Obesity and Abortion
Kate Cosby; Tracy Weitz, PhD, MPA; Diana Greene Foster, PhD
Introduction and Purpose/Objective(s): The purpose of this research was to: Describe current rates of obesity among women of reproductive age in the U.S.; Explain the ways in which obesity may impact a woman's reproductive health; Characterize the experiences and trajectory of obese women who access abortion services; Identify the challenges that obesity presents to the abortion practice from the clinician and management perspective; and Increase awareness about the relationship between obesity, reproductive healthcare, and abortion access.
Data-Collection Methods: Patient Data: The UCSF Delay study examined a cross section of abortion patients at one urban hospital-based clinic. Each patient completed a computer-assisted questionnaire, which gathered information about timing of menses, BMI, and interactions with providers. Provider Data: We gathered data from a convenience sample of providers using an online survey. We also gained access to the archive of a provider listserv and reviewed and excerpted relevant correspondence among providers.
Summary of Results: Forty-three providers responded to our survey online. Only 15% of providers claimed that it was "not challenging" to provide abortions to obese patients. The remaining 85% chose answers ranging from "somewhat challenging" to "extremely challenging." Providers identified issues ranging from "visualizing the cervix" to "using general anesthesia" as increasingly difficult with patient obesity. Qualitative data showed that clinics employ a variety of policies in order to address the added complications of serving obese patients. These policies ranged from referring patients to a hospital to requiring more staff in the procedure room to charging patients a "weight fee." Most providers did not consider obesity to be an "access issue" at their clinic. Nevertheless, many felt that obesity was an "access issue" in their region. Several patients suggested that their obesity may have contributed to their abortion delay because it increased the amount of time needed to find an appropriate provider. Yet quantitative analysis, using data from the same study, suggests that obesity is significant in delaying abortion because it increases the time that women take to suspect a pregnancy and take a pregnancy test.
Conclusions: Most of the physicians surveyed suggested that obesity presented a challenge in their abortion clinic, though the degree of challenge varied. Some physicians and administrators have responded to these challenges with obesity policies that may decrease access to abortion for some patients. In order to meet the reproductive health needs of all women, we must seek solutions that expand access to inpatient abortion care, increase training for providers on managing obesity in both the inpatient and outpatient setting, and develop equipment to accommodate obese women. Future research must evaluate the impact of obesity policies on access to care and work to isolate and understand the risks associated with providing abortion to obese women.
Cite this: Scientific Paper Abstracts Originally Presented at the National Abortion Federation's Annual Meeting; April 23, 2007; Boston, Massachusetts - Medscape - Nov 08, 2007.