The abortion option - A Values Clarification Guide for Health Care Professionals
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the abortion option
A Values Clarification Guide
for Health Care ProfessionalsThe National Abortion Federation (NAF) is the professional association of abortion providers
in the United States and Canada. We are grateful to Alix Hirabayashi and Lisa Butel who
revised, expanded, and updated this publication. We acknowledge Laureen Tews, MPH who
provided feedback and guidance, and who developed and wrote with Terry Beresford the 1998
publication on which this guide was based. We additionally acknowledge Annie Baker, Joan
Garrity, and Pat Anderson who provided expert feedback on the original 1998 publication and
Educational Foundation of America, The Richard and Rhoda Goldman Fund, The John Merck
Fund, Open Society Institute, and The David and Lucile Packard Foundation whose generous
support of NAF’s Access Initiative Project and programs to educate health care professionals
made this work possible.
© 2005 National Abortion Federation
1755 Massachusetts Avenue NW, Suite 600
Washington, DC 20036
202/667-5881
www.prochoice.orgTHE ABORTION OPTION: A VALUES CLARIFICATION GUIDE FOR HEALTH CARE PROFESSIONALS Why this publication was developed abortion training is not incorporated into The exercises in this publication are designed many residency programs, most health care to help you examine your beliefs about providers will need to decide for themselves abortion so that you may be better able to how important it is to learn about abortion care for women considering this option. and/or to obtain abortion training. Because one’s beliefs about abortion are linked to one’s thoughts about sexuality, The following exercises are designed to help pregnancy prevention, parenting, and you critically examine the factors that might adoption among other issues, some exercises influence your beliefs about parenting, examine these topics as well. While some adoption, and abortion and, for some, your exercises are geared specifically toward choice to become trained and to provide providers who are making decisions about abortion services. They are also intended to whether or not to obtain abortion training illustrate the possible consequences of your and ultimately to be involved in providing choice to provide or not provide service. It is abortion services to their patients, the for these reasons that the National Abortion majority of exercises are appropriate for the Federation developed this publication. wide range of health care professionals who provide care to women. As a health care How to use this publication provider, your responsibility to assess your The legal and historical overviews in Part I feelings about abortion and providing provide background information about the abortion care is greater than that of people in context in which abortion services are other professions, because your decisions will currently provided and the personal and ultimately determine whether or not women public health implications of restrictions on receive accurate information about their women’s access to abortion. This baseline reproductive health care options, are information can help set the stage for health empowered to make the health care decisions care professionals as they proceed with the that are best for them, and are able to obtain values clarification exercises. high quality, supportive, respectful abortion services if they choose abortion. Further, Many exercises that follow in Part II and Part because information about abortion is not III can be used either individually (Part II) or included as a routine component of most in a group setting (Part III). Ideally, both medical school or nursing curricula, and formats will be used so that you will have an The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF i
opportunity for personal reflection, free of Why it is important for health care
peer pressure, as well as the benefit of hearing professionals to examine our values
other people’s viewpoints and testing your In spite of our efforts at objectivity, we all
beliefs against possible challenges from others hold personal values that can influence how
in your group. we respond to our clients. Sometimes these
values are very clear to us and are easily
Further, each of the exercises is designed to articulated. Others exist at a deeper level, so
stand on its own and, thus, instructors or that we don’t necessarily recognize the
others using this publication, particularly in a influence they have on our behavior and
group setting, can choose to use only one or judgments as health care providers. Further,
two exercises that suit their particular one’s values may change in response to life
objectives. Certainly all the exercises have experiences and your encounters with clients
value, but given time constraints and other and colleagues may influence your beliefs
considerations, the publication is designed to without your having much of a chance to
give flexibility to those who use it. reflect on these changes.
We have arranged the exercises in sections to The exercises presented here are intended to
help guide users through the various sources help you clarify for yourself your present
of influence that affect one’s values. We have personal values about pregnancy options,
also included graphics in the upper corners of abortion, and abortion training, and to help
the pages that can serve to orient users to the you think about those values in the context of
broad categories addressed by the exercises in professional judgments you may be called
this publication. upon to make.
ii © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsTable 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 ............................................................................1
Overview of Abortion Laws and Policies in the U.S.......................................................1
Overview of Abortion Laws and Polices in Canada ........................................................2
Consequences of Limited Access to Abortion Services...............................................................4
Examples in the U.S. during the 1950’s and 1960’s .........................................................4
Examples 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............................7
A.1 – Family and Social Group .......................................................................................7
A.2 – Spiritual Beliefs......................................................................................................9
A.3 – Life Stage .............................................................................................................10
Section B: The Influences of Our Personal Experiences in the Formation Our Values ...........10
B.1 – Sexual Intimacy and Risk-Taking ........................................................................10
B.2 – Parenting, Adoption, Abortion, and Pregnancy Prevention .................................12
Section C: Self-Evaluation of Our Objectivity When Considering a
Woman’s Pregnancy Circumstances and Her Options ...........................................16
C.1 – Examining Our Comfort Level with Gestational Age ........................................16
C.2 – Examining Our Comfort Level with Circumstances...........................................17
of Each Woman’s Abortion Decision
C.3 – Individual Cases: Examining Our Potential Biases ............................................18
C.4 – Pregnancy Options Decision Making ..................................................................20
C.5 – Parenting and Adoption: Examining Our Potential Biases ................................22
Section D: Providing Abortion Care: Professional Values Clarification Exercises ..................24
D.1 – Views about the Role of the Health Care Provider .............................................24
D.2 – Personal Assessment of Professional Obligations ................................................24
D.3 – The Decision to Provide Abortion Care:
Motivations and Obstacles to Practice ................................................................25
D.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 iiiPast and Present – Historical Overview of Laws, Regulations, and Consequences
PART I: PAST AND PRESENT – HISTORICAL OVERVIEW OF
LAWS, REGULATIONS, AND CONSEQUENCES OF
LIMITED ACCESS TO ABORTION SERVICES
Legal Issues in the United States means that the decision whether or not to
and Canada have an abortion is left to a woman and
Given that your professional judgments, and her physician.
