Facilitators and Barriers to Providing Trauma-Informed Abortion Care

Individuals who undergo abortion are up to three times more likely to have experienced prior traumatic events compared with the general reproductive age population, including sexual assault, interpersonal violence, or adverse childhood events. We sought to elicit and understand perceived facilitators and barriers to providing trauma-responsive abortion care among abortion providers.

We recruited providers from Chicago-area abortion clinics to participate in a 45-minute, semi-structured one-on-one phone or Zoom interview. We used thematic content analysis to analyze data, developing and refining our code directory with iterative readings of the text. We used ATLAS.ti to apply codes, calculate Cohen's kappa scores to ensure inter-rater reliability, and identify major themes in the data.

We interviewed 20 abortion providers: 13 physicians and seven nurse midwives/advanced practice nurses. Half of the respondents expressed feeling confident in their ability to provide trauma-responsive care. Participants identified several facilitators to providing trauma-responsive abortion care at the individual level, including receipt of formal or informal training in trauma-responsive care and years of clinical experience, and at the structural level, accessible in-clinic behavioral health support and sedation. Barriers to providing trauma-responsive abortion care included perceived inadequate training, lack of clinical guidelines to standardize staff practices, and absence of screening protocols to identify individuals with a history of trauma.

Several provider and clinic-level factors influence providers' abilities to provide trauma-responsive abortion care. Greater provider training and standardization of trauma-responsive clinic practices and resources are warranted to enhance abortion care for all patients, including those with a history of trauma(s).