Pregnancy Options Counseling and Abortion Referral Practices Among Colorado Nurse Practitioners, Nurse-Midwives, and Physician Assistants

J Midwifery Womens Health. 2021 Jul;66(4):470-477. doi: 10.1111/jmwh.13214. Epub 2021 Mar 2.


Introduction: Access to abortion is a public health priority. Yet little is known about pregnancy options counseling and abortion referral practices, both essential to timely abortion care, among advanced practice clinicians (APCs; nurse practitioners, nurse-midwives, physician assistants).

Methods: Data were drawn from a stratified random sample of Colorado APCs, oversampling certified nurse-midwives (CNMs), women's health nurse practitioners (WHNPs), and rural clinicians. Pregnancy options counseling and abortion referral practices were described. Weighted multivariate logistic regression models were used to examine associations between participant characteristics and providing options counseling, referring for abortion, and referring to crisis pregnancy centers.

Results: Of 513 participants (response rate 21%), 419 provided pregnancy testing. Only 201(48%) reported they were willing and able to counsel on all 3 options. Religious or personal objection was the primary rationale for unwillingness to present abortion as an option (63%). However, lack of knowledge was the main rationale for unwillingness (64%) and inability to counsel (79%), whereas institutional barriers fueled inability to refer (59%). Although 53% referred for abortion care, 31% referred to crisis pregnancy centers. Characteristics positively associated with providing options counseling included being a CNM or WHNP (odds ratio [OR], 2.73; 95% CI, 1.32-5.66), having received options counseling training (OR, 2.84; 95% CI, 1.48-5.43), and feeling adequately trained on abortion counseling (OR, 6.61; 95% CI, 3.62-12.08). Characteristics positively associated with referring for abortion included being a CNM or WHNP (OR, 2.27; 95% CI, 1.18-4.36), having received options counseling training (OR, 2.39; 95% CI, 1.36-4.22), and feeling adequately trained on abortion counseling (OR, 3.5; 95% CI, 2.00-6.11). Only provider type was associated with referring to crisis pregnancy centers; CNMs and WHNPs had the lowest odds (OR, 0.29; 95% CI, 0.15-0.54).

Discussion: Pregnant patients in Colorado may not receive evidence-based pregnancy options counseling or abortion referrals. Clinician training on options counseling and abortion referrals is needed.

Keywords: abortion referrals; advanced practice clinicians; crisis pregnancy centers; pregnancy options counseling.

MeSH terms

  • Abortion, Induced*
  • Colorado
  • Counseling
  • Female
  • Humans
  • Midwifery*
  • Nurse Midwives*
  • Nurse Practitioners*
  • Physician Assistants*
  • Pregnancy
  • Referral and Consultation