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A comparison of termination of pregnancy procedures: Patient choice, emotional impact and satisfaction with care

Heath, Jennifer; Mitchell, Natalie; Fletcher, Joanne


Jennifer Heath

Natalie Mitchell

Joanne Fletcher



To investigate: (1) whether women self-report an ability to choose their preferred termination of pregnancy (TOP) procedure, (2) what factors influence this choice, and (3) what effect this choice has on emotional responses and satisfaction with care.

Study design

A mixed-method prospective comparative study in which women requesting a TOP between five and eighteen weeks gestation for social reasons (as opposed to medical indications), were invited to complete a semi-structured pre-TOP interview and questionnaire, and a post-TOP questionnaire four weeks after the procedure.

Main outcome measures

Quantitative data was collected using the Patient Health Questionnaire, Generalised Anxiety Disorder Scale, Positive and Negative Affect Scale, Impact of Event Scale – Revised, and Client Satisfaction Questionnaire.


Pre-TOP emotion-based factors did not differ between groups. Most women felt that they were able to choose their preferred method of TOP. Their decisions were based on factors categorised as procedure-related, lifestyle or social circumstance-related, emotional, or other factors. When no choice was perceived, common reasons reported were that: (1) gestation was too far along for there to be another option, or (2) an appointment was not available within the required timeframe. When women felt that the method of TOP performed was not their choice they found the procedure more stressful. All women reported high satisfaction with care.


A better understanding of the patient experience can inform service development, enabling staff to ensure that the services provided meet women’s needs. The perception that one is able to choose their preferred TOP procedure is important for reducing procedure-related stress and ensuring high satisfaction with care.


Heath, J., Mitchell, N., & Fletcher, J. (2019). A comparison of termination of pregnancy procedures: Patient choice, emotional impact and satisfaction with care. Sexual and Reproductive HealthCare, 19, 42-49.

Journal Article Type Article
Acceptance Date Dec 2, 2018
Online Publication Date Dec 3, 2018
Publication Date Mar 1, 2019
Journal Sexual and Reproductive Healthcare
Print ISSN 1877-5756
Electronic ISSN 1877-5764
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 19
Pages 42-49
Keywords Termination; Abortion; Choice; Emotional impact; Satisfaction with care; Nursing
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