Counselling focuses on an immediate, identifiable single problem area. The counselling session deals with the feelings, facts and circumstances that relate to that problemarea: the unwanted pregnancy.

Empathise and reflect feelings; question without judging and affirm the normalcy of the woman's ambivalence

Abortion counselling covers options counselling and pre-procedure counselling. In some countries informed consent has to be obtained as well.

If a woman decides to terminate her pregnancy practically always there will be a competition of rational arguments in favour of termination and emotional arguments to preserve the pregnancy.

Help the woman to recognise this conflict .

A counsellor has the task to discuss this dilemma with the patient so that she can make up her mind and make a well balanced choice. Discuss also the impact of childbearing. The patient should be told that she is at liberty to leave the clinic at any moment if she wants to reconsider her decision. Indeed it happens occasionally that a patient at the last moment, already on the operation table, suddenly decides that she does not want the termination done. It is very important in this situation to differentiate ambivalence from fear for the intervention and consider sedation. Although it disturbs the clinic routine and is bad for the doctor's temper the woman should feel free to leave the clinic unrebuked. Best is to send her back to the counsellor who should tell her that she may always come back if she wants to talk with her.


Why is it that a woman gets an unwanted pregnancy while she has easy access to contraception? A few patterns can be recognised. The list is by no means complete.

1.The young girl who is not yet prepared. The social pressure of friends or schoolmates may induce her to take part in sexual intercourse for fear of being an outcast. Wise parents foresee this and explain this to the girl giving her the choice to accept contraception. But not all parents are wise.

2.The woman has no male acquaintances and no sexual intercourse, so she does not practise contraception. Pregnancy may occur after an unforeseen meeting. See the discussion of the MAP in Chapter 6 .

3.The woman denies sexual desire because of some psychological or religious sexual inhibition and therefore, of course, does not practise contraception. This group of women provide the most fervent anti abortion activists. They consider abortion as an opportunity to avoid punishment for those women who are less restricted. When they have the misfortune to become pregnant they form the most difficult type of patient. The secret desire to become pregnant may cause an unrealistic fear for contraception, for instance that it causes cancer. This fear leads to neglecting contraception or 'forgetting' the pill. In certain cultures reproduction is seen as a form of self expression. The woman wants to show that she can become pregnant, the man that he can impregnate a woman. Since the pregnancy is undesired for practical reasons this can lead to repeated abortions.

4.Genuine failure of a more or less adequate contraceptive method.

5. Forced sexuality, 6.rape, 7.incest.

An abortion clinic should develop its own standards of counselling. Counselling should take place in a friendly relaxed way, before the procedure and afterwards again. It is important to listen actively, not only to the content, but also to the tone and the choice of words. The counsellor should be prepared to be present during the procedure if the patient wishes. Never force your well meant advises on the patient. If she does not want to be counselled her wish should be respected. She may want to solve her own problems.

Before the procedure try to get an impression if the woman wants the termination and if she has any doubts about her decision. Assess the need for additional counseling or extra reflecion time. The situation classified above under the numbers 1,2,6 and 7 will generally cause no problems. Try to find out if she comes of her own free will or if she is forced.


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