The pleasure, joy and positive emotional experiences of abortion accompaniment after 17 weeks' gestation.

Research documents how abortion can be emotionally difficult and stigmatising, but generally has not considered whether and how involvement in abortion may be a source of positive emotions, including pleasure, belonging and even joy. The absence of explorations that start from the possibility of abortion pleasure and joy represents an epistemic foreclosure. Moreover, it highlights how social science literature has tended to emphasise the negative aspects of abortion care in ways that produce or amplify normative negative associations. In this paper, we investigate the positive emotions, pleasure and joy of abortion involvement by drawing on interviews conducted in 2019 with 28 abortion accompaniers in Argentina, Chile, and Ecuador about their experiences accompanying abortions after 17 weeks' gestation. Abortion accompaniment is a response to unsafe and/or inaccessible abortion whereby volunteer activists guide abortion seekers through a medication abortion. Interviewees described how the practice of accompaniment generated positive emotions by building a feminist community, shared intimacy among women, and witnessing aborting people claim their strength. Importantly, these positive emotional experiences of involvement with abortion were not distinct from the broader marginalisation of abortion but were, instead, rooted in its marginalisation.

"Have you ever wanted or needed an abortion you did not get?" Data from a 2022 nationally representative online survey in the United States.

OBJECTIVE: Describe the prevalence of considering, wanting, and not obtaining a wanted abortion among a nationally representative sample of 15-44 year olds in the United States who had ever been pregnant. STUDY DESIGN: We analyzed data from ever-pregnant respondents (unweighted n = 1789) from a larger online survey about contraceptive access using the nationally representative AmeriSpeak panel. Among those not obtaining wanted abortions, weighted frequencies for sociodemographic characteristics and reasons for not getting the abortion are presented. RESULTS: Nearly 6% of the full sample reported having wanted an abortion they did not obtain. In open-ended responses, respondents most frequently reported individual reasons (43.8%) for not getting an abortion (e.g., changing their mind; personal opposition) and financial, logistical, or informational barriers (24.7%) likely related to policy. A quarter (24.1%) of the sample reported a past abortion. Among those who reported no past abortions, about one-fifth had considered abortion in the past, and 6.8% had wanted or needed one. Among those reporting no prior abortions who had considered abortion, only a third (34.3%) also report ever wanting or needing one. CONCLUSIONS: This study begins to quantify the experience, even before the Supreme Court's 2022 decision in Dobbs v. Jackson Women's Health Organization, of being unable to obtain a wanted abortion. Additionally, findings suggest that people in a national sample will answer questions about whether and why they did not obtain a wanted abortion. IMPLICATIONS: This study provides the first known national estimates of lifetime history of not getting a wanted abortion. Survey questions can be used for future research. Prospective and ongoing measurement of the inability to get a wanted abortion could be one part of documenting the effects of Dobbs on abortion access.

Exploring the emotional costs of abortion travel in the United States due to legal restriction.

OBJECTIVES: Pregnant people have traveled across state and national borders for the purpose of abortion since at least the 1960s. Scholarship has robustly documented the financial and logistical costs associated with travel, but less work has examined the emotional costs of abortion travel. We investigate whether abortion travel has emotional costs and, if so, how they come about. STUDY DESIGN: We conducted in-depth interviews with 30 women who had to travel across state borders in the United States for abortion care because of their gestation. We analyzed findings thematically. RESULTS: Interviewees described having to travel to obtain abortion care as emotionally burdensome, causing distress, stress, anxiety, and shame. Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal. CONCLUSIONS: People who have to travel for abortion care experience emotional costs alongside financial and logistical costs. The circumstances of that travel-specifically, being forced to travel because of legal restriction and service unavailability-are foundational to the ensuing emotional burdens. Findings add to the emerging literature on how laws and other structures produce the stigmatization of abortion at interpersonal and individual levels. IMPLICATIONS: With abortion bans following the overturning of the right to abortion and existing gestational limits in the US, more people will have to travel for abortion care. Attention to the emotional costs of abortion travel can help providers understand what their patients may be experiencing when they present for care.

