Guideline needed for consultations on unwanted pregnancy

General practitioners (GPs) do not yet have a guideline for consultations on unwanted pregnancy. According to researchers from Rutgers WPF and the Netherlands Institute for Health Services Research (NIVEL), clear guidelines and working relationships with gynaecologists, adoption agencies, and abortion clinics could help GPs support patients in making an informed decision about whether or not to terminate the pregnancy. The researchers have published their findings in the scientific journal Family Practice. Their findings are based on research data provided to the NIVEL Primary Care Database by sentinel practices.

The Netherlands has one of the lowest abortion rates in Europe. The number of abortions in a country is related to the country’s laws and the society’s views on abortion. If few abortions are performed in a country, this usually means that sex education and contraceptives are widely available. Even though reliable methods of birth control are readily available in the Netherlands, one in five women has an unplanned pregnancy once during her lifetime. Sixty-eight per cent of these are unwanted pregnancies and are terminated. In approximately one fifth of the unwanted pregnancies, the pregnant woman is under the age of twenty. More than forty per cent (42.7%) of the women have no partner, and for half of them it is their first pregnancy.

Laws
Abortion is legal in the Netherlands, and is covered by the basic health insurance package. By law, during the first consultation with the GP or doctor in the abortion clinic, women have to be informed about the options and provided with detailed information; they are also required to observe a five-day reflection period between the consultation and the abortion. Not all pregnant women who want an abortion consult their GP for this. Many of them go directly to an abortion clinic. Six out of ten women are referred to an abortion clinic by their GP. Even so, GPs have no guidelines on or written agreements with other health care disciplines for consultations on unwanted pregnancies.

Guideline for GPs
“A guideline for discussing options for unwanted pregnancies could help GPs support these pregnant women in their decision-making process,” says Gé Donker, epidemiologist and GP at NIVEL. “Right now, GPs don’t always know what’s expected of them during a consultation on unwanted pregnancy. They don’t always realise that the five-day reflection period starts after the first consultation with the GP, and that they’re expected to provide detailed information.”

Determined
“For women who are already determined to have an abortion, GPs might think that these women aren’t interested in hearing about other options,” she explains. “But women who are undecided have to be able to make an informed decision. And we don’t know if that’s always the case at the moment. Moreover, even for women who have made their decision, it’s good to check whether they had the information they needed to reach their decision. GPs have to make sure that patients have been thoroughly informed about all of the options, and have made their decision of their own free will. That’s a big responsibility, and they can only fulfil this by having an in-depth conversation with their patient.”

NIVEL Primary Care Database
The study used data provided by sentinel practices to the NIVEL Primary Care Database. The NIVEL Primary Care Database makes use of health care data that is routinely collected by various primary care disciplines, including 386 general practices with 1.2 million registered patients. Forty of these practices, with 57 GPs – the sentinel practices – also report on a weekly basis about the prevalence of a number of diseases, events, and procedures that are missing from routine databases and are not easy to include in them. These sentinel practices were established in 1970. Most of the databases cover multiple years.

Cooperating partner
Rutgers WPF