot conflict with my personal beliefs.

___ I have an obligation to provide whateverlegal care my patients need and that I amcompetent to provide, regardless of mypersonal judgments about their choices.

Write the reasons for your views. How longhave you felt this way? _________________________________________________________________________________________

Exercise D-3: The Decision to Provide

Abortion Care: Motivations and

Obstacles

1. Motivations:Which, if any, of the reasons listed belowmight motivate you to provide abortions foryour patients? Check all that apply.

___ Desire to provide comprehensive care formy patients

___ Need for a provider for patients in thecommunity where I practice

___ Commitment to help my patients avoidthe risks of self-induced, illegal, or poorquality abortions

___ Belief in the rights and responsibilities of my patients to make their own moralchoices

___ Desire to see only wanted childrenbrought into the world

___ Commitment to providing my patientswith the care they need, rather thanreferring them out to a provider they donot know

___ Desire to be competent in as manyaspects of reproductive health care aspossible and thus expand mymarketability and my career opportunitiesin this field

___ Desire to provide the same opportunityto obtain safe abortion services as I/mypartner had when I/she needed anabortion

___ Commitment to ensuring availability oflegal medical services for my patients

___ Desire to make a public commitment toabortion rights

___ Desire to foster a supportive environmentfor abortion rights and abortion providerswithin the medical community

___ Other(s): ________________________________________________________________________________________________



2. Obstacles:Which, if any, of the reasons listed belowmight deter you from providing abortions foryour patients? Check all that apply.

___ I find the idea of abortion personallyobjectionable.

___ I believe that abortion is contrary to myoath to do no harm.

___ Abortion is contrary to my religious beliefs.

___ I might have to face the memory of myown previous abortion experience(s).

___ I would worry about patients leaving mypractice.

___ My partners in my practice and/or thehospital where I have admittingprivileges are not supportive of or have apolicy against providing abortion services.

___ I would worry about my reputation withmedical colleagues.

___ There are administrative barriers (e.g.malpractice coverage, third-partyreimbursement, compliance with regulationsabout abortion practice and facilities).

___ Significant people in my life opposeabortion.

___ I would be concerned about my personalsafety vis-à-vis harassment and violenceby those opposed to abortion.

___ I would be concerned about the safety ofmy loved ones.

___ I am unsure about my competence if Iprovide abortions only occasionally.

___ Other(s): ________________________________________________________________________________________________

Exercise D-4: Overcoming Obstacles

to Providing Abortion Care:

A Self-Evaluation.

Given the perceived and real difficulties facing thosewho choose to provide abortions, it is not surprisingthat some clinicians choose not to become trained inabortion techniques or, even if they have been trained,choose not to provide abortions. At the same time,abortion providers have found ways to successfullyovercome the obstacles they face. The followingexercise is intended to provide some suggestions tohelp overcome obstacles to providing care and allowyou to assess your feelings about these options.

Looking again at the concerns you checked in Part 2 of Exercise D-3, consider ways thatsome health care providers deal with thoseissues. This exercise is two-fold: First, createa hierarchy of your personal concerns byindicating #1 as your biggest concern, and#12 as your smallest concern next to the listof statements A-L. After you have establishedthis hierarchy, refer to suggestions for eachstatement for further exploration.

A.____ I find the idea of abortion personallyobjectionable.

Suggestions for further personal exploration ofthis topic:

• Speak with abortion providers and learnhow they deal with any discomfort theymight have felt.

• Learn more about abortion procedures topinpoint the source of this discomfort.

• Shadow an abortion provider.• Observe some pregnancy options

counseling sessions.



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• Consider if there have there been othertimes when you had personal objectionsto aspects of medical care. How did youdeal with those objections? Where doyour objections stem from?

B.____ I believe that abortion is contrary tomy oath to do no harm.

Suggestions for further personal exploration onthis topic:

• Speak with abortion providers and learnhow they reconcile this.

• Consult resources on the healthconsequences of illegal and inaccessibleabortion.

Suggested resources:

Joffe C. Doctors of Conscience: The Struggle toProvide Abortion Before and After Roe v.Wade. Boston: Beacon Press, 1995.

Poppema S. Why I Am An Abortion Doctor.Amherst, NY: Prometheus Books, 1996.

Dorothy Fadiman’s Emmy-Award winningdocumentary trilogy From the Back Alley tothe Supreme Court and Beyond.

Voices of Choice – A Multimedia Project fromPhysicians for Reproductive Choice andHealth. Information available athttp://www.prch.org/voicesofchoice.shtml

C.____ Abortion is contrary to my religiousbeliefs.

