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Characteristics and determinants of quality non-directive pregnancy options counselling: A scoping review

Kari Vallury , Amanda Asher, Olivia Sarri, Nicola Sheeran

Abstract

Non-directive pregnancy options counselling (POC) is a core component of comprehensive reproductive healthcare and recommended care for pregnant people wanting support regarding making a pregnancy outcome decision. Approximately one quarter of people with unintended pregnancies, and people seeking abortion care, desire POC, which can support decision making, decision affirmation, and healthcare access. This study synthesises global evidence regarding the determinants of access to, and characteristics of quality non-directive POC. Five health databases were searched in line with PRISMA guidelines. Primary research articles were included if they addressed provision, experiences, or characteristics of non-directive POC, were published between 2011 and 2023, and written in English. Qualitative and quantitative data were synthesised and organised thematically. Twelve of the 4021 unique citations identified were included in the review. Four themes were generated: 1) characteristics of quality non-directive POC; 2) provider-level determinants of care quality and provision; 3) patient level factors impacting the desire for and receipt of care; and 4) Organisational setting and legal determinants of provision and quality of care. Across these themes, abortion-related values and policies at the provider, organisational and legislative levels were the most commonly described, and appear to be the most salient, determinants of POC access and quality. Quality POC includes non-directive, empathetic, compassionate discussions about all pregnancy options, with verbal and non-verbal cues conveying nonjudgment and respect, that can enable reproductive autonomy. However, we identified a range of patient, provider, organisational setting and legal level determinants that are likely to disproportionately impact access to POC for marginalised pregnant people. Research regarding POC access and quality outside of the USA is needed. Upskilling primary care and other health professionals in POC and embedding referral pathways to non-directive POC and abortion care throughout the health system will support Australia to achieve its commitment to universal access to reproductive healthcare by 2030.

SH24170  Accepted 08 January 2025

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