perhaps your personal values as well, are
influenced in part by legal limits and (b) During the second third of pregnancy
regulations that govern the medical (about 14 to 24 weeks), state laws may
profession, it is appropriate to give a brief regulate abortion procedures only in order
overview of the regulations and laws that to protect the woman’s health.
relate to abortion. These overviews are by no
means meant to serve as a comprehensive (c) During the later part of pregnancy (after
review, but will provide a basis for about 24 weeks), and after the fetus is
understanding where the law sets limits on viable, state laws may prohibit abortion
the provision of abortion as opposed to where except when it is necessary to preserve the
individual practitioners or hospitals might set life or health of the woman. Most states
personal or institutional limits. (40 states and the District of Columbia)
have passed laws to prohibit post-viability
An Overview of Abortion Laws and abortions under most circumstances and,
Policies in the United States in practice, there are only a small handful
of doctors nationwide who offer this care
Abortion laws differ, rather dramatically in to women who need it.
some cases, from state to state. However, the
Supreme Court has issued some key For some time, the framework of Roe v. Wade
decisions, starting with Roe v. Wade in 1973, served as the basis by which the
which today serve as the basic foundation for constitutionality of state laws related to
state abortion laws. abortion was determined. Subsequent Court
decisions, however, particularly Planned
In the Roe decision, the Court established that: Parenthood v. Casey in 1992, have established
that states can restrict pre-viability abortions,
(a) In the first third of a pregnancy (about the even in the first trimester and in ways that are
first 13 weeks), state laws and regulations medically unnecessary, as long as such
may not interfere with a woman’s right to restrictions do not place an “undue burden” on
end a pregnancy through abortion. This women seeking abortion services. Thus, state
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 1Past and Present – Historical Overview of Laws, Regulations, and Consequences
laws requiring waiting periods before a woman Medicaid recipients to refuse to cover
can have an abortion, mandatory counseling counseling or referral for services, such as
which promotes childbearing, reporting abortion, which the HMO objects to on
requirements, and parental consent or moral or religious grounds. As a result, even in
notification have been implemented in many states with expanded funding, women seeking
states. (Note: Some state constitutions have abortions may face obstacles to finding a
stronger privacy protection than the federal Medicaid provider that will cover services.
constitution and thus in these states some of
these restrictions would not be permitted.) Since 1996, anti-choice forces in Congress
have maintained a statutory ban on even
Additionally, in practice, individual hospitals privately funded abortions at all Department of
and practices can and do impose other Defense facilities, including military bases.
restrictions, such as gestational limits, These facilities are restricted from performing
anesthesia requirements, and so forth, on the most abortions, except in cases of rape, life
abortion services they provide. Thus even endangerment, and incest. Further, medical
though women in the U.S have a insurance for military personnel and their
constitutionally protected right to obtain pre- dependents only covers abortion in cases of life
viability abortions, these medical services endangerment. Although members of both the
might not, in fact, be available or accessible. House and Senate have repeatedly attempted
to remove these restrictions they have been
A woman’s access to abortion services in the unable to garner enough support to reverse it.
U.S. is influenced in part by her ability to pay
for that care, either out-of-pocket or through An Overview Abortion Laws and
her private or public health insurance program. Policies in Canada
The Hyde Amendment forbids the U.S. (Contributed By Joyce Arthur, Director & Spokesperson,
Medicaid program from paying for abortions Pro-Choice Action Network, Vancouver, British Columbia,
Canada) (April 2004)
except in cases of rape or incest, as well as
when a pregnant woman’s life is endangered by Canada first liberalized its strict law against
a physical disorder, physical injury, or physical abortion in 1969. The new law allowed
illness, including a life-endangering physical abortions to be performed in hospitals with the
condition caused by or arising from the approval of a “therapeutic abortion committee.”
pregnancy itself. States may use their own funds A woman could get an abortion only if the
to pay for abortions not covered by Medicaid. committee decided her life or health was in
However, only 23 states offer additional funding. danger. But the law resulted in arbitrary
obstacles and unequal access for women. Dr.
In addition, Congress permits health Henry Morgentaler, Canada’s pioneer abortion
maintenance organizations (HMOs) serving provider and pro-choice activist, fought various
2 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsPast and Present – Historical Overview of Laws, Regulations, and Consequences
court battles culminating in a 1988 Supreme many provinces flout the law due to an anti-
Court decision that threw out the entire choice political bias that dismisses abortion as
abortion law as unconstitutional. This ruling an “elective” and abortion clinics as private
became known as the Morgentaler decision. businesses operating outside of Canada’s
universal healthcare system.