Suggestions for further personal exploration onthis topic:

• Speak with abortion providers and learnhow they reconcile this.

• Speak with supportive members in yourreligious congregation about how toreconcile this, if this is possible.

• Examine other areas of your religion that you may find contrary to yourpersonal beliefs. How are you reconcilingthose issues?


Materials from Catholics for a Free Choice(http://www.catholicsforchoice.org/), theReligious Coalition for Reproductive Choice(http://www.rcrc.org/), or other religiouslyaffiliated groups that support abortion rights.

Life Matters: The Story of an Illegal Abortionist.A documentary. More information available athttp://www.filmakers.com/indivs/LifeMatters.htm

D.____ I might have to face the memory ofmy own previous abortion experience(s).

Suggestions for addressing this concern:

• Share concerns with trusted others whoknow about the experience or seekprofessional counseling or a supportgroup to work to resolve feelings aboutan abortion experience.

• Reflect on the benefits of helping othersthrough something you have experienced.


DePuy C & Dovitch D. The Healing Choice:Your Guide to Emotional Recovery After anAbortion. New York: Fireside, 1997.

Torre-Bueno A. Peace After Abortion: A Pro-Choice Self-Help Guide for Women and Men.San Diego: Pimpernel Press, 1996.www.peaceafterabortion.com/



E.____ I would worry about patients leavingmy practice.


• Keep a low profile (e.g. separating anabortion practice in time or space fromthe rest of one’s practice).

• Use careful language (e.g. D & C ratherthan abortion).

• Educate patients about why this is animportant part of medical practice.

• Network with colleagues who offerabortion to learn about the effect it hadon their practices.

• Network with pro-choice groups, colleagues,or organizations to build support.

• Consider that offering abortion servicescould signal to other patients that you areopen to all their concerns and lead tobetter patient-provider relationships.

• Consider that you may also gain newpatients who come to you for abortioncare and stay with you.


The Access Listserv is a network of familyphysicians who are interested in theintegration of early abortion services intofamily practice. Contact [email protected] for more information.

The Center for Reproductive Health Educationin Family Medicine has information abouttalking with patients about abortion servicesat www.reprohealthfamilymed.org.

F.____ My partners in my practice and/or thehospital where I have admitting privileges arenot supportive of or have a policy againstproviding abortion services.

Suggestions for successfully addressing this obstacle:

• Network with pro-choice colleagues inyour hospital and build support forproviding abortion services.

• Network with colleagues in otherhospitals who have successfully addressedpolicy restrictions.

• Use this guide as a starting point fordiscussion with colleagues.

• Reach out to pro-choice groups andindividuals in your community or regionto build support.

• Join a pro-choice professionalorganization.

• Consider adding abortion-related servicesfirst, such as post-abortion follow-upvisits, options counseling, or eveninformation brochures about abortionand pregnancy options.

• Consider assisting in a local clinic one ortwo days a week.


The Center for Reproductive HealthEducation in Family Medicine website hastools for beginning a dialogue withcolleagues and staff, including staff attitudesurveys at www.reprohealthfamilymed.org.

G.____ I would worry about my reputationwith medical colleagues.

Suggestions for successfully addressing this concern:

• Network with pro-choice colleagues.• Avoid discussing abortion with your

other colleagues.• Join a pro-choice professional

organization.• Speak out effectively in favor of abortion.



29

• Maintain an open mind and a willingnessto talk to all colleagues, regardless ofchoice stance.


For suggestions for responding to commonquestions or comments people make aboutproviding abortion services, an excerpt from“When People Ask ‘Where Do You Work?’”(Baker A. Abortion and Options Counseling: AComprehensive Reference, Revised andExpanded Edition. Granite City, IL: HopeClinic For Women, Ltd., 1995) is available athttp://www.ansirh.org/trainingworkbook/chapter9tools/Talking%20About%20Your%20Work%20With%20Others.doc

H.____ There are administrative barriers (e.g.malpractice coverage, third-party reimbursement,compliance with state regulations aboutabortion practice and facilities).

Strategies to address these issues:

• Network with colleagues who provideabortion services.

• Speak with staff of organizations thathave expertise with abortion regulations,such as the National Abortion Federation,The Center for Reproductive Rights, andthe American Civil Liberties Union.

• Join a pro-choice professional organization,such as the National Abortion Federation,for professional expertise.

• These barriers exist for other areas ofmedical practice, too. You or your staff mayhave already found ways to solve these issues.


