Influence of clinician referral on Nebraska women's decision-to-abortion time

Objective: To assess the association of clinician referral with decision-to-abortion time. Study design: We conducted a cross-sectional survey of women seeking abortion at all three Nebraska abortion clinics. We defined referral as direct (information for an abortion clinic), inappropriate (information for a clinic that does not provide abortions) or no referral. Women reported when they recognized their pregnancy, decided to seek abortion and contacted a clinician. The primary outcome decision-to-abortion time was time from certain decision to abortion. We used multivariate linear regression analysis, controlling for potential confounders. Results: Participants (n=356) were a mean of 26.8 +/- 5.3 years old, primarily white (62%), unmarried (88%) and urban (87%), with a mean gestational duration of 8(2/7) weeks (S.D.+/- 20 days). Forty-six percent (164) had contacted a clinician and 30% (104) had discussed abortion with one before their abortion. Of those, 30% received a direct referral, 6% received an inappropriate referral and 64% received no referral. Decision-to-abortion time did not vary by referral type [mean difference compared with direct referral: inappropriate referral, 1.1 days, 95% confidence interval (CI) -13.4 to 15.6, p=.88; no referral, 0.4 days, 95% CI -7.0 to 6.3]. The most common reasons cited for delay in obtaining an abortion were an inability to get an earlier appointment (105/263, 40%) and time needed to raise money to pay for the abortion (73/263, 28%). Conclusion: While neither occurrence of referral nor type was associated with decision-to-abortion times, women in Nebraska continue to face barriers to timely abortion care. (C) 2016 Elsevier Inc. All rights reserved.