The Supreme Court grounded the right to
abortion in women’s constitutional right to Clinics became legal only in 1988, but there is
“security of the person.” One judge also found not enough volume to support clinics except in
that the abortion law violated women’s rights to the largest cities. About two-thirds of abortions
“freedom of conscience” and “liberty.” Unlike in in Canada are still performed in public
the U.S., women’s equality rights are enshrined hospitals. However, only about 20% of hospitals
in Canada’s constitution, so courts have been perform abortions, which forces many women
very reluctant to confer any rights on fetuses – to travel long distances from their communities.
to do so would interfere with women’s Hospitals often restrict access to abortion
established constitutional right to equality. because of arbitrary or anti-choice policies. For
Various court rulings since 1988 have denied example, many hospitals impose restrictions
fetuses any legal recognition in Canada and no such as quotas, gestational limits, and general
abortion restrictions have ever been passed. anesthesia requirements. Most hospitals require
physician referrals and many have long waiting
Although the Canadian legislature tried to re- periods. A few hospitals require the approval of
criminalize abortion in 1990, the bill failed to two doctors, or parental consent for any surgery
pass. Today, Canada’s governments, judicial on minors with no exception for abortion.
system, and the mainstream media are largely Anti-choice doctors and hospital employees
pro-choice. often act as gatekeepers, preventing women
from accessing abortion services or even
Abortion is fully funded by Medicare in obtaining accurate information about them.
Canada, except for four provinces that refuse Finally, the Canadian Medical Association
to fully fund abortions in private clinics, even maintains an old policy that essentially curtails
though they have been ordered to do so under abortions after 20 weeks, unless they’re for
a federal law, the Canada Health Act. This compelling health or genetic reasons.
law says that provinces must provide all
Canadians with equal access to fully funded Anti-choice protest activity is low in Canada,
healthcare according to five basic principles: especially in recent years, although clinic
portability, accessibility, comprehensiveness, protests are still routine at some clinics,
universality, and public administration. particularly in British Columbia, Ontario, and
Abortion is probably the only medically New Brunswick. However, three Canadian
required treatment that doesn’t fully measure doctors were shot between 1994 and 1997,
up to any of these ideals. That is because with American James Kopp as the leading
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 3Past and Present – Historical Overview of Laws, Regulations, and Consequences
suspect. A bomb destroyed a Toronto clinic in Examples in the United States during
1992, and one of the shot doctors was also the 1950’s and 1960’s
stabbed by an unknown assailant in 2000. A We have excerpted passages from Carole Joffe’s
provincial bubble zone law in British Doctors of Conscience1 describing the experiences
Columbia, the Access to Abortion Services of physicians who practiced when abortion was
Act, protects two clinics and one hospital illegal in most states.
from protesters. Clinics in Alberta and
Ontario use court injunctions to keep A doctor who was a resident in a New York City
protesters at bay. hospital during the 1960’s describing what he
called the “Monday morning abortion line-up”:
As stated above, this overview should provide What would happen is that the women would get
enough general legal information for their paychecks on Friday, Friday night they
completing the exercises in this publication, would go to their abortionist and spend their
because the exercises focus on personal values money on the abortion. Saturday they would
clarification. It is prudent, however, for all start being sick and they would drift in on
health care providers in practice to be as Sunday or Sunday evening, either hemorrhaging
informed as possible about laws related to the or septic, and they would be lined up outside the
medical care that they provide and thus we operating room to be cleaned out Monday
would recommend further study of abortion morning. There was a lineup of women on
related regulations and legislation in your stretchers outside the operating room, so you
state or province. knew if you were an intern or resident, when you
came in on Monday morning, that was the first
Consequences of Limited Access to thing you were going to do. (Joffe, p.60)
Abortion Services
The negative impact on public health when Another doctor describing her residency
abortion is illegal or otherwise inaccessible is experience with illegal abortion in a county
well documented. As a health care provider, hospital:
your decision to provide women with There were two gyn wards. They were supposed to
unbiased information and appropriate have thirty-two beds each, but they had to have
referrals, or your decision to provide or not beds all up and down the hallways. They were
provide abortion services has a direct always full [because of illegal abortions]. They
influence, positive or negative, on the must have had one hundred and forty beds in those
accessibility of abortion. The following wards...The residents would get duties of twenty-
examples show possible consequences of four hour periods, and in that period, you’d get ten
limited access to legal abortion and may help to twelve admissions. They walked into the
you determine what role you might play in emergency room bleeding. The first thing the
addressing decreasing access.
1
Joffe C. Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade. Boston:
Beacon Press, 1995
4 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsPast and Present – Historical Overview of Laws, Regulations, and Consequences
doctor down there did was send them for an X-ray she was not responsive. We finally figured the only
to see what was in their belly-to see if there were chance we had was to do a hysterectomy. We took
knitting needles, hooks, catheters up their her to the O.R., but Anesthesia said, “We won’t
belly...Then when they got to the ward, the first give her anesthesia, without getting blood pressure
thing you did besides examine them was to do a or a pulse. We can’t monitor where we are, and so
culture for gas gangrene. It was a standard we we might kill her with the anesthesia.” So I had to
had, whether they had a fever or not, to take this do something I don’t recommend to anybody, which
culture, because if they had gas gangrene, you is a hysterectomy under local anesthesia. We got the
really had to take drastic measures, like surgery, uterus out – I still have a picture of it in my
heavy duty antibiotics, and all that kind of stuff. teaching files – it was basically a bag of pus. We
Until the suction curettage came through, the found a coiled up catheter in there. When we were
routine was that you accumulated all the women all done, I was walking along beside her in the
until two o’clock in the morning when all the corridor – they were taking her back to her bed.
