Study Offers Empirical Evidence on Effects of Ultrasound Viewing Before Abortion Care

November 29, 2012 — Summary of "Women's Perspectives on Ultrasound Viewing in the Abortion Care Context," Kimport et al., Women's Health Issues, November 2012.

In recent years, several states have enacted legislation mandating the use of ultrasound procedures in abortion care. To date, 24 states have laws regulating ultrasounds in the context of abortion care, such as requiring women to receive an ultrasound before an abortion or to view the ultrasound image.

Advocates on both sides of the abortion-rights debate make claims about the impact of ultrasound laws. Abortion-rights opponents have promoted the legislation under the guise of informed consent and argued that women who view an ultrasound are less likely to have an abortion than women who do not. Abortion-rights supporters oppose lawmakers' involvement in women's health care, as well as the content of the regulations, and they cite concerns that the mandates could be emotionally distressing for some women.

Despite the charged debate, neither side has empirical research to back its claims. Katrina Kimport of Advancing New Standards in Reproductive Health at the University of California-San Francisco's Bixby Center for Global Reproductive Health and colleagues developed a study to examine the effects of viewing an ultrasound for women with unwanted pregnancies who were seeking abortions.

Methods

The researchers conducted interviews with 20 women who received an ultrasound as part of their abortion care at two facilities in a politically conservative Southern state and in a facility in a politically conservative Midwestern state. Women at these facilities were given the option of viewing the ultrasound image but were not required to view it.

The interviews were conducted in-person and included questions on women's knowledge of, opinions about and perceived personal impact of the laws in the state regulating abortion care. Each woman completed a demographic questionnaire, which included information about age, race, ethnicity, education and pregnancy history.

Results

The study found that some women's responses supported abortion-rights opponents' assertion that ultrasound viewing can act as an abortion deterrent. For example, a 25-year-old white woman, who had three children, said that she became pregnant at age 23 as the result of rape. She wanted to carry the pregnancy to term but was urged by others to get an abortion. She ultimately decided against an abortion after viewing an ultrasound image of the fetus. However, when she became pregnant again, viewing the ultrasound image did not prevent her from having an abortion.

The findings also lent support to abortion-rights supporters' contention that an ultrasound can be emotionally difficult for women. A 43-year-old white woman, said that, when she was told she was pregnant, shown the ultrasound and heard the fetal heartbeat while seeking treatment for another health issue, it "gave me some psychological problems right there, because then I knew there was a human life there and all. But still, I knew I didn't want to give birth to it. I couldn't."

The researchers also noted some unexpected responses. Some respondents welcomed the opportunity to view the image, but it had no bearing on their decision to have an abortion. For example, a 28-year-old Native American woman said that she considered viewing her ultrasound part of being a responsible abortion patient because she wanted to "be completely aware as to what [she] was doing." A 23-year-old white woman chose to view the ultrasound despite the emotional difficulty it caused "to honor the complexity of her choice and recognize the fetus inside her," the researchers wrote.

A 27-year-old white woman said the ultrasound made her feel more comfortable with the decision to have an abortion. She said, "When she showed me the sonogram, it made me feel even better" about the decision. The researchers also pointed out “the importance of understanding ultrasound viewing in the context of the circumstances around each pregnancy. Ultrasound viewing does not have just one effect even on a particular woman."

All of the respondents agreed that having the option to view one's ultrasound, whether it was because of clinic policy or legal regulation, is a positive thing. However, none of the respondents felt that all women seeking an abortion should be required to view their ultrasound image.

Implications for Practice, Policy

The debate over the use of ultrasounds in abortion care is "intensifying," the researchers wrote, adding that regulations have been enacted "without empirical study of the impact of ultrasound viewing in the abortion context on women."

The researchers noted that the women interviewed had varied reactions to ultrasound viewing, with some considering it an informational aspect of their abortion experience and others viewing it negatively. "To the extent that [ultrasound] policies are motivated by a desire to dissuade women from abortion, our findings suggest that mandatory ultrasound viewing may have the opposite effect on some women," the researchers wrote.

The researchers suggested that abortion clinics offer women the opportunity to view their ultrasound image. However, they noted there is an important distinction between "law and clinical practice." They wrote, "Although offering women the opportunity to view their ultrasound might be good clinical practice, it is not appropriate to legislate this requirement," adding, "Furthering legislation around ultrasound in the abortion context does little to improve patient experience and may actually make it worse."