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CONTEXT: Various restrictions on abortion have been imposed under the pretense that women may be uninformed, undecided or coerced in regard to their decision to terminate a pregnancy. Understanding whether certain women are at risk of low confidence in their abortion decision is useful for providing client-centered care and allocating counseling time to women with the greatest needs.

METHODS: Data were abstracted from the precounseling needs assessment form and clinical intake form of 5,109 women who sought 5,387 abortions at one U.S. clinic in 2008. Multivariate logistic regression was used to analyze variables associated with women’s high confidence in their abortion decision.

RESULTS: For 87% of the abortions sought, women had high confidence in their decision before receiving counseling. Certain variables were negatively associated with abortions’ being sought by women with high confidence: being younger than 20, being black, not having a high school diploma, having a history of depression, having a fetus with an anomaly, having general difficulty making decisions, having spiritual concerns, believing that abortion is killing and fearing not being forgiven by God (odds ratios, 0.2–0.8). Having a supportive mother or male partner was associated with increased odds of high confidence (1.3 and 1.2, respectively).

CONCLUSION: Regulations requiring state-approved information or waiting periods may not meet the complex needs of all women. Instead, women may benefit more from interactions with trained staff who can assess and respond to their individual needs.