major surgery was done, and the last gunshot And one of the tragedies of this septic shock is that
wound had been cleared out of the emergency room people remain lucid until the end, and she was
– then the first-year residents dragged the patients holding my hand, and saying, “Doctor, help me,
down to the operating room and started doing the I’m dying.” And I knew she was, and I knew there
D. & C.’s at two o’clock in the morning. That’s was not a blessed other thing we could do for her,
when the operating room was quiet...There would and before she got to her bed, around midnight, she
be two or three operating rooms going at the same died, and I have been haunted by that girl ever
time. Between 2:00 and 6:00 AM you could get a since. (Joffe, p. 58).
certain number of D. & C.’s done and clean up the
women who weren’t septic, scrape their uteruses Examples in the United States after
and get them back upstairs so they could be Roe v. Wade
discharged in a day or two. (Joffe, p. 61) While the scenarios described above occurred
before Roe v. Wade, on a smaller scale, similar
A chief obstetrical resident in a public hospital situations sometimes still arise because safe,
in the 1950’s describing a twenty-two year old legal abortion is still not accessible to many
patient whom he treated for septic shock women. A 2003 study2 found that 87% of
following an illegal abortion: counties in America do not have a single
What happens there, the infection is so abortion provider. Some women, particular
overwhelming, the bacteria produce toxins that immigrant women, are unaware that abortion is
lead to a collapse of the cardiovascular system. legal in the U.S. and turn to alternative
These patients have no blood pressure, no pulse-in methods for self-abortion, for instance self-
some cases there is absolutely nothing you can do to administered misoprostol which has been
reverse the situation. We gave the girl blood, widely used by women in Latin American
cortisone, hydrocortisone – nothing was working, countries for self-abortion and is documented
2
Finer LB, Henshaw SA. Abortion incidence and services in the United States in 2000. Perspectives on Sexual and
Reproductive Health 2003; 34(1): 6-15.
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 5Past and Present – Historical Overview of Laws, Regulations, and Consequences
to be quite widely available in some B) On March 27, 1994, Kawana Ashley, a
communities and urban areas in the U.S. nineteen-year-old single mother with a
Further, legislative restrictions, such as parental three-year-old son, shot herself in the
consent laws, mandatory biased counseling, and stomach during the 25th or 26th week of
waiting periods, make it difficult for women, her pregnancy. She was hospitalized but
particularly young, low-income, and rural ultimately survived her injuries. Doctors
women, to obtain abortions. The following two delivered a female infant by emergency
stories are examples of the consequences of caesarean who died 15 days later. Ms.
access limited by financial constraints. Ashley was a Medicaid recipient, but since
Florida’s Medicaid program funds abortion
A) Rosie Jiminez, a 27-year-old woman living only in cases of rape, incest, or life
in Texas, died on October 3, 1977 from endangerment, she needed to find a way to
complications from an illegal abortion she pay for the surgery herself. Unfortunately,
obtained in Mexico. Rosie was on Medicaid by the time she got enough money together,
but, because the Hyde Amendment she was into her second trimester, and the
prohibits the use of federal Medicaid funds cost was higher. When she had raised the
to pay for abortion except in cases of rape, extra money she needed, she was beyond 20
incest, and life endangerment, she could weeks, the cutoff point at which the clinic
not obtain a safe legal abortion using her stopped providing abortions. Out of
health insurance. While some argued that desperation to end her unwanted pregnancy,
Rosie went to Mexico for her abortion Ms. Ashley endangered her own life.
because she was ashamed and wanted to
protect her privacy, the fact that she had The World Health Organization has estimated
twice before obtained a safe, legal abortion that worldwide approximately 80,000 women
using her Medicaid coverage, before each year die as a result of illegal or unsafe
Medicaid stopped funding abortion abortions.3 Additionally, hundreds of
services, clearly connects the cutoff of thousands suffer wide-ranging and serious
Medicaid funding with Rosie’s decision to health consequences. Clearly, limited or
resort to a cheaper, although illegal, nonexistent access to safe abortion has
abortion in Mexico. Rosie was a single monumental consequences for individual
mother of a five-year-old daughter. She was women and their families. These figures make
a scholarship university student supporting clear, however, the impact on public health
herself and her child while in school with when access to safe, legal abortion is restricted.
welfare payments and her income from a
part-time job. She was six months away
from obtaining her bachelor’s degree.
3
Unsafe abortion: Global and regional estimates of incidence of a mortality due to unsafe abortion with a listing of
available country data. Third edition. Geneva, Switzerland: World Health Organization, 1997. Available at
http://www.who.int/reproductive-health/publications/MSM_97_16/MSM_97_16_abstract.en.html
6 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsTools for Clarifying Our Values
PART II – TOOLS FOR CLARIFYING OUR VALUES
Individual Exercises for Values Section A: The Role of External Influences
Clarification in the Formation of Our Values
Sometimes it is helpful in the course of External influences on our thinking can
narrowing down our focus to look at both the encompass many areas. As we grow up we
external and the personal influences on the are introduced to values and ideas by everyone
development of our values. Life stage, social around us while we simultaneously compare
culture, and our early spiritual environment them to our personal experiences and
are examples of external influences on our perceptions. We have chosen to focus on the
values. Individual experiences with sexual influence of our culture (family/race/social
intimacy, parenting, adoption, abortion, and groups), our spiritual/religious beliefs, and
birth control also have their places in the life stage to connect them to our ideas about
shaping of our views. The following exercises family and parenting, and consequently
are designed to help you identify the pregnancy options and abortion.
