Referrals for reproductive care in home visitation: Administrator perspectives on staff responsiveness

Background: Home visiting programs build supportive, non-judgmental relationships between trained home visitors and at-risk parents of young children which are theorized to improve parental self-efficacy and confidence. These program models also offer linkage and referrals to services including family planning.  Little is known about how programs handle parental requests for referrals for reproductive services that are controversial to staff and may impact the helping relationship.

Method: Interviews approximately 90-120 minutes in length were conducted with 34 home visiting program administrators in a large Midwestern state.

Analysis: Interviews were audio-recorded, transcribed, coded thematically, and subjected to content analysis.   

Results: Abortion and contraception emerged as referral requests or topics that were sometimes challenging to program staff.  Mothers who were receiving home visiting and who experienced a subsequent pregnancy they sought program help to terminate tended to receive staff responses that framed abortion as implicitly or explicitly negative.  Implicitly negative responses framed abortion as a "bad" choice comparable to other "bad" choices participants made, such as to use drugs or have multiple sexual partners.  Explicitly negative responses framed abortion as incompatible with or oppositional to home visitation.  Responses to contraception were wide-ranging, with some staff opposing contraceptive referrals, some advocating program neutrality on contraception, and some welcoming contraceptive referrals.   

Conclusion: Responses seem in accord with political scientist Charles Lindblom’s concept of circularity or controlled volition, which suggests that programs may deflect requests for things they would prefer not to grant.  This may constrain choices on some reproductive issues for program participants.