title: Toll free but not judgment free: evaluating postabortion support services in Ontario.
abstract: BACKGROUND
  Crisis pregnancy centers (CPCs) account for the majority of advertised postabortion support providers in Ontario, Canada's largest and most populous province. Although the deceptive tactics used by CPCs to dissuade women from seeking abortion care are well documented, their provision of postabortion support has not been previously explored. Our study aimed to fill this gap.
  
  
  METHODS
  In 2014-2015, we conducted a mystery client study with 17 postabortion support providing organizations in Ontario. We used a predetermined character profile and set of prompts to seek phone-based services. Each interaction began with "I'm looking to talk to someone about my abortion." The interactions developed organically and mimicked the experience of a woman seeking postabortion support. We audio recorded and transcribed all interactions and used both inductive and deductive analytic techniques in our evaluation.
  
  
  RESULTS
  We spoke with three secular and three religiously affiliated talklines, one sexual health center and 10 CPCs offering phone-based support. Although all counselors effectively used active listening techniques such as supportive utterances and attentive silences, the interactions with lay counselors from religious talklines and CPCs contained shaming and stigmatizing language and medically inaccurate information. These interactions appear to be premised on the counselors' belief that abortion is traumatic and always requires a grieving process, regardless of the client's expressed feelings and needs.
  
  
  CONCLUSIONS
  The expanded provision of postabortion support by CPCs in Ontario represents a new method for these organizations to pathologize abortion. Our findings suggest that their services are judgmental and shaming, thereby contributing to abortion stigma.
  
  
  CONCLUSIONS
  Postabortion support services appear to be a new frontier by which CPCs are able to stigmatize and pathologize abortion. Increasing awareness of and access to existing nonjudgmental, nondirective postabortion services appears warranted.
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: LaRoche
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institute of Population Health, University of Ottawa, Ottawa, ON, Canada. Electronic address: angel.foster@uottawa.ca.
authors.forename: Angel M
authors.initials: AM
authors.lastname: Foster
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D000359:Aftercare / Q000379:methods / Q000523:psychology*; D001291:Attitude of Health Personnel; D003376:Counseling / Q000379:methods*; D005260:Female; D015277:Hotlines; D006801:Humans; D007600:Judgment; D009864:Ontario; D016544:Patient Simulation; D011247:Pregnancy; D012069:Religion and Psychology; D012752:Shame; D057545:Social Stigma; D017216:Telemedicine
keywords: Abortion; Canada; Crisis pregnancy centers; Reproductive health