Elsevier

Contraception

Volume 69, Issue 1, January 2004, Pages 59-62
Contraception

Original research article
Effect of nurses' attitudes on hospital-based abortion procedures in Massachusetts

https://doi.org/10.1016/j.contraception.2003.08.009Get rights and content

Abstract

Our study explored a largely unacknowledged obstacle to abortion access in Massachusetts: the unwillingness of nurses to staff abortion procedures. Evidence suggests that nurses tend to be more likely to oppose abortion than other medical professionals. However, the attitudes and practices of hospital-based nurses regarding abortion have not been thoroughly investigated. We collected qualitative information from physicians and nurse managers to understand how nurses' attitudes affect hospital-based abortion services in Massachusetts. We surveyed key respondents at all hospitals in Massachusetts where abortion services are available to any woman who requests them. Of the 20 individuals who responded (87%), 17 were physicians and 3 were nurse managers. We found that over half of physician respondents believed that the unavailability or unwillingness of nurses to staff abortions is a slight or moderate problem, and nearly a quarter of physician respondents characterized it as a large or very large problem. Thus, nurses' attitudes towards abortion and their unwillingness to assist with procedures may hinder patient access to abortion services.

Introduction

Despite the 1973 Roe vs. Wade ruling that legalized abortion in the United States, American women still face significant barriers to obtaining abortion services [1], [2]. Foremost, finding a competent physician willing and able to perform an abortion is a major obstacle. Several studies show that physicians' attitudes towards abortion have an impact upon the experience of abortion-seeking women [3], [4], [5], in that abortions may be provided (or not provided) at the discretion of the doctor. Training may also play a role, as Steinauer et al. [6] demonstrated that the likelihood of abortion provision may correlate with the type of abortion training that a doctor undergoes during residency. The effect of nurses' attitudes on American women's abortion experiences, however, is less well understood. Of the few existing studies on this topic, most do not include American nurses [7], [8], [9] or they focus on a nurse's right to invoke religious refusal clauses [10], [11].

The meager literature on the topic of nurses' attitudes toward abortion is mainly very dated. One survey from 1971 indicated that nurses were significantly less likely than doctors or social workers to support the legalization of abortion [12]. Another study in 1975 showed that nursing students' opinions on abortion were largely dependent on gestational duration of the pregnancy, the woman's reason for seeking an abortion and the religious orientation of the nursing student. Many students opposed abortion on personal religious grounds, at late gestational ages or for reasons other than rape or health endangerment. Still, at the time the survey was conducted, over 60% of nursing students supported the Supreme Court's 1973 ruling on abortion [13].

Research published within the last decade shows that nurses are becoming less likely to support reproductive choice. In 1988, only 52% of nurses were willing to work in a unit that provided abortions, and by 1998 that number had dropped to 39% [14].

Anecdotal evidence indicates that in some hospitals, abortion procedures have been hindered due to a lack of nurses willing to assist physicians with the procedure. The consequences of postponing abortions in order to resolve a nursing shortage can be serious, especially because the odds of finding a willing nurse may decrease as gestational duration increases. A delay may also impose psychological stress upon the woman waiting to undergo the procedure.

Hospital-based abortion services play a crucial role in maintaining women's reproductive health. This is especially true for rural women, who may not have access to a specialized abortion clinic, and for poor women, who may need access to free care, Medicaid-sponsored abortions or other assistance. Additionally, hospitals are more often equipped to perform late-term abortions, abortions for women with other special medical needs and are also better prepared to handle medical complications.

Section snippets

Materials and methods

Our study was designed to obtain qualitative information from physicians and nurse mangers about how nurses' attitudes affect hospital-based abortion services in Massachusetts. Out of over 60 obstetrics-gynecology departments in Massachusetts hospitals, only 12 provided “accessible” abortion services in 2002 [15]. Services are considered accessible when a woman who does not already have an established relationship with a private physician at that hospital can obtain abortion services.

During the

Cancellation or postponement of services

None of the physician respondents or nurse managers indicated that they had ever cancelled a procedure due to a lack of nursing assistance. More than one third of physician respondents did report, however, that they had had to postpone abortion services one or more times owing to a lack of nurses willing to assist. None of the nurse managers reported postponement of abortion services.

When asked whether abortions are canceled or postponed more often than other elective procedures due to a lack

Discussion

Our study suggests that many Massachusetts physicians working in hospitals that provide accessible abortion services believe that nurses' unwillingness to participate in abortion services poses at least somewhat of a barrier to abortion access. Some of these physicians report that their patients have had abortions postponed as a direct result of nurse unavailability. Particularly compelling are the statements from physicians that indicate that their desire to offer a wider variety of services

Acknowledgements

The authors thank Joel Weissman, Kathy Simmonds, Susan Yanow and Charlotte Ellertson for assistance in conceiving the study and preparing the manuscript. They also wish to thank Hilary Alpert for her assistance in reviewing the literature.

References (15)

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