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What have HMOs to do with reducing the number of abortions in a given community? Plenty, says Shari Plunkett. She has begun a chain of pregnancy-help centers (called First Resort) in the San Francisco Bay area that operate under a special arrangement with one of the largest HMOs in the country: When the health-care providers of this health maintenance organization have patients who are ambivalent or negative about their pregnancies, they refer them to First Resort for counseling. More than 40 percent of First Resort's clients come from those referrals, says Plunkett. "We're a medical and counseling service for women who are at the point of making a decision about carrying to term or having an abortion. About 70 percent of our patients fall into that category, while for most pregnancy care services, it's 20 to 35 percent." Plunkett spoke with CT columnist Frederica Mathewes-Green about this "mainstream medical" approach to abortion intervention—a model Plunkett hopes will be used across the country. (Plunkett may be reached at sp1rst@dnai.com)

It grew out of my frustration in trying to reach women contemplating abortion. It's not like they're all listening to the same radio station or reading the same newspaper. Two years ago I worked with an ad agency to put together radio spots targeting this group of women, and I learned two things. First, that we were trying to reach half a percent of the population. Second, that a four-month series of ads would cost almost as much as my whole budget for the year. It didn't make sense.

One of my donors said, "You need to have a big HMO to refer all their patients to you." I realized that that is where pregnant women are congregating, and we needed to reach them there. We began talking to physicians, asking if this was a service they would be interested in. One of the first we talked to, a pro-choice physician, said, "Absolutely, because I see women like that all the time. I can spend 20 minutes with them, but I can do nothing in comparison with what you do."

We told doctors, "We know that you regularly see women who are pregnant and don't want to be, and who are struggling with what to do. We know that you'd love to educate them on their options and hold their hands as they struggle through all their thoughts and fears and circumstances. We also know you don't have that kind of time—but we do. We'd like you to see us as specialists and refer those patients to us. We will provide them unbiased, compassionate, nonjudgmental pregnancy consulting. As soon as that woman makes her decision, whether to carry to term or to terminate the pregnancy, she's coming back to you."

Twenty-four hours after a patient drops off her urine sample, she phones the advice nurse who tells her if the test is positive. Then the nurse asks, "Is that good news or bad news?" If it's good news, the nurse tells her how to establish prenatal care. If she says "bad news" or that she's not sure, the nurse says, "Let me give you the phone number of the agency we use to do our pregnancy consulting." If the woman says, "I'm having an abortion," the nurse tells her that we will provide preabortion counseling for her. All we're doing is spending time with them at the point of their decision, and our hope is that ultimately they will make a decision to carry to term.

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October 5 1998, Vol. 42, No. 11