Introduction: The Politics of Abortion 50 Years after Roe.

Abortion is central to the American political landscape and a common pregnancy outcome, yet research on abortion has been siloed and marginalized in the social sciences. In an empirical analysis, the authors found only 22 articles published in this century in the top economics, political science, and sociology journals. This special issue aims to bring abortion research into a more generalist space, challenging what the authors term "the abortion research paradox," wherein abortion research is largely absent from prominent disciplinary social science journals but flourishes in interdisciplinary and specialized journals. After discussing the misconceptions that likely contribute to abortion research siloization and the implications of this siloization for abortion research as well as social science knowledge more generally, the authors introduce the articles in this special issue. Then, in a call for continued and expanded research on abortion, the introduction to this special issue closes by offering three guiding practices for abortion scholars-both those new to the topic and those deeply familiar with it-in the hopes of building an ever-richer body of literature on abortion politics, policy, and law. The need for such a robust literature is especially acute following the US Supreme Court's June 2022 overturning of the constitutional right to abortion.

Prenatal Care as a Gateway to Other Health Care: A Qualitative Study.

INTRODUCTION: Populations with higher rates of being uninsured in the United States have inconsistent access to health care and struggle to find care that fits their needs. For many without access to regular health care, prenatal care can be an entry point for obtaining care related-and unrelated-to pregnancy. We aimed to understand people's lived experience of whether and how pregnancy status enables access to health care unrelated to pregnancy. METHODS: This is a secondary analysis of 18 in-depth interviews collected between June 2015 and May 2017 as part of the Multistate Abortion Prenatal Study. Participants were new obstetrics patients at prenatal clinics in southern Louisiana and Baltimore, Maryland. Interviews were qualitatively analyzed using iterative thematic techniques to identify themes related to experiences navigating health care services on entry to prenatal care. MAIN FINDINGS: Most participants were insured through Medicaid, and all participants had low incomes. Pregnancy status enabled access to health insurance for many participants. Prenatal care facilitated access to non-pregnancy-related health care that participants had otherwise been unable to obtain before their current pregnancies. However, entry into prenatal care did not mean all participants' health needs were adequately addressed and some reported ongoing unmet medical needs. CONCLUSIONS: Our findings point to pregnancy as a gateway to health care (and insurance) and, further, illustrate how prenatal care can serve as a gateway to other medical care. Participants' experiences demonstrate how access to health care for women with low incomes can be dependent on pregnancy status, even for non-pregnancy-related health needs.

Abortion after Dobbs: Defendants, denials, and delays.

The U.S. Supreme Court's Dobbs decision will lead to more criminalization of activities during pregnancy, more abortion denials, and more abortions after the first trimester.

Making a third-trimester abortion referral: Learning from patients.

OBJECTIVES: Research on abortion referral practices has focused on referral to first-trimester abortion care. Research has not examined whether and how these recommendations apply to referrals for abortion later in pregnancy. METHODS: We conducted a secondary analysis of semi-structured interviews with thirty third-trimester abortion patients of their experiences of referral from prenatal and/or pre-third-trimester abortion care. We used thematic coding to identify referral-related actions participants desired or wished providers would avoid. RESULTS: Participants reported needs in referral for information that third-trimester abortion was a possibility and about third-trimester providers and funding resources. Several also reported a need for emotional support from the prenatal or abortion care provider who denied them abortion care. CONCLUSIONS: Many factors important for first-trimester abortion referral are important in third-trimester abortion referral, but the specifics of third-trimester care (namely the paucity of clinics, need for travel, and possibility of strong emotional attachment to the pregnancy) require additional practice actions. PRACTICE IMPLICATIONS: Providers can support their patients in need of third-trimester abortion care by proactively providing: information that third-trimester abortion is available; information on third-trimester providers and funding support (e.g., an abortion referral hotline); and clear, non-judgmental emotional support.