experiences that may contribute to your
present values about both the broad and Exercise A-1: Examining the Role of
specific aspects of abortion. Again, it is hoped Family and Social Groups on Our
that understanding our personal beliefs about Values
abortion will help us provide better care for The family or social group (i.e. heritage, extended
women facing an unplanned pregnancy and family, adoptive family, socio-economic group)
considering the option of abortion. The that we grow up in provides us with our
exercises are divided into four categories: customary beliefs and early social values. We use
external influences, personal experience these as a backdrop when we interact with others
influences, and, with those in mind, a woman’s and form opinions as we mature. Depending
life circumstances around her abortion. Finally, upon our personal temperament we may integrate
we look at professional roles and responsibilities. these values automatically or challenge them at
different points in our lives.
These exercises and questions can provide
you with insights as you work through them The purpose of this exercise is to reflect on the
alone. Discussing your reactions to and source and influence these core beliefs have on
thoughts about them with others can also your present ideas about parenting, abortion, and
expand your insights through shared and adoption.
different experiences.
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 7Tools for Clarifying Our Values
1. a) Did the family you were brought up in b) Does your present socio-economic group
discuss specific values around parenting, differ from that of the family you were
adoption, or abortion? ____ Yes ____ No brought up in? ____ Yes ____ No
If yes, describe: _____________________ If yes, has this affected your views about
__________________________________ parenting, adoption, or abortion? _______
__________________________________ __________________________________
__________________________________
b) Were there any family events that
changed these views while you were living 4. Which social group would you consider has
with the family? ____ Yes ____ No been the predominant influence on your
If yes, describe: _____________________ values on parenting, adoption, and
__________________________________ abortion?
__________________________________ Heritage/race ____ Socio-economic ____
Family ____
c) Describe any similarities or differences
between the values you presently hold 5. a) Choose one of the options in each
about parenting, adoption, or abortion and category that would be the most
your family’s values about parenting, encouraged by your predominant social
adoption, or abortion. ________________ group.
__________________________________ Number of Family Age of new
__________________________________ children forms parents
❑ 0 child ❑ single parent ❑ Teenage parents
2. Did your family’s values reflect your race/ ❑ 1 child ❑ two-parent ❑ Parents age 20-30
heritage or nationality’s values? ❑ 2 children ❑ multigenerational ❑ Parents age 30-40
in household
____ Yes ____ No
❑ 3-4 children ❑ same-sex parents ❑ Parents age 40-50
If no, how did they differ? ____________
❑ 5+ children ❑ single gay parent
__________________________________
__________________________________
b) Does this represent your present life
experience? ________________________
3. a) Did the socio-economic group you were
In what ways, if any, has this caused
brought up in have any influence on your
conflicts with your family? ____________
values about parenting, adoption, or
__________________________________
abortion? ____ Yes ____ No
__________________________________
If yes, describe its influence: ___________
__________________________________
__________________________________
8 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsTools for Clarifying Our Values
6. a) Do your current values differ from the 1. Have you held the same spiritual beliefs
values you were brought up with in any of since childhood? ____________________
the 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 2. How often, on average, during a day, do
❑ daycare ❑ divorce ❑ blended families you consciously refer to your spiritual
❑ sex before ❑ mixed race ❑ marrying outside beliefs before making a decision? After
marriage parents of culture
making a decision? __________________
__________________________________
b) If your values differ, what influenced the
__________________________________
change? ___________________________
__________________________________
3. Have you been challenged by life
__________________________________
circumstances that called on actions not
supported by your religious or spiritual
7. What percentage of your current ideas
beliefs? Were you able to reconcile these
about family is culturally (family/social
actions with your beliefs at a later date?
group) influenced? ____ Influenced by
Did you do this on your own or with
personal experience? ____ Other? ____
support?___________________________
__________________________________
Exercise A-2: Examining the Role of
__________________________________
Spiritual Beliefs on the Formation of
Our Values
4. Do your beliefs about any of the following
Our spiritual or religious beliefs may be rooted in topics that are influenced by your spiritual
our family or arrived at independently during values conflict with anyone in your life at
different points in our lives. Some people consider present?
these private contemplations while others share these
Beliefs about family? ___ Yes ___ No
beliefs openly in their everyday interactions. The
Beliefs about social roles? ___ Yes ___ No
merging of political and spiritual ideals in society
Beliefs about sex? ___ Yes ___ No
has historically been a difficult marriage. The
Beliefs about birth control? ___ Yes ___ No
purpose of these questions is for you to reflect on the
Beliefs about abortion? ___ Yes ___ No
role of your spiritual beliefs in your everyday life.
