The Framework: Counseling for Patient-Centered Abortion Care

Course Information & Objectives

This course is intended to teach patient-centered pregnancy decision counseling in patient scenarios that often prove challenging. Healthcare providers, including physicians, nurse practitioners, nurses, counselors, or clinic staff, often lack the training, language, or techniques to guide patients to self-directed decisions. This is especially evident in sexual and reproductive health (SRH) where stigma makes open discussion uncomfortable for patients and providers alike.

The WHO Clinical Practice Handbook for Safe Abortion Care requires counseling “using simple language, maintaining privacy, supporting women to ask questions and taking time to give answers, and not imposing our personal values and beliefs.” Patient-centeredness is one of the National Academy of Medicine’s six dimensions of health care quality. This intentional approach requires the provision of care that is respectful of and responsive to individual patient preferences, needs, and values and empowers people to take charge of their own health.

Course Objectives

At the end of the course, learners will:

  • Acknowledge the potential for a judgmental reaction to interfere with the patient-provider relationship and develop strategies to minimize its interference.
  • Identify strategies for maintaining a positive relationship with patients who make decisions about health care with which you may disagree.
  • Define patient-centered care.
  • Provide objective and compassionate pregnancy options counseling.
  • Practice patient communication skills.

How to use these materials

Learners can watch this didactic lecture in a flipped classroom model before completing the activities or may watch it during course time.

The small group activity is based on a didactic video lecture, Decision Counseling for Positive Pregnancy Test Results, that provides a knowledge base, terminology, and techniques, along with group activities and case studies. The Framework, which is comprised of four counseling videos, is intended to provide learners with a counseling framework and facilitate patient-centered counseling.

Individual Activity

Decision Counseling for Positive Pregnancy Test Results

  • Learners can watch this didactic lecture in a flipped classroom model before completing the activities or may watch it during course time.
  • Learners may be assigned any of the relevant readings found in the “Facilitator Notes & Teaching Points” section below (determined by the instructor’s desired learner workload).


Counseling Videos

The Framework: The Patient Has the Answer

The Patient has the Answer Summary: Only the patient is the expert in their life and needs.

Group Activities


After watching the above videos, break learners into groups of 3-4. Read the case aloud to the group and ask learners to discuss the case and questions listed below.

Small Group Activity

Case study:

Tania is 22 years old and presents at the clinic for a pregnancy test and you find that she is pregnant. She is thoughtful and introspective. She has a moral conflict with abortion but does not desire to parent at this time. Tania asks you whether or not you think abortion is a sin. How would you counsel Tania?

  1. How would you respond to Tania’s question?
  2. What, if any, feelings do you have about Tania’s gestational age?
  3. What are some things that you initially can say to Tania to establish rapport?
  4. How can you tactfully explore her moral conflict with abortion?

Large Group Discussion Questions

  1. Patient calls pregnancy a baby? How does that make you feel? What language would you use with that patient?
  2. How would you feel if a patient seeking an abortion wants to keep the ultrasound?
  3. What do you think about a patient who returns to your clinic for another abortion? How does that make you feel?

Facilitator Notes & Teaching Points

Facilitator Notes & Teaching Points

  • There is no knowledge that you possess about the answer to the patient’s dilemma that they do not.
  • One pregnancy decision is not “more moral” than another; she is a good person making a moral decision for herself.
  • Building rapport with patients starts with establishing trust that you are giving them accurate unbiased information and don’t have an agenda.
  • Create a space where patients feel that it is safe to ask questions.
  • Establish an environment free of stigma around pregnancy decisions by modeling unbiased language.


  • Perrucci, Alissa. Decision Assessment and Counseling in Abortion Care: Philosophy and Practice. 2012.
  • Foster DG et al., Attitudes and decision making among women seeking abortions at one U.S. clinic, Perspectives on Sexual and Reproductive Health, 2012, 44(2):117–124.

Download The Framework- Counseling for Patient-Centered Abortion Care Lesson Plan