Decision-making concerning unwanted pregnancy in general practice

In the Netherlands, termination of pregnancy is legal under well-defined conditions. Before undergoing the procedure, women have to observe a 5-day 'reflection period'. The official start of this period has to be established by a medical doctor, most frequently the GP.

To provide insight into the elements of counselling by GPs regarding unwanted pregnancies and the relationship between GP-reported elements of counselling and whether women change their minds concerning their wish for pregnancy termination or vice versa.

Data were collected via the registration system of the NIVEL Primary Care Database Sentinel Practices from 2004 to 2010. Standardized registration forms were used to collect data on unwanted pregnancy consultations. The data were analysed by chi-square analyses and logistic regression methods.

Most women who consulted their GPs for unwanted pregnancy opted for an abortion and did not change their minds. Approximately one in six patients were undecided. Of the women who had made up their minds, 8% altered their decision after consultation with their GP. Women with a higher gestational age and those who discussed alternatives with their GP were more likely to change their minds after consulting their GP. Women who were referred to an abortion clinic were less likely to change their minds.

In the case of unwanted pregnancy, discussion of all options in a protocolized way by the GP may support patients in their decision-making. Additional training of GPs may enhance awareness of the possible benefits of abortion counselling for the patients.