If yes, how have you reconciled these
Take a moment to reflect on the following differences? ________________________
questions and take note if these raise any __________________________________
other issues for you. __________________________________
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 9Tools for Clarifying Our Values
Exercise A-3: Examining the Role of when you were 18? Describe how your
Life Stage on the Formation of Our views have changed since that time._____
Current Views __________________________________
Our age influences our reactions to life and __________________________________
change. Youth provides us with optimism, easy __________________________________
access to childhood memories, and endless
possibilities but it can also limit our broader 4. Have your views about the choice of not
understanding of the impact of our decisions. having or having children changed since
Additional years bring us the perspective you were 18? Describe: _______________
provided by an accumulation of experiences but __________________________________
the depth of this perspective is dependent upon __________________________________
their range and the personal insights we have __________________________________
about these experiences. The purpose of these
questions is to remind us to pay attention to the 5. How does your present age affect your
influence of our age on our understanding of our perspectives when discussing pregnancy
clients’ dilemmas and the fluid nature of our options with a patient? _______________
perspectives throughout our lives. __________________________________
__________________________________
1. How did you feel about romantic
relationships when you were 16? 25? 35? Section B: The Role of Our Personal
45? Describe the differences: __________ Experiences in the Formation of Our Values
__________________________________ We have raised questions about the external
__________________________________ influence of family and social culture, age, and
__________________________________ spiritual values on the formation of our values. In
the following exercises we explore how our own
2. What do you think would be the ideal age experiences (and those of our intimate others)
for a woman to have her first child? Have with sexual intimacy, and our histories with
your views changed about this since you pregnancy, fertility, infertility, adoption, abortion,
were 18? Since you were 30? 40? 50? What and parenting can also influence our perspective.
influenced these changes? _____________
__________________________________ Exercise B-1: Examining Our Own
__________________________________ Experiences with Sexual Intimacy and
__________________________________ Risk-Taking.
Because the need for an abortion always begins with
3. What did you think of teenage pregnancy, the act of sex, it is important to be aware of our
adoption, single parenting, and abortion underlying attitudes about this topic. Depending
upon our own personalities, our sexual identity and
experiences are often deeply personal and not often
10 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsTools for Clarifying Our Values
discussed with others. We gather information through 4. Which of the following have had an
our own experiences, what we read and see in the impact on your sexual or intimate
media and literature, and from stories gleaned from relationships:
our social circle. Take a moment to reflect on the Sexual abuse or sexual assault _______
following questions and ask yourself if any of these Coerced sex _______
experiences affect how you would consider a patient’s Sexual infidelity _______
sexual history and its role in her pregnancy. (yours, partner’s, parents’)
Infertility or fear of infertility _______
1. Was your first sexual intimacy well planned Sexually transmitted disease _______
or spontaneous? Was birth control an issue? One night stand _______
Given your present perspective, is there Unplanned pregnancy _______
anything you would change about that Abortion _______
experience? If yes, describe. ___________ Drugs or alcohol _______
__________________________________
__________________________________ 5. Which of the topics listed in #4 above
__________________________________ would you feel the most comfortable
discussing with a client having a similar
2. How healthy is your own sex life at experience in her own life? ______ The
present? Is there anything you would like least comfortable? ______
to be different? If you are unable to make
any changes, how has this affected your life 6. Describe how your experiences (or lack of )
at present? Describe: _________________ influence your discussions with clients in a
__________________________________ positive way. _______________________
__________________________________ __________________________________
__________________________________ __________________________________
3. Have you always had a sexual partner 7. Describe how your experiences (or lack of )
during your adult years? If not, what was influence your discussions with clients in a
the longest period of time you went negative way. ______________________
without sexual intimacy? Describe any __________________________________
effects it had on your life at the time. ___ __________________________________
__________________________________ __________________________________
__________________________________
__________________________________ 8. What strategies would you use to improve
__________________________________ your comfort level with these topics if they
impacted the life of one of your clients?__
__________________________________
__________________________________
__________________________________
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 11Tools for Clarifying Our Values
Exercise B-2: Examining Our Own Have any of these experiences complicated or
Experiences with and Views about assisted in your ability to understand your
Parenting, Adoption, Abortion, and clients’ choices? If yes, describe: __________
Pregnancy Prevention ____________________________________
Not all of us become parents, but many of us have ____________________________________
had experiences and/or risks with pregnancy. Our
experiences often affect how we see others in 2. Which, if any, of the following have you had
similar situations. Think about your responses to personal experience with in the role of child
these questions and your present ideas about the or family member? (check all that apply)
challenges of parenting, adoption, abortion, and Welfare _______
pregnancy prevention. Mental health problems _______
Drugs and alcohol abuse _______
Parenting Prenatal health risk by mother _______
Our experiences with parenting color the way we Single parenting _______
see it as an option for women. It is important to Divorce/blended families _______
acknowledge our own experiences to help us be
aware of our biases. Was your experience as a parent or child
compromised in any way by these issues?
1. If you do not have children, which of the Describe: ____________________________
following statements would apply to you? ____________________________________
(check all that apply) ____________________________________
Do not want to have children _______
Not ready to have children _______ How have you coped with these experiences?
Infertility/difficulty conceiving _______ ____________________________________
Lack of opportunity _______ ____________________________________
Do not want to be a single parent_______
Financial reasons _______ Have any of these experiences complicated or
Health reasons _______ assisted in your ability to understand your
Career goals _______ clients’ choices? If yes, describe: __________
Placed a child for adoption _______ ____________________________________
Loss of a child _______ ____________________________________
Undecided _______
Other _______ 3. Would you or others view your parents/
family as the “perfect” family? ______
If any of the above reasons have created stress If yes, describe the impact on your present
in your life, describe how you have coped. views on parenting and family. _________
____________________________________ __________________________________
____________________________________ __________________________________
12 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsTools for Clarifying Our Values
4. If you are a parent, have you experienced Considered adoption when _______
any of the following with your child I or my partner became pregnant
(children)? (check all that apply) Work(ed) in the adoption field _______
Health challenges _______
How have these experiences affected your
Mental health issues _______
personal life? _________________________
Drug addictions _______
____________________________________
Financial challenges _______
Single parenting _______
Have any of these experiences challenged or
Divorce _______
assisted in your objectivity as a health
Death of a child _______
professional when counseling a woman about
pregnancy options? If yes, describe: _______
How have you coped with these experiences?
