1. Module 3: Special Topics in Reproductive Health Referral-Making
Provide Referrals Curriculum 185

2. Module 3: Objectives Melanie Zurek Sept 2010
In Module 3, our objectives are to train frontline providers to effectively:
Place abortion in the context of normal reproductive health care
Explain basic information and address common myths about abortion
Reflect on their own beliefs so as to: recognize their own biases; recognize the diverse perspectives of different individuals within a participant group; enhance empathy/ appreciate the difficulty of assigning an abstract moral hierarchy to women’s situations.
Melanie Zurek
Sept 2010
Provide Referrals Curriculum 186

3. Module 3: Objectives Melanie Zurek Sept 2010
In Module 3, our objectives are to train frontline providers to effectively:
Place abortion in the context of normal reproductive health care
Explain basic information and address common myths about abortion
Reflect on their own beliefs so as to: recognize their own biases; recognize the diverse perspectives of different individuals within a participant group; enhance empathy/ appreciate the difficulty of assigning an abstract moral hierarchy to women’s situations.
Melanie Zurek
Sept 2010
Provide Referrals Curriculum 187

4. Knowledge is Power! Module 3 7 Facts about Abortion
We’re all entitled to our own opinions. But we’re not entitled to our own facts.
7 Facts about Abortion
Talking about sensitive issues like abortion can be tough. Knowing the facts can help you offer the information and support your patients/clients need to make the best decisions for themselves and their families.
NOTE TO TRAINER for posing questions: The next slide answers the question: “What proportion of women have an abortion during their reproductive years?”
Provide Referrals Curriculum 188

5. Module 3: FACT
1 in 3
According to Guttmacher, “21% of all pregnancies (excluding miscarriages) end in abortion.”
Also, according to Guttmacher, “At least half of American women will experience an unintended pregnancy by age 45, and at 2008 abortion rates, one in 10 women will have an abortion by age 20, one in four by age 30 and three in 10 by age 45.”
The 21% statistic explains that the likelihood of an individual pregnancy (one woman who is pregnant one time) ending in an abortion for that pregnancy is 21%. Whereas, over the course of all the woman’s pregnancies in her lifetime, there is a one in three chance that at least one of those will end in abortion.
Trainers may wish to use this opportunity to discuss the different impact that lack of access to abortion has on low-income communities and communities of color. From Guttmacher:
Eighteen percent of U.S. women obtaining abortions are teenagers; those aged 15–17 obtain 6% of all abortions, 18–19-year-olds obtain 11%, and teens younger than 15 obtain 0.4%.
Women in their 20s account for more than half of all abortions: Women aged 20–24 obtain 33% of all abortions, and women aged 25–29 obtain 24%.
Non-Hispanic white women account for 36% of abortions, non-Hispanic black women for 30%, Hispanic women for 25% and women of other races for 9%.
About 61% of abortions are obtained by women who have one or more children.
Forty-two percent of women obtaining abortions have incomes below 100% of the federal poverty level ($10,830 for a single woman with no children).
Twenty-seven percent of women obtaining abortions have incomes between 100–199% of the federal poverty level. 
NOTE TO TRAINER for posing questions: The next slide answers the question: “Is abortion safe?”
About one in every three women in the U.S. have an abortion during their lives.
Guttmacher Institute, Fact Sheet: Unintended Pregnancy in the United States,
Provide Referrals Curriculum 189

6. Abortion is safe Module 3: FACT
Performed in proper conditions, abortion is safe and simple.
Guttmacher Institute, Fact Sheet: Unintended Pregnancy in the United States,
Fewer than 1% of women having an abortion experience a major complication. Where women lack access to safe services, complications from unsafe procedures are a significant public health problem.
NOTE TO TRAINER for posing questions: The next slide answers the question: “Aren’t women who have children unlikely to choose abortion?”
Provide Referrals Curriculum 190

