A 26-year-old woman seeking an abortion

Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy

Case reports have associated severe nausea and vomiting of pregnancy (NVP) with elective termination of pregnancy. Therefore, our objective was to explore the determinants of consideration of termination and actual termination of pregnancy among women with NVP. From 1996 to 1997, callers to an advertised NVP Healthline underwent a semi-structured interview. From callers who retrospectively reported on NVP in a previous pregnancy, a nested unmatched case-control study was performed. Callers were divided into three groups: those who reported having electively terminated their pregnancy due to NVP, those who considered termination due to NVP and those who never considered termination. The severity of nausea and vomiting, and frequency of psychosocial morbidity, were compared between cases and controls, and multivariate logistic regression analysis was used to determine factors independently associated with termination and/or consideration of termination of pregnancy due to NVP. Of 3201 callers with NVP, 413 women reported having considered termination of pregnancy for NVP, 108 reported termination due to NVP and 2609 reported never having considered termination for NVP. The following factors were independently associated with a woman's consideration of termination of pregnancy due to NVP: unplanned pregnancy (p = 0.002), multiparity (p = 0.0001), more severe vomiting (p = 0.003), feelings of depression (p < 0.0001) and reported adverse effects of NVP on both her partner's daily life (p = 0.04) and her relationship with her partner (p = 0.0003). The following factors were independently associated with actual termination of pregnancy due to NVP: unplanned pregnancy (p < 0.0001), multiparity (p = 0.03) and feelings of depression (p = 0.001). There were no significant interactions between factors. Consideration of termination, or actual termination of pregnancy, due to NVP are associated with psychosocial circumstances, which should be taken into consideration when managing these women.

The silent consumer: women's reports and ratings of abortion services

BACKGROUND

Abortion is one of the most common surgical procedures performed on women in the United States, and its safety has been demonstrated. Little research has focused, however, on women's reports and ratings of the service.

OBJECTIVES

This study explored the association of demographic factors, medical outcomes, and client ratings of service dimensions with global satisfaction.

RESEARCH DESIGN

For this cross-sectional study, permission to access clinic medical records was obtained. Surveys were distributed after the procedure, with instructions to return by mail.

SUBJECTS

Study subjects were 797 women who underwent an outpatient surgical abortion at 1 of 2 New England health centers in 1996 and 1997.

MEASURES

Demographic data, pregnancy history, and information on the procedure were collected from medical records. Survey items measured reports of access, medical outcomes, and satisfaction ratings with service domains.

RESULTS

Women with positive ratings of staff sensitivity and of the counseling process and information received and those who had the procedure at a younger gestational age were less likely to report that care could be better. Although very few women reported a medical complication, this was associated with agreement that care could have been better, as was reporting agreement that the wait between the preexamination visit and the procedure was too long.

CONCLUSIONS

Satisfaction with abortion services is high. Education and counseling play very important roles. Survey items could routinely be used to monitor services.