Counseling versus Information Duarte Vilar Lisbon 3 March 2010

A political question? Counseling in the provision of abortion services as an issue of public and political debate Counseling is often part of the abortion legislation in several countries In some of them, compulsory counseling previous to abortion is part of the law

2007 in Portugal In February 2007, the question “do you agree with the legal possibility of women have an abortion on request until 10 weeks of pregnancy” was subject of a referendum and the YES wined with 60% of the votes

Compulsory and directive For antichoice (and the PR), counseling should be not only compulsory but should also be directive in order to convince women to give up of the abortion

In the 1 st consultation in the hospital, women present their situation and (if it already exist) their decision. Psychological counseling is optional and is provided on women’s request. Information on the different abortion methods (availabe…) is also provided. In the 2 nd consultation (3 days after at minimum), women present their decision and the process starts.

Psychological consultation About 10% of women have a psychological consultation (when they are under16, when they recidive abortion, when they ask for this support or when professionals suspect from family pressures, or if woman is emotionally distressed. But only very few women request intensive psychological counseling.

A False Dylema We think It is important to be very attentive to all emotional aspects that are involved: in the suspect and confirmation of an unwanted pregnancy, in the process of decision making about this situation, in the several aspects that are involved in the process of abortion and in the post abortion aspects. Thus, we are not talking only about specific counseling on the decision of continuing or interrupting the pregnancy. We are talking about psychological support in women that want it or, in some cases, need it clearly even if they don’t request it in an explicit way.

Help Line OPÇÕES In December 2006 APF started athehelp line OPÇÕES” (Options, Choices). This help line receives around one thousand call per year which corresponds, more or less to 5% of the number of women that have an abortion in Portugal. Around 50% of the women call just for ask guidance to legal abortion services. The other 50% call for more specific requests of information or support.

Emotional Aspects Facing an unexpected and unwanted pregnancy, women may have: feelings of guilt (even if they were using contraception) confusion fear and anxiety negative pressures from partners, family members, and professionals loneliness ambivalence. When women decide to have an abortion they may have doubts and different levels of anxiety on issues like: fear of being exposed and of lack of confidentiality fear of family reactions or fear of professionals reactions fear of the process of abortion itself (pain, safety, etc) fear of further consequences of abortion.

A changing situation We believe that these aspects may be more relevant in a help line, rather in the hospitals or health centers but still, all professionals involved in abortion provision know that these situations are frequent. We do believe that the need of emotional support will be less requested on the measure that: women have a more supportive personal and social environment, women they know more about their rights, and have positive perceptions on the way how they are received by professionals.

Medical Abortion Because medical abortion is a process that is mostly lived by the woman at home, professionals must provide all the information needed including, information on eventual pain, bleeding and of course other practical information on these aspects (and must be accessible for the women in need)

Linking to Sexual and Reproductive Health We have to profit these situation to understand the mechanisms of unwanted pregnancy and to discuss and eventually improve the questions of contraceptive use in order to prevent future unwanted situations, in a context of women’s empowerment.

Be attentive, be supportive That’s why between compulsory counseling and mere information there is another and necessary professional attitude and behavior that involves: – active listening, – active observation – provision of support. And in this process, professionals have, first of all, to respect women demands and decisions, and have, also, to be very attentive to possible vulnerabilities and try to do the best in order to offer a quality service.