Table 1.

Example approaches of integrating abortion into contraceptive counseling. Helpful and unhelpful qualities identified for each Example

Example 1: Mention of abortion as back-up method Imagine a patient who goes to the doctor to talk about birth control options. The doctor reviews a list of birth control methods: the pill, the patch, condoms, the IUD, the implant, the ring, Plan B, withdrawal, etc., and at the end, the doctor says, “I want to remind you that even though people use birth control, they sometimes get pregnant when they don't want to be. If that happens, then your options would be to continue the pregnancy to parent a child, continue the pregnancy and make an adoption plan, or to end the pregnancy with an abortion.”
Salient quality		Representative quote
Helpful (Dominant)	Non-directive	“…it don't seem too harsh. Well, they explain it pretty good about, like, if you did get pregnant on accident or whatever, basically, that you could – ‘cause they also explained adoption and stuff, so it's not just flat abortion. Giving you the other options, also. …I think [this approach] is helpful no matter what.” CB, age 37, California Central Valley, believed abortion should be illegal in most cases, completed some high school
	Non-directive	“… she's not imposing her personal opinion like, well, you know, ‘I, personally, wouldn't do that,’ you know? She's giving you the option with putting abortion in there… She's including that in there to give that woman that right to make that choice.” EZ, age 34, San Francisco Bay Area, believed abortion should be legal in all cases, completed some college
	Destigmatizing	“… it's helpful because say that does happen, you have a mistake. […] you already know that your doctor is understanding that things do happen and […] he or she already has discussed with you your three options. So, […] that is a little bit more approachable […] – because it's scary if you do have a unplanned pregnancy. So, maybe just having this already in your ear, […] you could go back and let them know, you know, a mistake did happen, and I want to now talk about my plan with my pregnancy.” TW, age 34, California Central Valley, believed abortion should be legal in all cases, completed some college
Unhelpful	Irrelevant	“I feel like it's jumping the gun […] if I'm just coming for birth control, like I'm not pregnant. And so the fact that I'm not even pregnant, we don't need to discuss adoption. We don't need to discuss abortion. […] I feel like it's not there yet. Um, so it's like it's too soon. […] It's not coming at the discretion of the patient.” SW, age 24, San Francisco Bay Area, missing abortion legality opinion, completed 4-year college
	Destigmatizing	“I don't think a doctor would even have to bring that up. People know, you know, what they're doing. I mean, people know that you can either be a parent, or abort the child, or - like give the child up for adoption. […] I think if the doctors continue to say that to people, then […] people would just be more irresponsible. […].” EB, age 41, San Francisco Bay Area, believed abortion should be illegal in most cases, completed high school
Example 2: Mention of abortion to assess acceptability of pregnancy management options Imagine a patient who goes to the doctor to talk about birth control options. The doctor says, “before we talk about birth control options, I'd like to frame our conversation by asking you what you would do if you became pregnant in the next few months. Your options would be to continue the pregnancy to parent a child, continue the pregnancy and make an adoption plan, or to end the pregnancy with an abortion.” And the doctor says to the patient, “Thinking for yourself, which of these would be acceptable to you?”
Salient quality		Representative quote
Helpful (Co-dominant)	Customizable	“I mean, I feel like, that could be useful, as well, because […] you wanna build a relationship with your patient, and […] it would be good to get a sense of what they want or what their plans are in terms of, like, you know, getting pregnant or starting a family...” LD, age 33, San Francisco Bay Area, believed abortion should be legal in all cases, completed some college
	Thought-provoking	“[…this one is helpful because] first they're letting you - like everybody knows that if you have sex, there's always gonna be like the possibility of […] getting pregnant. But probably like the first-timers, they would probably make them think a little bit more about like if you do have sex, then this is what could happen if you're not careful, […] they're probably gonna make you think like if […] you're ready for that at that point in your life.” HG, age 27, California Central Valley, believed abortion should be illegal in most cases, completed high school
Unhelpful (Co-dominant)	Irrelevant	“It seems like, ‘what does this have to do with anything?’ […] What if before I tell you whether or not you have cancer, [I asked] what if you did have cancer? […] I guess it would make me think about what I would do, […] but things are actually different whether - when you're in the situation than before the situation. So again, seems kind of […] unhelpful..” CH, age 31, San Francisco Bay Area, believed abortion should be legal in most cases, completed 4-year college
	Centers pregnancy	“It just put a bad stigma on the whole overall thing, you know, birth control, sex, pregnancy… I wouldn't even want to talk about birth control. […] because she just scared the shit out of me. Like, let's spring your question around you gettin’ pregnant in the next few - I don't think some doctors understand how hard it is for a woman to even open up about things about birth control, pregnancy, terminating pregnancies, and what their options is.” EZ, age 34, San Francisco Bay Area, believed abortion should be legal in all cases, completed some college
	Stigmatizing	“I would definitely be thrown off because I'm coming to my provider for options to prevent, not to be questioned. […] they're not bad questions, but I would definitely […] already feel like he is ready to judge.” MM, age 32, San Francisco Bay Area, believed abortion should be legal in most cases, completed some college
Example 3: Mention of abortion as a birth control method Imagine a patient who goes to the doctor to talk about birth control options. The doctor reviews the birth control options with the patient: the pill, the patch, condoms, the IUD, the implant, abortion, the ring, Plan B, withdrawal, etc. This doctor lists abortion as one of the birth control methods.
Salient quality		Representative quote
Helpful	Destigmatizing	“I guess, I would be like, ‘Oh, yea, I guess that is a form of birth control.’ Like it would just remind me that it's out there. You know what I mean? ‘Cause when I'm thinking of birth control, I'm not thinking about abortion. I'm thinking, you know, the other things […it's helpful that] it's listed as an option..” BL, age 34, San Francisco Bay Area, believed abortion should be legal in all cases, completed high school
Unhelpful (Dominant)	Destigmatizing	“…that's like giving somebody a free pass… I've seen it for myself, like, I don't take these pills, we don't use condoms, if I get pregnant, I can just go to the clinic and… you know what I mean?” MV, age 39, California Central Valley, believed abortion should be legal in all cases, completed some college
	Destigmatizing	“Um, it seems like it shouldn't be there. […] not even thinking about the moral implications—[abortion] as a birth control method is the most invasive and, like, as a health care provider, […] suggesting an option that is the most invasive seems like the wrong way to go about it.” CH, age 31, San Francisco Bay Area, believed abortion should be legal in most cases, completed 4-year college
Example 4: Mention of abortion while discussing effectiveness (only presented to one-third of interviewees) Imagine a patient who goes to the doctor to talk about birth control options. The doctor says, “You have lots of different options for birth control methods. There are also different factors to think about, like how effective each method is, how easy it is to use, and side effects. For example, when we think about effectiveness, some birth control methods are better at preventing pregnancy than other methods. When used correctly, some methods are over 90% effective, and some are even better, like 99% effective at preventing pregnancy. One thing people consider is how they would feel if their method didn't work and they got pregnant, if they would continue their pregnancy or have an abortion. However they feel about that situation can affect the birth control method they choose.
Salient quality		Representative quote
Helpful (Dominant)	Comprehensive	“This really does lay down most of the ground knowledge for birth control. It tells people that, you know, it's not 100%, we can't promise anything. It-it's very honest and, uh, straightforward..” JF, age 20, California Central Valley, believed abortion should be legal in all cases, completed some college
Unhelpful	Confusing	“They confused me. […] I'm not going to come in and get birth control if I'm not going to make sure it's at least, you know, […] 99 percent effective…” PO, age 24, California Central Valley, believed abortion should be illegal in most cases, completed high school