Women faced with the prospect of an abortion who have already visited an abortion provider for information rarely struggle with their final choice, suggests a new study published Thursday in Contraception.

Researchers, primarily from the University of California, San Francisco (UCSF), conducted a survey of about 500 Utah women seeking abortion. The women had paid a visit to one of four family planning centers from October 2013 to April 2014. Just before their first consultation, however, they were asked to rate how confident they felt about their decision as well as if they felt any lingering conflict. They were also contacted via phone 3 weeks later for a follow-up interview. Regardless of when they were asked, women generally had little doubt about the necessity of their abortion or felt conflicted, and of the some-300 women who stayed in touch with the researchers, 89 percent had already gone through with it.

“Our study found that women seeking an abortion are certain about their decision,” lead author Dr. Lauren Ralph, a epidemiologist at UCSF’s Advancing New Standards in Reproductive Health, told Medical Daily. She further noted that the average level of uncertainty was lower than seen with men about to undergo knee surgery or with cancer patients contemplating their treatment.

Ralph and her colleagues performed their research to address a persistent claim made by anti-abortion advocates and lawmakers — that women require lengthy waiting periods, reams of educational material, parental approval, and stringent medical exams like ultrasounds to avoid making a rash decision. Utah in particular requires women to pay two visits to a center before an abortion can be obtained.    

“These laws assume that decision making on abortion is exceptional compared to other health care decisions, and women need additional time and information to make their decision,” explained Ralph. “Our findings directly challenge this assertion and demonstrate that women are certain of their decision when they present for care.”

Unlike past similar studies, the women were polled via two different surveys that asked them to agree or disagree with each statement presented. One is already regularly used by abortion specialists (example: Abortion is a better choice for me at this time than having a baby) and the other is used to assess how sure and informed patients are about undergoing common medical procedures (example: I am satisfied with my decision).

Women on average scored in the lower teens of both surveys (on a scale of 1 to 100), but there were certain groups of women who had more difficulty. These included women under the age of 19, those with a religious affiliation (particularly those Mormon, a larger than usual religious group in Utah), and those who believed various myths about the procedure, such as that abortion can cause breast cancer. The 11 percent of women who remained pregnant at the time of follow-up were also less certain about their abortion. In total, however, only 6 percent of women expressed a high degree of uncertainty on both surveys.

While only 63 percent of women were followed up with via phone, which may have skewed the final results, the fact that uncertain women weren’t more likely than certain women to drop out of the later interview lowers that possibility, the authors said. By its own nature, though, the study can't account for women contemplating an abortion but who may never visit a center. 

Research elsewhere has shown that upwards of 95 percent of women who obtain an abortion don’t regret their decision years later, though some certainly experience sadness or grief at the time. Similar to the current study, these conflicting emotions were most common among women who experienced stigma or less support from their community (the Mormon Church formally opposes abortion, except for life-threatening situations).

Far from ignoring women who feel unsure about getting an abortion, Ralph believes that abortion providers can use these surveys as a tool to identify conflicted patients so that they can provide more specific counseling or better informed consent. Of note, several states have passed laws requiring doctors to recite inaccurate medical information about the risks of abortion, including the cancer myth.  

“The fact that most women scored so low on the scale,” Ralph said, “suggests that a universal requirement that providers assess certainty using this measure would not necessarily benefit women or providers.”

Similarly, they rebut the notion that women "universally benefit from laws requiring them to have additional counseling visits, wait up to 72 hours before receiving care, or view ultrasounds," Ralph added.

Source: Ralph L, Foster D, Kimport K, et al. Measuring Decisional Certainty Among Women Seeking Abortion. Contraception. 2016.