The experiences and adaptations of abortion providers practicing under a new TRAP law: a qualitative study.
OBJECTIVE
Abortion laws are proliferating in the United States, but little is known about their impact on abortion providers. In 2011, North Carolina instituted the Woman's Right to Know (WRTK) Act, which mandates a 24-h waiting period and counseling with state-prescribed information prior to abortion. We performed a qualitative study to explore the experiences of abortion providers practicing under this law.


METHODS
We conducted semistructured interviews with 31 abortion providers (17 physicians, 9 nurses, 1 physician assistant, 1 counselor and 3 clinic administrators) in North Carolina. Interviews were audio-recorded and transcribed. Interview transcripts were analyzed using a grounded theory approach. We identified emergent themes, coded all transcripts and developed a thematic framework.


RESULTS
Two major themes define provider experiences with the WRTK law: provider objections/challenges and provider adaptations. Most providers described the law in negative terms, though providers varied in the extent to which they were affected. Many providers described extensive alterations in clinic practices to balance compliance with minimization of burdens for patients. Providers indicated that biased language and inappropriate content in counseling can negatively impact the patient-physician relationship by interfering with trust and rapport. Most providers developed verbal strategies to mitigate the emotional impacts for patients.


CONCLUSIONS
Abortion providers in North Carolina perceive WRTK to have a negative impact on their clinical practice. Compliance is burdensome, and providers perceive potential harm to patients. The overall impact of WRTK is shaped by interaction between the requirements of the law and the adaptations providers make in order to comply with the law while continuing to provide comprehensive abortion care.


CONCLUSIONS
Laws like WRTK are burdensome for providers. Providers adapt their clinical practices not only to comply with laws but also to minimize the emotional and practical impacts on patients. The effects on providers, frequently not a central consideration, should be considered in ongoing debates regarding abortion regulation.
Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA. Electronic address: Rebecca.mercier@jefferson.edu.
Rebecca J
RJ
Mercier
Department of Social Medicine, University of North Carolina at Chapel Hill, 341A MacNider Hall, CB 7240, Chapel Hill, NC 27599, USA.
Mara
M
Buchbinder
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, CB 7570, Chapel Hill, NC 27514, USA.
Amy
A
Bryant
School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB 7460 Chapel Hill, NC 27599, USA.
Laura
L
Britton
D000028:Abortion, Induced / Q000941:ethics / Q000331:legislation & jurisprudence*; D000029:Abortion, Legal / Q000941:ethics / Q000331:legislation & jurisprudence*; D003376:Counseling; D005193:Family Planning Services / Q000379:methods / Q000592:standards*; D005260:Female; D066296:Grounded Theory; D019983:Guideline Adherence; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D009657:North Carolina; D010817:Physician-Patient Relations; D011247:Pregnancy; D036301:Qualitative Research; D014933:Women's Rights
Abortion; Abortion legislation; Abortion providers; Abortion restrictions