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O20Trauma responsive abortion care (on trac study): The abortion experiences of patients with a history of trauma

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      Objectives

      Due to intersectional structural inequities, individuals seeking abortion have experienced disproportionately high rates of trauma. We sought to elicit patient perspectives on how prior trauma(s) influenced their abortion experiences.

      Methods

      We recruited individuals from Chicago-area abortion clinics to participate in semi-structured interviews exploring how prior trauma(s) influenced their abortion experience and how interactions with providers/staff ameliorate or worsen the impact of past trauma(s). Participants were aged 18 or older, had experienced an abortion and self-identified a history of trauma (sexual assault, domestic violence, or adverse childhood experience). We used modified grounded theory to identify salient themes.

      Results

      We conducted 30 interviews, identifying trauma-activating factors and trauma-responsive strategies before, during, and after obtaining the abortion. Participants reported that, pre-abortion, restricted access and a lack of procedure options activated trauma-related feelings of autonomy loss and that they desired unbiased information, particularly from peers. Participants described how physical pain/discomfort and provider/staff use of inappropriate language during procedures worsened their experience; while use of neutral language, warnings prior to touch, proper draping, and constant checking-in and offering options helped mitigate effects of prior trauma(s). Post-procedurally, participants desired mental health support specifically addressing stigma, though this resource was rarely available.

      Conclusions

      Applying key tenets of trauma-responsive care to all patients seeking abortion mitigates impacts of prior traumas on the abortion experience. Providers can resist re-traumatization on a clinical level via the use of language, bi-directional communication, and by offering options, including pain management and behavioral support. On a systemic level, providers can advocate for increased abortion access and address stigma.
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