See Chapter 9 “Office Practice” in GoodmanS, Paul M, Wolfe M, Stewart FH and the

TEACH Trainers Collaborative WorkingGroup.* Early Abortion Trainers Workbook.UCSF Center for Reproductive HealthResearch & Policy: San Francisco, CA(2004). * Hufbauer E, Schwarzman M,Curington J, Robinson S, Hastings J.Available at http://www.ansirh.org/trainingworkbook/trainingworkbook.html

The Center for Reproductive HealthEducation in Family Medicine hasnumerous administrative resources availableat www.reprohealthfamilymed.org.

I.____ Significant people in my life opposeabortion.

Suggested ways to handle these concerns:

• Do not discuss this aspect of your workwith them.

• Listen to and acknowledge their sourcesof discomfort.

• Discuss with them the reasons for yourdecision to provide care.

• Provide written and media resources forthem to consider on the topic of abortionand abortion providers.

• Be willing to discuss areas where you mayalso feel some discomfort. Perhaps it is thesame area and your reconciliation of theissue may help them understand your work.

J.____ I would be concerned about mypersonal safety vis-à-vis harassment andviolence by those opposed to abortion.


• Keep a low profile about your involvementin providing abortion services.

• Study and assess the personal risk.


Additional Instructions for Using Selected Exercises from the Guide in a Group Setting

• Take extra personal security measures aswell as for offices or clinics.

• Establish relations with the local police.• Network with pro-choice organizations,

such as the National Abortion Federation,that can provide help when needed.

• Reach out to pro-choice groups andindividuals in your community or regionto build support.

• Stop doing procedures if the threat felttoo great.


Security staff at the National AbortionFederation work closely with providers onissues related disruption, harassment, andviolence and provide security trainings,assessments, alerts, and 24-hour clinic support.

The website for the U.S. Department ofJustice National Task Force on ViolenceAgainst Health Care Providers includesinformation about the enforcement of lawsto protect reproductive health care providersand their patients, as well as security tips athttp://www.usdoj.gov/crt/crim/faceweb.htm

De Becker, G. The Gift of Fear: SurvivalSignals that Protect Us from Violence. GavinDe Becker, 1997

K.____ I would be concerned about the safetyof my loved ones.


• Keep a low profile about your involvementin providing abortion services.

• Study the facts and assess for yourselfwhether your family would be at risk.

• Ask your loved ones not to discuss your work.

• Establish relations with the local police.• Reach out to pro-choice groups and

individuals in your community or regionto build support.

• Stop doing procedures if the threat felttoo great.


See Suggested resources under J above

L.____ I am unsure about my competence if Iprovide abortions only occasionally.

Some suggestions:

• Refer patients elsewhere if at all doubtful.• Obtain additional experience by working

occasionally at an abortion clinic.• Find a skilled provider in the community

to work with you or provide extra training.• Participate in continuing medical

education courses about abortion andabortion techniques.

• Consider offering medical abortion as analternative to vacuum aspiration until youfeel competent with aspiration skills.

• Stop or scale back the scope ofprocedures if you did not feel confidentin your competency.


The National Abortion Federation’s website(www.prochoice.org) includes extensiveprofessional education resources andmaterials, including an online CMEprogram on medical abortion, informationabout training opportunities, and links toother organizations that provide training orhave educational resources.



31

Facilitating group exercises and groupdiscussion can be a daunting task, particularlywhen the subject under discussion is oneabout which people have strong and personalfeelings. At the same time, however, thegroup process is invaluable in terms ofclarifying one’s own values and learning fromothers. Included at the end of this section is alist of resources for those who would likemore guidance and information about theprocess of facilitating group discussions.

What follows are 1) tailored instructions forusing in a group setting selected exercisesfrom Part II that are most appropriate for thisforum and 2) additional questions forprompting group discussion. We haveincluded an estimate of the approximate timeto allow for completing each exercise.However, the timing of these exercisesdepends very much on a number of factorsincluding the size of the group, the level ofparticipation, the diversity of opinions held byparticipants, and the dynamics among theparticipants.

Finally, it might be helpful to set the tone forgroup sessions by indicating that there is noneed to reach group consensus, but striving tounderstand each other’s views can be veryuseful. Further, hearing the ideas of colleaguesmight cause participants to reconsider their

initial thoughts. The way we expand ourthinking and grow is by receiving moreinformation from other viewpoints that makea lot of sense to us – it doesn’t matter if wedidn’t think of it first. So feel free to let newthinking change your mind at any time.