Is third-trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States.

CONTEXT: In the United States, third-trimester abortions are substantially more expensive, difficult to obtain, and stigmatized than first-trimester abortions. However, the circumstances that lead to someone needing a third-trimester abortion may have overlaps with the pathways to abortion at other gestations. METHODS: I interviewed 28 cisgender women who obtained an abortion after the 24th week of pregnancy using a modified timeline interview method. I coded the interviews thematically, focusing on characterizing the experience of deciding to obtain a third-trimester abortion. RESULTS: I find two pathways to needing a third-trimester abortion: new information, wherein the respondent learned new information about the pregnancy-such as of an observed serious fetal health issue or that she was pregnant-that made the pregnancy not (or no longer) one she wanted to continue; and barriers to abortion, wherein the respondent was in the third trimester by the time she was able to surmount the obstacles to abortion she faced, including cost, finding a provider, and stigmatization. These two pathways were not wholly distinct and sometimes overlapped. CONCLUSIONS: The inherent limits of medical knowledge and the infeasibility of ensuring early pregnancy recognition in all cases illustrate the impossibility of eliminating the need for third-trimester abortion. The similarities between respondents' experiences and that of people seeking abortion at other gestations, particularly regarding the impact of barriers to abortion, point to the value of a social conceptualization of need for abortion that eschews a trimester or gestation-based framework and instead conceptualizes abortion as an option throughout pregnancy.

Abortion as obtainable: Insights into how pregnant people in the United States who considered abortion understand abortion availability.

OBJECTIVE: In the United States, restrictive abortion policies are concentrated in a subset of states. Little research has examined how people who consider abortion make sense of abortion obtainability and the extent of regulation of abortion care in their state. STUDY DESIGN: We conducted in-depth interviews with 30 pregnant women in Maryland, a state with high abortion service availability and few policies restricting abortion, and 28 pregnant women in Louisiana, a state with low service availability and numerous restrictions, who had considered but not obtained an abortion for their pregnancy. We analyzed findings using inductive qualitative analytic techniques. RESULTS: All participants were financially struggling. Most participants in Maryland considered abortion easy to get, while a plurality of participants in Louisiana considered abortion difficult to get. Yet, despite their measurable differences in access, participants in both states considered abortion generally obtainable. Participants in Louisiana who thought abortion difficult to get, but nonetheless obtainable, cited strategies that they already employed for other challenges in their lives as options for overcoming abortion barriers. CONCLUSIONS: Pregnant women who consider abortion and are subject to restrictions do not necessarily perceive restrictions as barriers. Their accounts illustrate how those impacted by restrictions adapt to constraints on their reproductive autonomy just as they manage many other challenges that restrict their freedom to live self-determined lives. IMPLICATIONS: Financially struggling pregnant people who considered abortion in Louisiana did not perceive restrictions as barriers to abortion, illustrating the broader adoption of strategies to deal with constraints among women living on low incomes.

Reducing the burdens of forced abortion travel: Referrals, financial and emotional support, and opportunities for positive experiences in traveling for third-trimester abortion care.

In the United States, travel is a fact of the abortion care provision landscape. This is largely due to the uneven geographical distribution of providers and state-level gestational duration bans that constrain what abortion care is available locally. When abortion travel is compelled by legal restriction, it is forced travel. Research has comprehensively documented that forced abortion travel is burdensome; people who must travel for abortion experience financial, logistical, and emotional burdens. Generally overlooked, however, is variation in the experience of travel-related burdens and whether and how such burdens can be reduced. Given current political hostility to abortion, the number of people who must travel and the distances they must travel for abortion are likely to grow, making the question of how travel-related burdens can be reduced in the absence of policy change of increasing relevance. Using thematic analysis of semi-structured interviews with 30 cisgender women in the United States who were forced to travel to obtain third-trimester abortion care, I identify three ways that the burdens of forced abortion travel can be mitigated without policy change: prompt referrals; financial and practical support for travel; and emotional support. In some instances, respondents experienced the received emotional support as so valuable as to offset the other burdens of travel, pointing to the possibility that some people might prefer to travel for abortion care whether or not they are forced to do so. Respondents also reported unexpected positive aspects of traveling, including experiences of kindness and human connection, underscoring that not all aspects of abortion travel are negative. Findings thicken our understanding of forced abortion travel and identify structural and interpersonal practices that can reduce the associated burdens, complementing legal and policy-oriented critiques of legal regulation that makes abortion travel necessary.