7. Most are moms Module 3: FACT
Six in 10 women obtaining abortion already have at least one child.
Guttmacher Institute, Fact Sheet: Unintended Pregnancy in the United States,
In fact, 3 out of 10 women seeking abortion care already have two or more children.
NOTE TO TRAINER for posing questions: The next slide answers the question: “Some people are personally opposed to abortion because of their religious beliefs. What do they think about other women’s right to choose?”
Provide Referrals Curriculum 191

8. Freedom of religion Module 3: FACT
Millions of religious people support access to abortion, many of whom are personally opposed to abortion.
CNN.com, Survey: Few religious groups want Roe v. Wade overturned despite belief abortion morally wrong, January 16, 2013,
NOTE TO TRAINER for posing questions: The next slide answers the question: “Teenagers are the main group having abortions, right?”
Provide Referrals Curriculum 192

9. Most are in their 20s Module 3: FACT
Adolescents comprise only 18% of abortion clients in the U.S.
Guttmacher Institute, Fact Sheet: Unintended Pregnancy in the United States,
NOTE TO TRAINER for posing questions: The next slide answers the question: “Isn’t the abortion rate higher in liberal parts of the country?”
Provide Referrals Curriculum 193

10. Similar rates across the U.S.
Module 3: FACT
Similar rates across the U.S.
The incidence of abortion has declined nearly every year between 1990 and However, access to abortion services remains a critical issue, particularly since the number of abortion providers has been falling for the last three decades.
Guttmacher Institute, Fact Sheet: Unintended Pregnancy in the United States,
NOTE TO TRAINER for posing questions: The next slide answers the question: “I’ve heard that emergency contraception and medication abortion are the same thing.”
Provide Referrals Curriculum 194

11. EC & Medication Abortion are Different
Module 3: FACT
EC & Medication Abortion are Different
EC is a form of birth control that prevents a pregnancy after unprotected sex. It can be taken up to 5 days after unprotected sex. EC does not end a pregnancy and will not work if you are pregnant. EC can be purchased over-the-counter. Medication abortion ends a pregnancy. It works in early pregnancy, up to 10 weeks. Unlike EC, the medication is not over-the-counter and can only be dispensed by a clinician.
Reproductive Health Access Project: Emergency Contraception and Medication Abortion: What’s the Difference,
NOTE TO TRAINER for posing questions: The next slide answers the question: “I’ve heard that abortion leads to depression, to cancer, and can keep a woman from being able to get pregnant in the future. Is that true?”
Provide Referrals Curriculum 195

12. The Science is Clear Module 3: FACT
Medical research shows that abortion does not increase a woman's chance of depression or cancer, or impact future fertility.
Guttmacher Institute, Fact Sheet: Unintended Pregnancy in the United States,
Frank P, et al., The effect of induced abortion on subsequent fertility. Br J Obstet Gynaecol Jun;100(6):
NOTE TO TRAINER for posing questions: The next slide returns to the STAR model. It answers the question: Is having accurate facts part of making a STAR referral?
Provide Referrals Curriculum 196

13. . . . . . . . . . . . Module 3: The STAR Model for Effective Referrals
SUPPORTIVE
“I know my role in the face of my client’s/patient’s need.”
“Supporting my client’s decision is the best way I can do my job helping her.”
THOROUGH  
“I have the correct information about the service she needs.”
“I am knowledgeable about the care she is seeking.”
ACTIVE   
“I actively help my client/patient locate and schedule the care she needs.”
“I actively assess her needs for, and help connect her to, supportive services such as childcare or transportation—to help her to utilize the referral she is seeking.”
REFERRAL-QUALITY
“I follow up, asking about her experience accessing this provider and if there is anything else she needs.”
“I use her experience to better help the next client or patient seeking a referral.”
Be a STAR
NOTE TO TRAINER: Ask participants which part of the model does accurate information fit into? [Probe for THOROUGH: I have the correct information… I am knowledgeable about the care she is seeking.”
Provide Referrals Curriculum 197

14. Provide Referrals Curriculum 198