Level with Gestational Age:

(Suggested time allotment: 30 minutes)

Draw an imaginary line across the room andlabel the following points on the line: atconception, at implantation, at the end of thefirst trimester, at quickening, at the end of thesecond trimester, at some point in the thirdtrimester. Ask participants to stand on theline at the point where they stop feelingcomfortable with the idea of abortion. Askparticipants at different points along thecontinuum to share what made them choosetheir position while others in the group justlisten. Afterwards, open up the floor forgeneral discussion and reactions to the ideasthat were expressed. Repeat for differentlevels of professional involvement in abortion:1) making abortion referrals, 2) assisting withabortion services, and 3) providing abortions.

PART III – ADDITIONAL INSTRUCTIONS FOR USING

SELECTED EXERCISES FROM THE GUIDE IN A

GROUP SETTING




Level with Circumstances of Each

Woman’s Abortion Decision:


Conduct an anonymous poll by havingparticipants write agree or disagree in responseto five statements you have selected from therange of possible feelings about womenobtaining abortions (e.g. I can accept awoman’s decision in any circumstance whenshe has made an informed and voluntarychoice for abortion, I can accept a woman’sdecision to end a pregnancy that threatenedher physical health, I can accept a woman’sdecision to end a pregnancy if she is in anunstable relationship or is not in a relationship,I can accept a woman’s decision to end apregnancy if she is very young, I find abortionunacceptable under virtually any circumstance).Collect the papers and redistribute them soeach participant has someone else’s answers infront of them. Designate one side of the roomas “agree” and one as “disagree,” then read eachstatement and have participants go to the sideof the room corresponding to the answer onthe sheet of paper they are now holding. Aftereach statement, ask a few participants fromeach side of the room to give a rationale forthat position, reiterating that the personoffering the explanation does not necessarilyhold that opinion. After a few people fromeach side of the room have offered a rationalefor that position, open it up to generaldiscussion so participants can respond to theideas which were expressed.

Possible discussion questions if participants arenot talking:

1) What was most difficult about this exercise?

2) What was your reaction to the list ofcircumstances under which someone mightfind abortion acceptable? Did it seem like awide range or did you expect a moreextensive list?

3) Which circumstances seemed easiest toselect or rule out? For what reason?

4) What are the possible reasons why thedebate about abortion so often focuses onthe woman’s life, rape, and incest rather thanon other circumstances which might bemore common?

Exercise C-3: Individual Cases:

Examining Our Potential Biases

Part 1 and 3

(Suggested time allotment: 1 hour)

For each exercise, label stations around the roomwith the case descriptions for the exercise. Askparticipants to go to the station that representstheir choice and discuss with others at the samestation their reasons for so choosing. After allstations have reported back to the full grouptheir reasons, participants can change stations ifthey have changed their choice. Then ask thefull group to talk together in an effort to reachconsensus. Repeat for Part 3, although there isno need to reach consensus on this one.

Discussion questions:

1) Which choice was hardest to make (denyingabortion access in cases where an abortionmight be judged as generally sociallyacceptable OR providing abortion in caseswhere abortion might be judged as sociallyunacceptable)? Why?


The Abortion Option: A Values Clarification Guide for Health Care Professionals

33

2) How can a clinician handle personaldiscomfort in dealing with patients whosechoices are beyond the clinician’s personalcomfort zone?

3) How, if at all, is a woman’s choice to have anabortion for reasons a health care providermight not agree with different from awoman or man’s choice to make othermedically related choices, such as smoking orriding a motorcycle without a helmet, whicha health care provider might not agree with?

Part 2


Ask participants to rank their choices inwriting. Then read the list of women aloudasking how many people ranked each womanas their first choice by having those who choseraise their hands. Ask for someone who chose#1 to make the case for her; then for each ofthe other women, have someone who chose hermake the case. Ask participants not to discussor argue while the cases are being presented.How did you refute the arguments made forthe women you did not choose?

Discussion questions:

1) How did having to choose make you feel?

2) Why is it so difficult to make these kinds ofchoices?

3) How could you avoid ever having to makechoices of that sort in your practice?

Exercise C-4: Pregnancy Options

Decision Making


Have participants break into small groups (3-5participants) and read the six descriptions. Askthe groups to discuss and reach consensusabout which two women they will “assign” toeach of the three pregnancy options (adoption,abortion, parenting). After 20 minutes, havethe groups report back the decisions they madeand the reasons for their decisions. Allow eachgroup to report their decisions withoutinterruption and then open discussion up.

Additional discussion questions:

1) How did it feel to have to make thesedecisions as a group?

2) Which cases, if any, were fairly easy toassign? Why?

3) Which cases were most difficult? Why?