In-person later abortion accompaniment: a feminist collective-facilitated self-care practice in Latin America.

In Argentina, Chile and Ecuador, abortion at later durations of pregnancy is legally restricted. Feminist collectives in these contexts support people through self-managed medical abortion outside the healthcare system. The model of in-person abortion accompaniment represents an opportunity to examine a self-care practice that challenges and reimagines abortion provision. We formed a collaborative partnership built on a commitment to shared power and decision-making between researchers and partners. We conducted 28 key informant interviews with accompaniers in Argentina, Chile and Ecuador in 2019 about their model of in-person abortion accompaniment at later durations of pregnancy. We iteratively coded transcripts using a thematic analysis approach. Accompaniers premised their work in a feminist activist framework that understands accompaniment as addressing inequalities and expanding rights, especially for the historically marginalised. Through a detailed description of the process of in-person accompaniment, we show that the model, including the logistical considerations and security mechanisms put in place to ensure favourable abortion outcomes, emphasises peer-to-peer provision of supportive physical and emotional care of the accompanied person. In this way, it represents supported self-care through which individuals are centred as the protagonists of their own abortion, while being accompanied by feminist peers. This model of supported self-care challenges the idea that "self-care" necessarily means "solo care", or care that happens alone. The model's focus on peer-to-peer transfer of knowledge, providing emotional support, and centring the accompanied person not only expands access to abortion, but represents person-centred practices that could be scaled and replicated across contexts.

What are We Forgetting? Sexuality, Sex, and Embodiment in Abortion Research.

Abortion has been alternately legalized and criminalized, tacitly approved of, and stigmatized, in various settings over time. The contours of its treatment are dependent on social and political contexts, including concern over women's sexuality, but it is not clear that existing conceptual frameworks enable expansive examination of the relationship between abortion and sexuality. We conduct a critical interpretive synthesis review of the literature that jointly engages with sexuality and abortion, focusing on the U.S., to highlight the frameworks that authors use to understand the relationship between the two. We find two conceptual frameworks of abortion and sexuality in operation: one that treats the two as discrete, causal variables that operate at the individual level; and another that focuses on how beliefs about what constitutes (in)appropriate sexuality explain ideological positions on abortion. We identify limitations of both frameworks and propose a new conceptual framework - one that highlights sexual embodiment - to inspire future research in this area and generate opportunities for knowledge extension. Such an approach, we contend, can elucidate broader social forces that shape both abortion and sexuality and bring research on abortion into conversation with recent scholarship on the important role of sexuality in other sexual and reproductive domains.

"It's Worked Well for Me": Young Women's Reasons for Choosing Lower-Efficacy Contraceptive Methods.

STUDY OBJECTIVE: To understand the diverse reasons why some young women choose contraceptive methods that are less effective at preventing pregnancy, including condoms, withdrawal, and emergency contraception pills, even when more effective contraceptive methods are made available to them. DESIGN: In-depth interviews with young women at family planning clinics in July-November 2016. Interview data were thematically coded and analyzed using an iterative approach. SETTING: Two youth-serving family planning clinics serving predominantly Latinx and African American communities in the San Francisco Bay Area, California. PARTICIPANTS: Twenty-two young women ages 15-25 years who recently accessed emergency contraception to prevent pregnancy. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Young women's experiences using different methods of contraception, with specific attention to methods that are less effective at preventing pregnancy. RESULTS: Young women reported having previously used a range of higher- and lower-efficacy contraceptive methods. In interviews, they described affirmative values that drive their decision to use lower-efficacy methods, including: a preference for flexibility and spontaneity over continual contraceptive use, an emphasis on protecting one's body, and satisfaction with the method's effectiveness at preventing pregnancy. Some young women described using a combination of lower-efficacy methods to reduce their pregnancy risk. CONCLUSION: Young women make contraceptive decisions on the basis of preferences and values that include, but are not limited to, effectiveness at preventing pregnancy. These reasons are salient in their lives and need to be recognized as valid by sexual health care providers to ensure that young women receive ongoing high-quality care.

