Module 3 – What
Special Topics in Reproductive Health Referral-Making
Training frontline providers to effectively:
- Place abortion in the context of normal reproductive health care
- Explain basic information—and address common myths—about abortion (e.g., types of abortion; demographic profile of abortion clients; prevalence; safety; emotional effects; availability)
- Reflect on their own beliefs so as to: recognize their own biases; recognize the diverse perspectives of different individuals within a participant group; enhance empathy / appreciate the difficulty of assigning an abstract moral hierarchy to women’s situations.
65 minutes, including:
- 15 minutes: Activity: Hard to Know These Days What’s True
- 10 minutes: Activity: Plain Facts
- 30 minutes: Activity: The Last Abortion
- 10 minutes: Activity: Six Questions quiz
- Flashcard sets (one per every three participants)
- Laptop and Projector
- Module 3 – Handout Flashcards
- Module 3 – Handout Six Questions on Reproductive Health
- Prizes (two) for the winners of the Quiz
- Trainer Resources Only [Not for Distribution to Trainees]
Hard to Know These Days What’s True
This activity reviews basic facts/myths related to abortion, pregnancy, and sexual activity.
Materials: Flashcard sets (one set per every three participants)
To Prepare: Review the information on the flashcards.
- Acknowledge that we are bombarded with information, especially online, and it can be challenging to know what information is reliable and updated. Tell trainees: “Talking about sensitive issues like abortion can be tough. Knowing the facts can help you offer the information and support your patient’s/client’s need to make the best decisions for themselves and their families.”
- Ask participants where they gather accurate and reliable information about women’s health matters.
- Break the audience into groups of three and distribute the flash cards. Each group should get a set of flash cards. Have participants go over them together, then share which fact (if any) was most surprising or interesting.
- Ask volunteers to offer which fact they found most interesting or surprising, given what people hear on the street or elsewhere. [This will also provide a clue about what information needs reinforcing.]
- Close by reconfirming that abortion is a topic about which an overwhelming amount of misinformation is circulated. Explain that the next activity is a brief PowerPoint that clears up some of that misinformation and myths, with straightforward facts. Remind them that having solid facts can help them speak with their clients with confidence and accuracy.
This activity reinforces basic facts related to abortion, pregnancy, and sexual activity.
Materials: PowerPoint projector + slides; Guttmacher Institute reference sheets on abortion
To Prepare: Review the information on the Guttmacher reference sheets
- Acknowledge that abortion is difficult for many people to talk about, which makes it even more important for those who make referrals to have accurate and reliable information. Explain that the following slides address a few key myths with simple, straightforward facts.
- Using the PowerPoint, reinforce key facts about abortion, keeping to very simple messages. [If you want to set up the presentation as posing/answering questions: The Notes section of each slide in the PowerPoint has the question that is answered in the following slide.] Take questions as you go along, and draw from the Guttmacher reference sheets as needed, but return to reinforce the basic simple message. (Conveying these facts repeatedly is useful.)
- Helpful phrases you may want to use in discussion include:
- (To diminish defensiveness about facts and misinformation) Why might this seem believable? (regarding provider beliefs or values)
- There are people who feel this way. If you are one of them, how are you going to navigate this with your patient or client?
- On arriving at the last slide (the STAR model), ask whether having accurate facts is part of making a STAR referral. Ask which part of the model it fits? (Probe for: Thorough.)
- Acknowledge that this is a lot of information to absorb, but that you’ll touch back on it before closing.
The Last Abortion (adapted from IPAS)
This activity is adapted from IPAS’ Abortion Attitude Transformation: A Values Clarification Toolkit for Global Audiences. As IPAS explains “[t]he different scenarios in this activity highlight the complex circumstances surrounding a woman’s decision to seek an abortion. Participants are encouraged to examine and challenge their biases against certain pregnant women or certain circumstances, as well as their beliefs about abortion policies that restrict access to abortion. This activity illustrates the difficulty and dangers of valuing one woman’s reasons for abortion over another woman’s reasons.”
To Prepare: Make copies of The Last Abortion — Scenarios handout, one per participant.