Exercise C-5: Parenting and Adoption:

Examining our Potential Biases

(Suggested time allotment 25 minutes)

Label one end of the room “Very Comfortable”and the other end of the room “VeryUncomfortable” and explain that the linebetween those two extremes represents acontinuum. Read the descriptions of 2-3 of the“Choosing to Parent” cases one at a time andask participants to go to the spot along thecontinuum that corresponds to the firstemotional response they have to eachdescription. Have one or two people from eachspot share with the group their reasons for sochoosing. After all stations have reported back



to the full group their reasons, participants canchange stations if they have changed theirchoice. Repeat with 2-3 of the “ChoosingAdoption” scenarios.


1) If you had to choose one or the other, wereyou generally more comfortable with theparenting scenarios or with the adoptionsscenarios? Why?

2) For those who had a change in comfort levelafter listening to others, what made you feeldifferently?

Exercise D-1: Views about the Role of

the Health Care Provider


Have participants break down into smallgroups (4-5 participants) and read the excerpt.Ask participants to work on the discussionquestions which follow in their small groups.Have smaller groups report back to the groupas a whole the most compelling or controversialissue this excerpt elicited in their small groupdiscussions.No additional discussion questions.

EXERCISE D-2: Personal Assessment of

Professional Obligations


Ask participants to consider the scale anddecide which position best represents theirview. Then, have them cluster in different partsof the room according to the position they havechosen and discuss briefly their reasons fortheir choice with others in their cluster. Thenask individuals from each cluster to offer their

reasons while others in the group just listen.Afterward, open it up to general discussion soparticipants can respond to the ideas whichwere expressed.


1) What is your reaction to this question?

2) What other medical services might a healthcare provider “opt out” of providing?

3) What are some of the ways that a healthcare provider can reconcile personal beliefswith a patient’s needs and beliefs?

4) What is the difference, if any, for denyingmedical services for medical reasons vs.personal reasons?

EXERCISE D-3: The Decision to Provide

Abortion Care: Motivations and

Obstacles to Practice


Have participants complete Part 1 and Part 2individually. Then have participants work ingroups of two to three people and discuss theiranswers. Smaller groups should report back tothe larger group for further discussion one ortwo issues which were especially compelling orcontroversial in their small group discussions.Suggestions for discussion questions for eachquestionnaire are listed below.

Overall discussion question: The purpose ofthese particular exercises is to have youcritically assess whether or not to be trainedand ultimately provide abortion services. Youhave a greater responsibility to assess yourfeelings about abortion and providing abortionthan people in other professions since, as a



35

health care professional, you will ultimately bethe one to make or not make safe abortionservices available. What are your thoughtsabout this statement?

Discussion questions for Part 1:

1) Which reasons for providing abortions aremost compelling?

2) What makes them compelling?

3) Which reasons might a health care providerfind more compelling than a lay person? (i.e.In what ways has your professional educationand training influenced your beliefs?)

4) What is the importance, if any, ofcommunicating the health care provider’sperspective to the public?

Discussion questions for Part 2:

1) Which reasons for not providing abortionsare most compelling?

2) What makes them compelling?

3) Which reasons might a health care providerfind more compelling than a lay person? (i.e.In what ways has your professional educationand training influenced your beliefs?)

4) What is the importance, if any, ofcommunicating the health care provider’sperspective to the public?

5) What other medical services might you “optout” of providing? For what reasons?

6) If there are other services which you mightopt out of providing, how are these similar ordifferent from abortion? If you would not“opt out” of any other service, what aboutabortion makes it different from othermedical services?

EXERCISE D-4: Obstacles to Providing

Abortion Care: A Self-Evaluation


Have participants complete the questionnaireindividually. Then work on one barrier at atime, asking participants to indicate whichsuggestions might enable them to overcomethat difficulty.


1) Which reasons for choosing not to provideabortions can most easily be dealt with andovercome? Why?

2) Which reasons seem most difficult to dealwith or overcome? Why?

3) How realistic are the suggestions forovercoming the reasons for choosing not toprovide abortion?

4) Are there other suggestions not included inthe lists that might be helpful?

5) What would make it easier to overcome thebarriers to providing abortions?

6) What would make it harder?

Suggested References about

Facilitating Group Discussions

Beresford T. How To Be a Trainer. Baltimore,MD: Planned Parenthood of Maryland, 1980.

Boyer RP with McCormick S. Helping PeopleLearn about Sexuality. Bristol, PA: PlannedParenthood of Bucks County.

Cook AT, Kirby D, Wilson P, and Atler J.Sexuality Education: A Guide to Developing andImplementing Programs. Santa Cruz, CA:Network Publications, 1984.

Silberman M, Auerbach C, and Silberman ML.Active Training: A Handbook of Techniques,Designs, Case Examples, and Tips. San Francisco,CA: Jossey-Bass Inc. Publishers, 1997.

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