Emotions over five years after denial of abortion in the United States: Contextualizing the effects of abortion denial on women's health and lives.

BACKGROUND: The Turnaway Study was the first to follow women denied abortions because of state law or facility policy over five years. The study has found negative effects on women's socioeconomic status, physical health, and on their children's wellbeing. However, women did not suffer lasting mental health consequences, prompting questions about the effects of denial on women's emotions. METHODS: In this mixed methods study, we used quantitative and qualitative interview data from the Turnaway Study to offer insight into these findings. We surveyed 161 women who were denied abortions at 30 facilities across the United States between 2008 and 2010 one week after the abortion denial and semiannually over five years. Mixed-effects regression analyses examined emotions about having been denied the abortion over time. To contextualize the quantitative findings, we draw on in-depth qualitative interviews with 15 participants, conducted in 2014-2015, for their accounts of their emotions and feelings over time. RESULTS: Survey participants reported both negative and positive emotions about the abortion denial one week after. Emotions became significantly less negative and more positive over their pregnancy and after childbirth. In multivariable models, lower social support, more difficulty deciding to seek abortion, and placing the baby for adoption were associated with reporting more negative emotions. Interviews revealed how, for some, belief in antiabortion narratives contributed to initial positive emotions. Subsequent positive life events and bonding with the child also led to positive retrospective evaluations of the denial. CONCLUSIONS: Findings of emergent positive emotions about having been denied an abortion suggest that individuals are able to cope emotionally with an abortion denial, although evidence that policies leading to abortion denial cause significant health and socioeconomic harms remains.

A qualitative exploration of women's experiences discovering pregnancies in the emergency department.

OBJECTIVES: The few studies examining pregnancy testing in emergency departments (EDs) address pregnancy-related physical risks. Here, we examine experiences of people who discover pregnancies in EDs. METHODS: Between 2015 and 2017, as part of a larger study, we conducted interviews with 29 women in Southern Louisiana (n = 13) and Baltimore, MD (n = 16), who reported discussing their pregnancy during an ED visit. We analyzed these interviews for content and themes. RESULTS: Respondents reported diagnosis of pregnancy as a routine and straightforward component of care received in EDs. They reported receiving diagnostic studies and therapeutic interventions to rule out and treat complications of pregnancy and care for what brought them to the ED to begin with, such as treatments for nausea and vomiting; education about physical symptoms and nutrition-related needs during pregnancy; and referrals to prenatal care. However, we find evidence of unmet needs related to patient-centered communication, such as providing emotional care to women discovering pregnancies in EDs and lack of support for transitions to abortion care. CONCLUSIONS: While diagnosis of pregnancy in the ED may be routine for ED clinicians, it is not necessarily routine or straightforward for people receiving the diagnosis. ED clinicians should not assume that all people who discover their pregnancies in the ED want to continue their pregnancy. People who discover pregnancies in EDs may benefit from patient-centered communication and support for the range of transitions to care people might need in addition to the routinely provided diagnostic and therapeutic interventions. IMPLICATIONS: ED clinicians may need additional training and support to ensure that they can meet the range of needs of people who discover their pregnancies in the ED.

Pregnant Women's Reasons for and Experiences of Visiting Antiabortion Pregnancy Resource Centers.

