Many people who seek abortion services prefer to speak about their needs in a language other than English, even if they’re proficient in English. Furthermore, informed consent for abortion options, aftercare, and contraception requires sensitivity to cultural and religious preferences and nuances of language.

In a commentary in Contraception, physicians at Brigham and Women’s Hospital draw on their knowledge of drivers of language-related inequities to suggest best clinical practices for patients with language barriers who need abortion care. They suggest opportunities to advance abortion equity at the clinician, health system, and societal levels.

The authors are Sherry Yang, a student at Harvard Medical School, Deborah Bartz, MD, MPH, a physician in the Brigham Department of Obstetrics and Gynecology, and colleagues. This summary focuses on the practices individual clinics could implement most readily.

Ensure Collaborative Competency With Interpreters

When working with an interpreter, whether in-person or remote, it’s important to:

• Introduce yourself and other team members present, and give the interpreter time to convey the introductions and greetings to the patient
• Face the patient and maintain eye contact, even if the patient replies to the interpreter
• Direct all questions to the patient (e.g., “How are you feeling today?” not “Can you ask her how she is feeling?”)

Encounters with an interpreter are opportunities to improve skills that apply to all healthcare conversations: using clearer (not louder) language, pausing between sentences, simplifying descriptions, and avoiding the use of medical jargon.

Train Designated Abortion Interpreters

Peri-abortion counseling is particularly vulnerable to a lack of interpreter expertise and awareness because of the stigmatized and often misinformed U.S. abortion discourse. Clinic leaders who train interpreters on abortion-specific content help ensure consistent, high-quality communication.

To address concerns regarding confidentiality, particularly in small communities with few interpreters, remote or non–face-to-face options could be offered as well.

Between encounters, designated interpreters can regularly check in with patients to provide comfort and promote trust, then alert providers of additional concerns. Over time, designated interpreters may become patient advocates who can share insights with the care team about improving their operations.

Promote Cultural Brokerage

“Cultural brokerage” refers to four key aims that can be accomplished by one person or a coordinated group of people: language support, bridging cultural differences, social support, and advocacy and navigation of the healthcare system.

Designated interpreters and language-concordant abortion doulas familiar with a clinic’s practices can improve care in several ways:

• Explain the clinic’s counseling and care process to patients
• Promote shared decision-making by communicating patient preferences to providers
• Allow clinicians to assess each patient’s understanding using the teach-back method (asking patients and families to state what they learned in their own words)

Conduct Pre- and Post-Encounter Clinical Huddles

A brief team huddle before the clinical encounter is an important opportunity to establish the purpose of the counseling conversation, clinical expectations, and culturally relevant background information. Clinicians can also ask cultural brokers for individualized advice on approaching sensitive situations.

Abortion providers may use the Check-In for Exchange of Clinical and Key Information (CHECK-IN) framework for pre-encounter huddles. Designed to facilitate collaboration between an interpreter and clinician in the palliative care setting, it assists in establishing the goals of an encounter, providing situational background information, brainstorming communication strategies, anticipating challenges, and defining specific roles.

An additional CHECK-IN is recommended after abortion counseling to allow the interpreter or cultural broker to share the patient’s concerns and advocate for additional services if indicated.