Does Viewing an Ultrasound Deter Women from Having an Abortion?

February 5, 2014

ultrasound viewing study
Source: Relationship Between Ultrasound Viewing and Proceeding to Abortion / Obstetrics & Gynecology January 2014

We all know what forcing women to undergo and view ultrasounds prior to an abortion is supposed to do — influence women to carry their pregnancies to term.

That’s why crisis pregnancy centers, which operate with an anti-abortion agenda, offer ultrasounds even though most are not equipped to provide medical services, and anti-abortion mobile buses park near schools and offer free ultrasounds to pregnant women.

But does viewing an ultrasound really deter women from choosing abortion?

According to research findings, bolstered by a new study, the answer is probably no.

Researchers from University of California, San Francisco and Planned Parenthood looked at data for more than 15,000 women seeking abortions at a Los Angeles Planned Parenthood clinic in 2011. All patients underwent a pre-procedure ultrasound, which can be standard in abortion care, and all were offered the opportunity to view the ultrasound screen. (Mandating that women undergo an ultrasound, view it, and listen to a description of the fetus is a whole other issue.)

Less than half, 6,346 women, chose to view it. Almost all of them, regardless of their viewing choice, went on to have abortions (98.8 percent).

Researchers also considered how certain the women felt about their decisions to have an abortion. Women who were highly certain about their decision did not waver, regardless of whether they viewed the ultrasound.

As might be expected, women who were were less certain of their decision to abort the pregnancy and who viewed the ultrasound were slightly less likely to have an abortion than like-minded women who did not view it (95.2 percent of those who viewed it continued with the abortion compared with 97.5 percent of those who did not).

Other factors, such as gestational age, weighed more heavily on the decision. Women who were 17 to 19 weeks pregnant, for example, were almost 20 times more likely to continue the pregnancy than women up to nine weeks pregnant, regardless of whether or not they viewed the ultrasound. The authors suggest that this may have to do with women’s feelings about terminating a pregnancy earlier vs. later.

The authors caution that their findings may be different from situations in which the ultrasound is forced, but they conclude that mandatory viewing should be avoided:

Finally, these results cannot be generalized to women’s experience of ultrasound viewing in settings where it is mandatory, although given the very high percentage of women proceeding with abortion after viewing the ultrasound image, it is unlikely that mandatory viewing would substantially affect the number of abortions performed. It may, however, affect patient satisfaction and health outcomes, which research shows are enhanced when patients feel control over decisions related to their care. Mandating that women view their ultrasound images may have negative psychological and physical effects even on women who wish to view.

The clinical implications of this study are twofold. First, women should be offered the opportunity to voluntarily view their ultrasound images before abortion. However, because fewer than half of women select this option, mandatory viewing should be avoided. Second, health care providers engaged in ultrasound viewing should be sensitive to how patients react to their images but avoid making assumptions about the effect of viewing on patient decision-making. Patients with low decisional certainty about the abortion decision may need more time and support in reaching a decision about whether abortion is the correct decision for them.

For more on the use of ultrasounds in the context of abortion, read this excellent commentary by Tracy Weitz, one of the study’s authors and director of the Advancing New Standards in Reproductive Health (ANSIRH) at UCSF (and a contributor to “Our Bodies, Ourselves”). Written last March, during the height of political battles around mandating transvaginal ultrasounds, Weitz takes a closer look at the weak rationale for anti-abortion activists thinking that ultrasound viewing would reduce the number of abortions.

To date, she notes, “no peer-reviewed empirical data has supported this proposition that viewing an ultrasound image discourages women from abortion. In fact, what limited information does exist suggests that women seeking abortions have a range of experiences associated with viewing their ultrasound and any mind-changing occurs in a complex context that may or may not include ultrasound viewing along with other factors.”

Conversations about mandatory ultrasound, Weitz argues, should be focused on how these laws drive up costs, make providing abortion care more difficult, do not improve health outcomes, and eliminate patient autonomy.

To learn more about situations and states in which ultrasounds are regulated in the context of abortion, view this fact sheet from Guttmacher Institute. Currently, three states mandate that an abortion provider perform an ultrasound and show and describe the image; eight states mandate the ultrasound and require the provider to offer the patient the opportunity to view the image.

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