Highlighting the unique challenges of displaced women, Médecins Sans Frontières/Doctors Without Borders (MSF) remind us that 40% of pregnancies worldwide are unintended. For those who prefer numbers, that’s about 85 million unintended pregnancies per year. With such high numbers, much attention is directed toward giving women choices.

Decision-Making

When women have choices, they should also have the opportunity to enter into a decision-making process. A great many things may impact, impede, complicate or restrict the decision process. Nevertheless, finding ways to give women decision support must be a priority.

Are choices on their own enough?

Is it choice, alone, that empowers women and improves health outcomes?

How does one move through choice toward making a decision?

And is a decision with two or more possible outcomes complex?

 If so, are women empowered simply by the choices they are given or is something more needed?

When Choice Overwhelms

For example, a woman who wants to prevent pregnancy is likely to pay a visit to her physician. Imagine if the physician showed her just three different types of birth control and encouraged her to pick one but failed to provide her with any information. What seemed like a good thing (pregnancy prevention options) just became overwhelming (choices without process).

The same choices presented with decision-coaching transforms the experience and elevates choice to empowered decision-making.

We might be tempted at times to think the choice is obvious and unconsciously assume there’s no need for decision-coaching. The reality couldn’t be further from the truth. Everyone is unique and so her personal decision-making pathway will be as well.

A midwife on a search and rescue ship operated by SOS Mediteranée shares about women who are often displaced and vulnerable. Listen to what Jonquil says in the video produced by  Médecins Sans Frontières Australia.

Recapping what Jonquil said,

“But many women are very happy to be pregnant and they’re very proud to be pregnant and I even had labouring ladies on board. I was very privileged to be present when a Nigerian woman had her baby. And luckily she was travelling with her husband and her two other children. It was a very wonderful moment, it lifted everybody’s spirits”.

Dire Circumstances

The response of the Nigerian woman who gave birth in what most would consider dire circumstances might have surprised you. In the video she shared,

“I thank God I am so happy, I give birth in this very place.”

No Place for Assumptions

A decision-coach never assumes a decision is obvious or clear but helps bring clarity through a decision-making process. Decision Aids and Decision Coaching are indispensable tools all women should have access to. ClearLinQ Training & Coaching has developed specialized tools to support a pathway to Clarity, visit ClarityTools.org for more information.

Terri Mazik CEO/Co-founder ClearLinQ

References

http://becauseimawoman.msf.org/en/

https://www.guttmacher.org/news-release/2014/new-study-finds-40-pregnancies-worldwide-are-unintended

https://youtu.be/v6jSA34LiaA

The article exposes in graphic detail the disturbing and shocking account of how Mpho risked her life to meet her predator who in turn not only physically violated her during the procedure but extorts her for more money in her most vulnerable state. Tragically, the violation didn’t end there. The first procedure didn’t work forcing her to face the torment a second time.

In the country of Lesotho, abortion is illegal and any woman caught attempting to have an abortion will be arrested. Fearing arrest Mpho refused to seek medical attention even when she experienced excruciating pain and significant blood loss following the second procedure. After her traumatizing experience, Mpho began to fear for her future health, reflect on the emotional turmoil of her abortion, and now lives with the prospect of being found out and arrested.

In the article, Mpho is quoted as saying,

“Until you’re in that situation, you don’t know why people do things.”

The situation Mpho is referring to is the crisis of an unintended pregnancy. According to the World Health Organization (WHO), 87 million women every year become pregnant unintentionally, of which 46 million end in an induced abortion. Of that number upwards of 18.4 million women access unsafe abortions.

For many women, unintended pregnancy is one of the most isolating, unsupported, and stigmatized seasons of their lives. In that short season, her focus is not whether abortion is legal or illegal, whether she’s pro-life or pro-choice, has a faith or not, or even whether she has little means or great means to pay for healthcare. The reality is no woman knows how she will respond to her unintended pregnancy until she’s personally faced with the social, emotional, intellectual, spiritual and physical elements of her unique situation.

The “things” Mpho is referring to are the risks women in crisis will take to get back to their pre-pregnancy state. This includes but is not limited to the risk of accessing unsafe abortion practices, the risks in making this intense decision alone, the risk in having an abortion to save a relationship, the risk to their health (including the risk of not being able to have children in the future), the risk of maternal death, the risk of emotional trauma, or the risk of not consulting a trained medical professional. According to the WHO 68,000 women die every year from unsafe abortions, and abortions performed by untrained professionals. Hospital admissions for complications associated with unsafe abortions represent up to 50% of obstetric care.

