Evaluating the Impact of a Mandatory Pre-Abortion Ultrasound Viewing Law: A Mixed Methods Study

BackgroundSince mid-2013, Wisconsin abortion providers have been legally
required to display and describe pre-abortion ultrasound images. We aimed
to understand the impact of this law.MethodsWe used a mixed-methods study
design at an abortion facility in Wisconsin. We abstracted data from
medical charts one year before the law to one year after and used
multivariable models, mediation/moderation analysis, and interrupted time
series to assess the impact of the law, viewing, and decision certainty on
likelihood of continuing the pregnancy. We conducted in-depth interviews
with women in the post-law period about their ultrasound experience and
analyzed them using elaborative and modified grounded theory. ResultsA
total of 5342 charts were abstracted; 8.7% continued their pregnancies
pre-law and 11.2% post-law (p=0.002). A multivariable model confirmed the
law was associated with a higher odds of continuing pregnancy (aOR=1.23,
95% CI: 1.01-1.50). Decision certainty (aOR=6.39, 95% CI: 4.72-8.64) and
having to pay fully out of pocket (aOR=4.98, 95% CI: 3.86-6.41) were most
strongly associated with continuing pregnancy. Viewing fully mediated the
relationship between the law and continuing pregnancy. Interrupted time
series analyses found no significant effect of the law but may have been
underpowered to detect such a small effect. Nineteen of twenty-three women
interviewed viewed their ultrasound image. Most reported no impact on
their abortion decision; five reported a temporary emotional impact or
increased certainty about choosing abortion. Two women reported viewing
helped them decide to continue the pregnancy; both also described
preexisting decision uncertainty. ConclusionsThis law caused an increase
in viewing rates and a statistically significant but small increase in
continuing pregnancy rates. However, the majority of women were certain of
their abortion decision and the law did not change their decision. Other
factors were more significant in women’s decision-making, suggesting
evaluations of restrictive laws should take account of the broader social
environment.