____________________________________
____________________________________
____________________________________
____________________________________
2. If you have no personal experience with
Have any of these experiences complicated or
adoption, has your objectivity been
assisted in your ability to understand your
challenged as a health professional when
clients’ choices? If yes, describe: __________
counseling a woman about pregnancy
____________________________________
options? If yes, describe: ______________
____________________________________
__________________________________
__________________________________
Adoption
Fewer of us have personal experience with adoption
Abortion
than we do with parenting. As with parenting, it is
Our experiences with abortion vary. It is
important to acknowledge how our experiences or
important to assess where our experiences are
lack thereof may influence our views of this option.
derived from and the influences they may have on
our objective understanding of other women’s
1. If you have a personal experience with
choices.
adoption, which of the following apply?
(check all that apply)
1. If you have experience with abortion,
I am adopted _______ which of the following apply? (check all
Family member/friend is adopted_______ that apply)
Placed a child for adoption _______
Family/friend placed _______ My partner or I have had an abortion ____
child for adoption I have accompanied a family member ____
Trying or tried to adopt _______ I have accompanied a friend ____
Family member/friend _______ I am aware that a family member and/
adopted a child or close friend has had an abortion ____
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 13Tools for Clarifying Our Values
My partner or I have considered 3. If you have no personal experience with
abortion because of pregnancy ____ abortion, has this had any effect on your role as
I work in the abortion field ____ a health care professional counseling a woman
My family or I picket at about her pregnancy options? If yes, describe:
abortion clinics ____ __________________________________
__________________________________
Which of the above (if any) have had the
most impact on your views on abortion? Pregnancy Prevention
____________________________________ Our attitudes about abortion sometimes have
____________________________________ links to our views on the preventative side of
pregnancy. Birth control failure, absence, or
Have any of these experiences challenged misuse is a complex topic too often simplified if
or assisted your objectivity as a health care we do not address the complexity of individual
professional when counseling a woman about personalities, the power dynamics of relationships,
her pregnancy options? If yes, describe: cultural differences, and women’s experiences with
____________________________________ the side effects of medications. Take a moment to
____________________________________ reflect on your own experiences and evaluate
these in relation to your views on pregnancy
2. If you or your partner has had an abortion, prevention.
describe the most difficult aspects of this
decision. __________________________ 1. Considering your own experiences with
__________________________________ birth control methods, have you
experienced any of the following? (check all
Describe the positive aspects of this decision. that apply)
____________________________________
Difficulty accessing birth control _______
____________________________________
Parental disapproval _______
Partner conflict _______
If you could, what would you have changed
Financial difficulties _______
about the experience? __________________
Misinformation _______
____________________________________
Compliance difficulties _______
Lack of preparation _______
Have any of these experiences challenged or
Failure of method _______
assisted your objectivity as a health care
Medical contraindication _______
professional when counseling a woman about
Use influenced by drugs or alcohol_______
her pregnancy options? If yes, describe: ____
Assumed partner was using _______
____________________________________
Cultural difference _______
____________________________________
14 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsTools for Clarifying Our Values
If yes, how did you solve these problems? 3. Would you describe yourself as a risk taker
____________________________________ in general? ____ Yes ____ No
____________________________________ Do you take risks with your health?
___ Yes ___ No
If you have been pregnant, how many of your Smoker? _______
pregnancies are the result of any of the above Overweight? _______
difficulties with birth control? _______ No exercise? _______
Seatbelts? _______
2. Have you or your partner experienced any Sunscreen? _______
of the following side effects from a birth Drive too fast? _______
control method? (check all that apply) Always practice safe sex? _______
Allergic reaction _______ Safe oral sex? _______
Weight gain _______ Regular pap or other
Mood changes _______ routine tests? _______
Irregular bleeding _______ Ask potential partner about STD’s
Nausea _______ before sex? _______
Pain _______ Have you taken risks with
Change in sexual performance _______ birth control? ____ Often? _______
Acne _______ Have you discussed this with a health
Change in sexual pleasure _______ professional? _______
Change in libido _______
Do you follow the same birth control advice you
If yes, how many times have you changed give to clients you counsel? ___ Yes ___ No
your method? _______ If no, why not? _______________________
____________________________________
Has this caused stress in your life? If yes, ____________________________________
describe: ____________________________
____________________________________ Have your experiences strained or assisted
____________________________________ your objectivity when you discuss birth
control and pregnancies with clients? If yes,
describe: ____________________________
____________________________________
____________________________________
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 15Tools for Clarifying Our Values
Section C: Self-Evaluation of Our At viability _____
Objectivity When Considering a Woman’s At the end of the second trimester _____
Pregnancy Circumstances and Her Options At some point in the third trimester_____
When a woman presents with a pregnancy and It depends on the reason for
is examining her options, her circumstances will the abortion _____
play a role in her decision. It is natural for a
health care provider to be evaluating her choice 3. Now consider this list again as it relates to
along with her in order to provide objective and your comfort level with three varying
respectful professional care. It is important to degrees of your professional involvement in
examine our own comfort level with her choice abortion. At what point do you feel
and consider our reactions when our neutrality uncomfortable with:
is challenged. We will begin by looking at the a) making abortion referrals for patients
option of abortion and our personal responses
b) assisting with the provision of abortion
to issues such as gestational age, and then
services
follow with the circumstances of the individual
woman who is making this decision. c) providing abortions
Exercise C-1: Examining Our Comfort Write your reasons for feeling this way about
Level with Gestational Age gestational age. How long have you felt this
way?________________________________
For some people the acceptability of a patient’s ____________________________________
abortion decision is dependent on the stage of ____________________________________
pregnancy at which the abortion might take place.