CONTEXT: The primary mission of pregnancy resource centers is to dissuade women from choosing abortion. Reproductive health and rights advocates have asserted that these centers interfere in abortion decision making. However, the reasons pregnant women go to such centers and what they experience while there have not been examined. METHODS: Between June 2015 and June 2017, in-depth, semistructured phone interviews were conducted with 21 pregnant women who had presented at prenatal care clinics in southern Louisiana and Baltimore, Maryland, and who had visited a pregnancy resource center. Topics covered in the interviews included reasons for visiting a center and the experience of the visit. Transcripts were analyzed first thematically and then using grounded theory. RESULTS: Most of the women were low income and had not been considering abortion when they visited a pregnancy resource center. Respondents reported that they had gone to these centers for pregnancy-related services, material goods and social support. They chose these centers because the resources were free, and they were largely satisfied with their experiences. Nonetheless, their receipt of services and goods was limited and often contingent on participation in the centers' activities. CONCLUSIONS: Pregnancy resource centers play a role in meeting the acute material and social needs of low-income pregnant women. However, the constraints on the resources the centers offer mean that this support cannot be part of a reliable system of care. Advocates and policymakers should take a nuanced approach to regulating these centers and consider the reasons women visit them, especially low-income women.

Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma.

BACKGROUND: Despite weak theoretical grounding and ample research indicating women feel high levels of decision rightness and relief post-abortion, claims that abortion is inherently stressful and causes emergent negative emotions and regret undergirds state-level laws regulating abortion in the United States. Nonetheless, scholarship does identify factors that put a woman at risk for short-term negative postabortion emotions-including decision difficulty and perceiving abortion stigma in one's community-pointing to a possible mechanism behind later emergent or persistent post-abortion negative emotions. METHODS: Using five years of longitudinal data, collected one week post-abortion and semi-annually for five years from women who sought abortions at 30 US facilities between 2008 and 2010, we examined women's emotions and feeling that abortion was the right decision over five years (n=667). We used mixed effects regression models to examine changes in emotions and abortion decision rightness over time by decision difficulty and perceived community abortion stigma. RESULTS: We found no evidence of emerging negative emotions or abortion decision regret; both positive and negative emotions declined over the first two years and plateaued thereafter, and decision rightness remained high and steady (predicted percent: 97.5% at baseline, 99.0% at five years). At five years postabortion, relief remained the most commonly felt emotion among all women (predicted mean on 0-4 scale: 1.0; 0.6 for sadness and guilt; 0.4 for regret, anger and happiness). Despite converging levels of emotions by decision difficulty and stigma level over time, these two factors remained most important for predicting negative emotions and decision non-rightness years later. CONCLUSIONS: These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself. Findings challenge the rationale for policies regulating access to abortion that are premised on emotional harm claims.

Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider - but do not have - abortions.

We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people's individual complex situations-including economic insecurity, mental health, and substance use-and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access.

Patient-provider communication before and after implementation of the contraceptive decision support tool My Birth Control.

OBJECTIVE: To compare differences in patient-provider communication among patients who, prior to contraceptive counseling, used or did not use a decision support tool ("My Birth Control") which has educational and interactive modules and produces a provider printout with the patient's preferences. METHODS: As part of a cluster-randomized trial of the tool in four San Francisco safety net clinics, we collected and thematically analyzed 70 audio recordings of counseling visits (31 pre- and 39 post-tool implementation) from 15 providers randomized to the intervention. RESULTS: Without the tool, most providers began by asking participants what method they were considering and focused counseling on that method or on directing patients towards long-acting reversible contraception; with the tool, most focused on reviewing and discussing multiple methods of interest to the participant as indicated on the printout. Discussion of patients' preferences for specific method features was not observed in pre-implementation recordings but was part of several post-implementation recordings. Several participants explicitly noted they had gained knowledge from the tool. CONCLUSION: Observed counseling differences suggest the tool may have a positive impact on patient-centeredness of contraceptive counseling, consistent with findings from the main study. PRACTICE IMPLICATIONS: My Birth Control shows potential for improving patient-centeredness in counseling without extensive provider training.