Stopping this cycle starts with women no longer feeling they have to risk their own lives when faced with an unintended pregnancy. For some, the answer will mean giving more women free and equal access to safe abortion services. For ClearLinQ it means giving women something more, something that will truly increase their ability to make informed choices. This includes a proper decision-making framework, adequate professional support, accurate risk analysis, emotional support, values clarification, reliable medical information, and a judgment-free space to freely process an unintended pregnancy decision.

Reversing this cycle starts with criminalizing the predators, giving the victims a voice, destigmatizing the conversation, equipping medical professionals, increasing access to services, and women who won’t settle for anything less!

Marlene Caicco                                                                                                                                                                  Co-founder/Vice-President

References

https://www.cnn.com/2018/03/07/health/lesotho-abortions-asequals-intl/index.html

http://www.who.int/whr/2005/chapter3/en/index3.html

When you hear the phrase “holding space for others” what images conjure up in your mind? We often hold seats for people at an event, or a place in line, but that’s not the kind of space I’m referring to here. Although I’ve been practicing the concept of “holding space for others” for over 15 years, I’ve only recently heard the phrase. “Holding space” for people as beautifully explained by Heather Plett  is for me another way of thinking about and describing Decision Coaching (also referred to as decision counselling and decision support).

While decision coaching can sound intense the term holding space is gentle and inviting. The terms may sound very different from one another but in reality the two approaches share some common elements. So what does “holding space for others” mean? Heather Plett provides a definition in her blog post, “What it means to ‘hold space’ for people, plus eight tips on how to do it well”.

It means that we are willing to walk alongside another person in whatever journey they’re on without judging them, making them feel inadequate, trying to fix them, or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control. [1]

An effective decision coach may be a little more structured in terms of how they facilitate support but in essence they are doing the same thing. Simply put, a decision coach offers non-directive support to a client, which may include their partner and/or family through a decision-making process. The decision coach guides the process (not the decision) by engaging the client in a discussion around important elements of decision-making.

Choosing an option without engaging in a decision-making process isn’t so much a decision as it is a “choice by default”. When faced with a complex decision (a decision with multiple options and no clear way forward) it is tempting to deny yourself the “space” you need to engage in a decision-making process. A decision coach “holds space” for you so that you are able to engage in productive decision-making.

A decision coach “holds space” for you.

An open access article  outlines some of the ways a decision coach will “hold space” for you when faced with a decision that has multiple options. The authors suggests a decision coach will include the following elements in their support [2]:

• Helping you to assess your decision-making needs;
• Providing you with information regarding the benefits, and harms of your options (this may include the use of a Decision Aid);
• Ensuring you understand your options;
• Taking the time to help you clarify your values with respect to your options and their risks;
• Helping you to finds way to consider, discuss and access the support you need;
• Helping you to consider the reality of any hurdles you may face in implementing;
• Ensure you are making progress in your decision-making.

The next time you are faced with a complex decision, you may want to invite someone to “hold space” for you. Allowing others to “hold space” for you empowers you to make fully informed decisions. Everyone deserves that.

They each have their own way of catching prey. The Sanderling is probably the most entertaining to watch. This little bird runs toward the receding waves, pecks at the sand then swiftly darts away just in the nick of time.

Adrian Dancy – Creative Commons

The Seagull dives into the water, waves and all, in an attempt to snag a fish. The Great Blue Heron stands tall and stalwart waiting for extended periods of time until just the right moment. Then he plunges his head into the shallow water in hopes to capture his prey.

Each of these birds from tiny to tall face the same ocean and varying risks. For these beautiful creatures it may be more instinct than decision-making that frees them to face the ocean for their dinner. As these birds naturally interacted with their surrounding they unknowingly illuminated the risks and benefits of decision-making.

When faced with making a decision that has multiple options, weighing the risks and benefits of each option is an important part of informed decision-making. This important piece can sometimes be overlooked. Time, pressure, fear are just some of the things that impede informed decision-making.