This exercise is designed to help you examine your If you had different cutoff points depending
own feelings about this very personal question on the level of your involvement in providing
and its possible influence on the exercises to follow. services, what are the reasons for these
differences? If your feelings were consistent
1. Does gestational age affect how you feel across the different levels of involvement,
about your patient’s abortion decision? what are the reasons for this? ____________
____ Yes ____ No ____________________________________
____________________________________
2. If gestational age does affect your response,
at what point do you feel uncomfortable
with your patient’s abortion decision?
At conception _____
At implantation _____
At the end of the first trimester _____
At quickening (i.e. point of
fetal movement) _____
16 © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care ProfessionalsTools for Clarifying Our Values
Exercise C-2: Examining Our Comfort ___ to end a pregnancy if the woman
Level with Circumstances of Each does not want any more children
Woman’s Abortion Decision ___ to end a pregnancy if the woman is
Sometimes we are comfortable with one woman’s not financially able to care for a
abortion decision, but are challenged by the child
circumstances surrounding another woman’s decision. ___ to end a pregnancy if the woman
This exercise is designed for you to reflect on your feels she is not ready for the
personal responses to the following situations. It also responsibility of having a child
illustrates the wide range of circumstances that may ___ to end a pregnancy if a child would
influence a woman to decide to have an abortion. interfere with educational or career
goals
___ I can accept a woman’s abortion decision
___ to end a pregnancy if the woman is
in any circumstance when she has made
unready for how a child could
an informed and voluntary choice for
change her life
abortion.
___ to end a pregnancy if the woman is
___ I can accept a woman’s abortion decision
very young
in certain circumstances including: (check
___ to end a pregnancy if the woman has
all that apply)
not had a previous abortion
___ to end a pregnancy that threatened
___ to end a pregnancy because of gender
her life
___ other(s): _____________________
___ to end a pregnancy that threatened
________________________________
her physical health
________________________________
___ to end a pregnancy that threatened
her mental health
___ I find abortion unacceptable under
___ to end a pregnancy involving virtually any circumstances.
significant fetal abnormality
___ to end a pregnancy resulting from What are the reasons for your beliefs? How
rape or incest long have you held these beliefs? _________
___ to end a pregnancy resulting from ____________________________________
birth control failure ____________________________________
___ to end a pregnancy if the woman is ____________________________________
unmarried ____________________________________
___ to end a pregnancy if the woman is
in an unstable relationship or is not
in a relationship
The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF 17Tools for Clarifying Our Values
Exercise C-3: Individual Cases: ___ 22 year old carrying a fetus with
Examining Our Potential Biases severe deformity
Parts 1 and 2 of this exercise individualize the ___ 24 year old heroin addict who already
circumstances of a woman’s abortion decision by has three children in state custody
providing more details to expose the complexity of ___ 26 year old single mother who has a
the decision. By putting yourself into the role of the young child with leukemia
health care professional responsible for providing ___ 30 year old with 2 children whose
access to abortion to only one of the following husband died recently in a car crash
women, you are challenged to examine your
personal views and to experience the difficulties What factors influenced your choice? How
associated with limited access on the health did it feel to have to make this choice?
professional as well as the patient. This exercise ____________________________________
also illustrates the difficulty with comparing one ____________________________________
patient’s circumstance with another. Until we are
put in this position we may assume that 2. The six women described below have come
determining a hierarchy of needs would be difficult to you requesting a referral for abortion.
but not impossible. Pay attention to your reactions Due to circumstances beyond your control,
to this challenge when putting yourself in the role only one more abortion can be done and
of the decision-maker. Part 3 helps us identify our you must choose which one of your six
personal discomfort, if any, when faced with the patients is to receive the last abortion.
circumstances of some women’s abortion decision. Rank the cases from 1 (most want to refer
for an abortion) to 6 (least want to refer).
1. Before Roe v. Wade legalized all first
__ Gloria is 14 years old, unsure about
trimester abortions in the U.S., some
what to do. She has supportive parents.
hospitals provided a very limited number of
“special case” legal abortions. Hospital __ Louise is 19 years old, has two children
therapeutic abortion committees had the and has had two previous abortions.
task of determining which cases were __ Selma is 24 years old, a student in
worthy of being granted a safe, legal medical school and engaged to be
abortion. You are on that committee and married. She wants to begin her career
must determine which ONE of the before starting her family.
following patients, all of whom are __ Eileen is 29 years old, single and
requesting an abortion, will be granted the pregnant with an IUD in place.
one remaining legal abortion left in your __ Margaret is 35 years old, divorced,
yearly quota. pregnant from a one-night encounter,
___ 12 year old incest victim her first sexual experience following her
___ 15 year old rape victim divorce.
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