Evaluation of prenatal genetic counselors' abortion education and training as variables associated with self-efficacy

Prenatal genetic counselors in many states have modified their practices, considering new state-level abortion restrictions enacted after the 2022 US Supreme Court Dobbs decision. Therefore, genetic counselors' preparedness to counsel patients under these restrictions warrants new attention. Using a cross-sectional design, we assessed prenatal genetic counselors' self-efficacy given their exposures to abortion education during and after their graduate training and other variables potentially associated with self-efficacy. Participants were board-certified or eligible prenatal genetic counselors practicing in the United States. They completed an anonymous online survey, which assessed demographics, exposures to abortion topics, and the six-factor Genetic Counseling Self-Efficacy Scale (GCSES; subscale range 0 (low)-100 (high)), answered using context from a hypothetical prenatal case scenario. Kruskal-Wallis and Wilcoxon rank sum tests compared median GCSES factor scores for each demographic and curricular variable. Chi-square and Fisher's exact tests compared coverage of abortion topics according to location of graduate program (restrictive vs. protective state, per Guttmacher Institute). We analyzed 94 surveys (93% female, 53% aged <25-34, 66% restrictive states). GCSES scores skewed high (65.00-100.00). Higher scores on complex skills, communication, genetic testing, and basic psychosocial skills were associated with older age (p's < 0.01), more years since graduation (p's < 0.01), and more years' experience practicing as a prenatal genetic counselor (p's < 0.01); graduate program exposure to counseling about pregnancy termination option was associated with higher scores on complex skills, communication, and genetic testing (p's < 0.05). Participants reported high self-efficacy to address the prenatal scenario regardless of location of graduate program or current practice. Still, if graduate programs wish to increase their coverage of abortion topics, our results indicate that exposures to counseling the option of pregnancy termination through practical experiences, such as clinical rotations or role plays, are the most effective didactic tools for promoting self-efficacy in prenatal sessions.