Complex decisions (two or more possible outcomes) can feel overwhelming. Knowing how to proceed can help you navigate a challenging decision and reduce stress. BMJ (originally the British Medical Journal) suggests some key points to remember when considering options: [1]

• Look into all your options.
• Make sure you understand the risks and benefits of each option.
• Make sure you understand how the risks and benefits will affect you personally.
• Make sure you have enough information to make a choice.
• Make sure you understand the risks and benefits of deciding to do nothing.

Unintended pregnancy decisions can be complex with three possible options to consider. ClearLinQ believes women should be supported in decision-making. My Decision Aid © was designed to assist practitioners who support women faced with unintended pregnancy decisions. Although My Decision Aid © does NOT provide a final decision, it does support women and their practitioners to begin to consider their options.

Leaving complex decision-making to instinct is OK for the shoreline birds, but far from ideal for women facing unintended pregnancy decisions. Taking advantage of decision support tools like My Decision Aid © can be empowering for both the practitioner and the woman faced with unintended pregnancy.

“Fully exploring the risks and benefits of [each option] can help you decide what is most important to you, so you can make an informed decision.”[2]

Don’t avoid decision-making, dive in!

[1] http://clinicalevidence.bmj.com/x/set/static/ebm/practice/807268.html

[2] BMJ Publishing Group Limited, 2015. BMJ Clinical Evidence: Practice EBM: Weighing up risks and evidence. http://clinicalevidence.bmj.com/x/set/static/ebm/practice/807268.html

One of the highlights of my summer vacation is watching the sunset on the beach. One evening while walking the beach minutes before sunset I spotted a message in the sand,

I said yes (heart). 

Someone I’ll probably never meet was proposed to, perhaps just minutes before I arrived at that very spot. She wanted to share her answer with the world, or at least those of us who walk the beach during sunset. She said yes!   I’m guessing she was confronted with a surprise (hopefully a pleasant one) and had to make a decision.

In her case the decision-making window was probably pretty tight (guessing seconds…which could feel like minutes for him). In all likelihood she had already been thinking through the scenario. Perhaps she wasn’t taken completely by surprise. Maybe she had been thinking long and hard about the day, the moment, and the instant he would ask and how she would feel and respond. Perhaps they had talked it through and it wasn’t a surprise at all.

No matter the circumstances there was something about her announcement in the sand that gave me pause.

Her declaration in the sand wasn’t just an answer, it was a decision…a big, crucial, and life-altering decision. Her future was about to change, not minimally but substantially. How much time, energy, thought, consideration, preparation, and deliberation do you think went into her decision?

The truth is we’ll never know for sure. We do know she wanted people to know her decision and based on that we’re inclined to think she was happy about her decision. At the end of the day neither you nor I will ever know what was involved in her decision-making process.

For those of you who imagine she considered it both seriously and at length would probably feel she made a well-informed decision. For those of you who imagine she was half expecting the proposal but hadn’t allowed herself to ponder it to deeply just in case it didn’t happen…well you might think she allowed the romance of the moment to sweep her off her feet. You might be wondering if she’s jumped into something prematurely. Finally for those of you who imagine she had no idea this was coming and was taken completely by surprise, you probably have an urge to encourage her to slow down and take time to seriously consider her options and what it means to (1) say yes, (2) say no, or (3) say nothing.

Unintended pregnancy is almost always a surprise. Women are reluctant to talk about it, and certainly no one ever writes in the sand…

I’m unexpectedly pregnant! 

Too often women faced with unintended pregnancies are taken completely by surprise and allow the pressure of the moment to pave their way forward.  A pressure filled way forward doesn’t necessarily make room for informed decision-making. My Decision Aid © is a tool developed specifically to assist practitioners who support women faced with unintended pregnancy decisions. My Decision Aid © is the first of its kind, and while it does not provide women with a decision it does assist women to begin to enter into to a decision-making process. My Decision Aid © empowers women to begin to consider their level of certainty, knowledge, value and support with respect to their unintended pregnancy decision.

“I said yes”, makes us want to cheer. “I’m unexpectedly pregnant”, makes us want to run. Both require decision-making. The first we hope and expect is informed, the second we turn away from and ignore, but it too deserves to be informed.

ClearLinQ Training & Coaching Inc. exists to empower women facing unintended pregnancy to engage in decision-making so they too can boldly declare their decision in the sand.