- Explain to participants that different states have different legal and financial barriers to accessing abortion. These restrictions can delay women’s access to abortion care or impede women’s access to abortion services altogether.
- Divide participants into small groups.
- Ask participants to imagine they live in a state where there can only be one more safe, legal abortion performed. (Acknowledge that this is a contrived scenario for the purposes of this activity.) Explain that you will give them a handout that describes six women who have expressed their desire to terminate their pregnancy and have applied to be granted this last abortion. The small groups represent the professional [insert relevant training group: nurses, social workers, domestic violence advocates, etc.] who will decide which woman should receive the last abortion.
- Give each participant a copy of The Last Abortion Scenarios handout and ask them to spend a few minutes silently reading the scenarios.
- Tell participants they have 10 minutes to discuss the scenarios in their small groups, decide to which woman they will grant the last abortion and appoint a spokesperson to briefly present their decision and rationale to the large group.
- Rotate from group to group to ensure that participants understand the instructions and are able to finish the task on time.
- Bring the large group back together and explain that each small group will have up to two minutes to present their decision and rationale. Ask others not to comment yet on individual presentations.
- Once all small groups have presented, ask each participant to silently reflect on biases they may hold against certain women seeking an abortion and their life circumstances and how these biases may have affected their decision about whom they did or did not grant an abortion.
- Facilitate a discussion about the women selected and those not selected and rationales given. Try to maintain neutrality while discussing participants’ rationales.
- Ask participants how this activity relates to how abortion services are often rendered in their state. You may want to ensure that some of the following points are covered:
- Restrictive abortion policies, and even individual providers, often determine which women are more entitled to an abortion than others based on their biases about women’s reasons and circumstances. The decision to grant some women an abortion and not others carries lifelong consequences for those women, their families and communities.
- Each of the women in these scenarios expressed a desire to terminate her pregnancy, and it is likely that each woman thought through her reasons carefully to arrive at this decision.
- Sometimes counselors or providers may try to convince certain women to continue their pregnancy because of their personal beliefs that these women should not terminate their pregnancy. This can cause these women to feel pressured to make a decision that may result in undesirable consequences for their lives. In some cases, it may cost women their health and even their lives.
- It is important that we as providers or professionals examine our personal beliefs and see how they can affect women’s decisions and actions.
- Close the activity by explaining that there is no one correct answer and that it is impossible to objectively decide which woman deserves access to abortion services over another. Question what person has the right to make such a judgment for another human being. Point out that the stakes are extremely high when access to abortion for certain women is restricted.
- Conclude with the statement that there can never be one last abortion.
Six Questions on Reproductive Health Quiz
To Prepare: In addition to the copies of the quiz and an answer sheet on hand for you, secure a prize for the winning pair members. This can be chocolate, gift cards, a set of markers, or any other low-cost item. You may also wish to change some of the questions on the quiz; if you do, be sure to modify the answer key as needed. This is a quick activity to reinforce information from the earlier part of the session, and to end on a lively note.
- Put people in pairs and tell them you will pass out a quick set of six questions, face down, and tell them not to turn it over until every pair has a copy. Explain that they should answer all questions as quickly as they can, and then stand up when they are finished—that the first pair to correctly answer all questions gets a prize.
- Pass out the Six Questions quiz, face down, one to each pair, reminding them not to turn it over yet. When every pair has a copy, tell them to start, and remind them to stand up when they have finished.
- As the pairs stand, take their answer sheet and quickly (but carefully!) grade it. Use the following answer key (if you have not changed the questions):
Q1: C. Q2: C. Q3. D. Q4: C. Q5: C. Q6: B [For easy use, it’s CCDCCB]
- Let everyone else finish, then have the winning team review the answers to each question. Express your hope that everyone learned at least one useful thing. Ask if there are any further questions, then give out the prize and thank everyone for their participation.
- Close with a reminder that:
- We all hold our own values dear.
- It’s important to be aware of our own biases so we can keep them from interfering with our role as providers.
- The STAR model can help keep us focused on what we do need to provide a client: Support for her own decisions; Thorough/Accurate Information; Active ways to help; and Referrals of high quality.