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Abortion Aftercare Instructions in the United States: A Content Analysis of Patient Handouts

  • Zoey Thill
    Correspondence
    Correspondence to: Zoey Thill, MD, MPP, MPH, Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, 3544 Jerome Ave, Bronx, NY 10467.
    Affiliations
    Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York
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  • Author Footnotes
    1 Present address: Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Health, 227 East 30th Street, New York, NY 10016.
    Dyanna Charles
    Footnotes
    1 Present address: Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Health, 227 East 30th Street, New York, NY 10016.
    Affiliations
    Gynuity Health Projects, New York, New York
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  • Author Footnotes
    2 Present address: University of California, Berkeley School of Public Health, 2121 Berkeley Way West, Berkeley, CA 94720.
    Ariana H. Bennett
    Footnotes
    2 Present address: University of California, Berkeley School of Public Health, 2121 Berkeley Way West, Berkeley, CA 94720.
    Affiliations
    Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York
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  • Allison Paul
    Affiliations
    Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York
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  • Marji Gold
    Affiliations
    Albert Einstein College of Medicine, Montefiore Medical Center, Department of Family and Social Medicine, Bronx, New York
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  • Author Footnotes
    1 Present address: Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Health, 227 East 30th Street, New York, NY 10016.
    2 Present address: University of California, Berkeley School of Public Health, 2121 Berkeley Way West, Berkeley, CA 94720.
Published:April 12, 2022DOI:https://doi.org/10.1016/j.whi.2022.02.005

      Abstract

      Background

      At the clinical visit for abortion care, patients typically receive a handout with information about what to expect and how to care for themselves after the abortion. Published guidelines give little to no guidance regarding the content of postabortion instructions.

      Methods

      We collected aftercare instruction handouts for first trimester procedural and medication abortion from abortion clinics throughout the United States. Instructions were coded and analyzed using conventional content analysis.

      Results

      Of the 84 unique aftercare handouts we received, most included information about symptoms to expect (included in 98% of procedural handouts, 97% of medication handouts), how to manage symptoms (included in 100% of procedural handouts, 100% of medication handouts), and specific behaviors to avoid (included in 94% of procedural handouts, 66% of medication handouts). The most common behavioral avoidance instructions were “pelvic rest” (included in 90% of procedural handouts, 63% of medication handouts), avoiding strenuous activity (included in 61% of procedural handouts, 29% of medication handouts), and avoiding submersion in water (included in 41% of procedural handouts, 26% of medication handouts). Handouts varied with regard to the extent and duration of specific recommendations. They also varied in tone, word choice, and other characteristics.

      Conclusions

      There exists a wide range of abortion aftercare instructions throughout the United States. Inconsistency among instructions may reflect a lack of published, evidence-based clinical guidelines. Standardizing aftercare instruction handouts based on patient-oriented evidence could improve patient experience after abortion.
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      Biography

      Zoey Thill, MD, MPP, MPH, was a Family Medicine fellow in Family Planning at Albert Einstein College of Medicine during this study. Her research interests include patient-provider communication and abortion integration into primary care.

      Biography

      Dyanna Charles, MPH, is an NYU Langone Health Research Project Manager for a mathematical modeling team focusing on HIV, HCV, and opioid use. During the study, Dyanna was a Program Associate at Gynuity Health Projects coordinating studies in women's reproductive health.

      Biography

      Ariana H. Bennett, MPH, is a doctoral candidate in public health at UC Berkeley. At the time of the study, Ariana was the Director of Research for the Family Medicine Fellowship in Family Planning at Albert Einstein College of Medicine.

      Biography

      Allison Paul, MD, MPH, was a Family Medicine fellow in Family Planning at Albert Einstein College of Medicine when this research was conducted, and now works within the department providing full-spectrum primary care and studying doctors' attitudes about abortion.

      Biography

      Marji Gold, MD, is the director of the Family Medicine Fellowship in Family Planning at Albert Einstein College of Medicine. Dr. Gold’s research interests include assessing the impact of simplifying medication abortion and training family physicians in early abortion care.