Anesthesia providers’ perspectives on abortion provision: a qualitative study Open Access

Reeves, Jennifer (Spring 2019)

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Background:  Hospital-based abortion care can be affected by abortion stigma, including the negative attitudes of other healthcare staff. Overall, anesthesia providers as a population of providers that participate in abortion care are not well studied. Recent state legislation in Georgia affects abortion access and has serious implications on general obstetric care. Further study of the effects of restrictive abortion gestational age limits and the perspectives of anesthesia care providers is needed to effect change and improve abortion access.

Objective:  Our study explored anesthesia providers’ attitudes towards providing anesthesia for abortion.

Methods:  In-depth qualitative interviews were conducted with Georgia-area anesthesia providers who provide care for pregnant patients. Participants were recruited from four scientific meetings of regional anesthesiology organizations from February 2018 until February 2019. Demographic information including personal experience in abortion provision was collected. Recruitment continued until thematic saturation of the primary aim was reached. A codebook was created and refined in an iterative fashion, and thematic and comparative analyses were performed with MAXQDA qualitative software.

Results:  15 in-depth interviews with Georgia-area anesthesia providers were conducted, which included a wide representation of different provider types, location, and years of experience. In conceptualizing how anesthesia providers approach participation in abortion, our research revealed several major themes: professional versus personal views, transfer of responsibility, and workplace communication as facilitator. The multi-level factors that affect anesthesia providers’ participation in abortion provision that emerged from participant interviews aligned consistently with the social ecological model (SEM).

Conclusions:  These findings enrich our understanding of Georgia-area, hospital-based anesthesia providers and generate potential targets to interventions or programs to enhance collegiality and improve abortion access in these settings.

Table of Contents

Table of Contents

Chapter 1: Introduction and Statement of the Problem and Purpose. 7

Introduction and Rationale. 7

Problem Statement 8

Theoretical Framework. 9

Research Question and Purpose Statement 11

Significance Statement 12

Definition of Terms. 12

Chapter 2: Literature Review.. 14

Abortion in the US and Globally. 14

Abortion Stigma. 15

Abortion Attitudes of Healthcare Workers. 18

Implications of US legislation on Abortion and Obstetric Care. 21

Chapter 3. Methodology. 24

Introduction. 24

Population and Sample. 24

Research Design and Measures. 25

Procedures. 27

Analysis. 29

Chapter 4. Results. 31

Introduction. 31

Sample Characteristics. 31

Major Themes. 32

I. Professional versus Personal 32

II.  Transfer of Responsibility. 40

III. Workplace Communication as Facilitator 45

IV. Social Ecological Model 51

Summary of Findings. 60

Figure 1. 61

Table 1: Participant Demographics. 62

Figure 2: Spectrum of Acceptability of Abortion Indication. 64

Chapter 5. Discussion. 65

Introduction and Summary of Study. 65

Discussion of Key Results. 65

I. Professional versus Personal 67

II.  Communication as Facilitator 71

III. Transfer of Responsibility. 73

Strengths and Limitations. 74

Implications, Recommendations, and Conclusions. 77

References. 81

Appendix 1: Participant Interview Guide. 87

Appendix 2: 22-Week Ban Supplement 94

Appendix 3: Verbal Consent Form.. 96

Appendix 4: APPAP Code Book. 98

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