Abortion Experience Research Articles

Multivariable regression analysis of list experiment data on abortion: results from a large, randomly-selected population based study in Liberia

BackgroundThe list experiment is a promising measurement tool for eliciting truthful responses to stigmatized or sensitive health behaviors. However, investigators may be hesitant to adopt the method due to previously untestable assumptions and the perceived inability to conduct multivariable analysis. With a recently developed statistical test that can detect the presence of a design effect – the absence of which is a central assumption of the list experiment method – we sought to test the validity of a list experiment conducted on self-reported abortion in Liberia. We also aim to introduce recently developed multivariable regression estimators for the analysis of list experiment data, to explore relationships between respondent characteristics and having had an abortion – an important component of understanding the experiences of women who have abortions.MethodsTo test the null hypothesis of no design effect in the Liberian list experiment data, we calculated the percentage of each respondent “type,” characterized by response to the control items, and compared these percentages across treatment and control groups with a Bonferroni-adjusted alpha criterion. We then implemented two least squares and two maximum likelihood models (four total), each representing different bias-variance trade-offs, to estimate the association between respondent characteristics and abortion.ResultsWe find no clear evidence of a design effect in list experiment data from Liberia (p = 0.18), affirming the first key assumption of the method. Multivariable analyses suggest a negative association between education and history of abortion. The retrospective nature of measuring lifetime experience of abortion, however, complicates interpretation of results, as the timing and safety of a respondent’s abortion may have influenced her ability to pursue an education.ConclusionOur work demonstrates that multivariable analyses, as well as statistical testing of a key design assumption, are possible with list experiment data, although with important limitations when considering lifetime measures. We outline how to implement this methodology with list experiment data in future research.

A qualitative exploration of perceptions and experiences of contraceptive use, abortion and post-abortion family planning services (PAFP) in three provinces in China

BackgroundThe INPAC project aims to evaluate the effectiveness of integrated post-abortion family planning (PAFP) services into existing hospital based abortion services in China. A qualitative study was conducted in three provinces to contribute to developing effective PAFP services through understanding influences on contraceptive use, experiences of abortion and existing PAFP, and their effect on future contraceptive practices from the perspective of users, in the context of social and institutional change.MethodsTwenty-nine in-depth interviews (IDIs) were undertaken with women who had experienced abortion between 1 and 6 months prior to interview, recruited from three urban and two rural facilities in each province. Thirteen IDIs were also conducted with male partners. Six focus group discussions (FGDs) were carried out with community members from different social groups, including unmarried and married women and men, urban residents and rural-to-urban migrants.ResultsSocial networks and norms are important in shaping attitudes and behaviour towards abortion and contraception. Widespread concerns were expressed about side-effects, reliability and effects on future fertility of some modern contraceptives. The combination of limited information and choices and a lack of person-centred counselling in PAFP with anxieties about side effects underlies the widespread use of unreliable methods. Gendered power relations significantly influence contraceptive (non)use, with several examples illustrating women’s relative lack of power to decide on a method, particularly in the case of condoms. Although the availability of contraceptive information from respected providers can offer impetus for individual behaviour change, social distance from providers reduces opportunities for clients to discuss their difficulties regarding contraceptive use; particularly, but not exclusively for young, unmarried clients.ConclusionsIncreased access to non-commercial, reliable information on contraceptive methods is needed. PAFP services must go beyond simple information provision to ensure that providers take a more person-centred approach, which considers the most appropriate method for individual clients and probes for the underlying influences on contraceptive (non)use. More sensitive reflection on gender norms and relationships is required during counselling and, where women choose this, efforts should be made to include their male partners. Specific attention to provider positionality and skills for counselling young, unmarried clients is needed.

Abortion Knowledge and Experiences Among U.S. Servicewomen: A Qualitative Study.

U.S. servicewomen have a higher rate of unintended pregnancy than civilian women, yet the military does not provide or cover abortion, except in limited circumstances. Servicewomen's experiences with abortion care have received little research attention. Twenty-one in-depth interviews with servicewomen who had had an abortion during active-duty service in the prior two years were conducted between January 2015 and July 2016. Women reported on their experiences accessing abortion, as well as their knowledge and opinions of the military's abortion policy. Data were analyzed thematically using inductive and deductive codes. In regard to their pregnancy and abortion experiences, servicewomen cited concerns about confidentiality, stigma and negative effects on their career, which prevented half of participants from seeking care from the military. Of those who visited a military treatment facility during pregnancy, some reported feeling upset or abandoned by the lack of options counseling and referral. Women reported that the military's abortion policy had negative health and emotional consequences for servicewomen, and negative financial and logistical consequences for both servicewomen and the military. Most did not have accurate knowledge of the abortion policy. Upon learning the law, the majority believed that the military should provide and cover abortion; yet, servicewomen also expressed apprehension about the military's involvement in abortion care, because of concerns about privacy and negative effects on women's careers. Policy recommendations to better meet the needs of servicewomen include wider dissemination of the military's abortion policy, establishing abortion referral and support guidelines, and improving confidentiality in military health services.

Emerging Trends in Pregnancy-Loss Memorialization in American Catholicism

Pregnancy loss (miscarriage, stillbirth, and abortion) is an age-old, and typically hidden, part of women's lives, yet only in recent years has it started to receive recognition to match its prevalence. Based on ethnographic research, this article analyzes liturgical and memorial practices developing within American Catholicism to acknowledge and commemorate pregnancy losses. Growing efforts have emerged as parishes, dioceses, and other Catholic organizations across the country have developed rites and memorials that provide formal ways to attend to grief that often accompanies experiences of miscarriage, stillbirth, and abortion. The memorials range from “miscarriage masses” to public monuments to postabortion ministry retreats. This article argues that these memorial practices seek to change how pregnancy-loss experiences are understood or “known” by ritual participants by reframing them within Catholic narratives of forgiveness and healing, thereby transforming situations of isolating loss into stories of grace, community, and shared sorrow.

A trauma-informed social work framework for the abortion seeking experience

ABSTRACTThis purpose of this article is to discuss the abortion seeking experience in relation to stress, trauma, and trauma-informed care. Definitions of stress and trauma are provided, and potential points of stress during the abortion seeking experience will be discussed in the areas of unintended pregnancy, policy barriers, provider access, and the external clinic environment. Abortion stigma will also be discussed in relation to individual stigma, mass media stigma, community stigma, social work practitioner stigma, and the impact of stigma on the abortion seeking experience. Next, we discuss a trauma-informed lens for considering the abortion seeking experience in the United States, and a trauma-informed social work framework for interacting with clients during the abortion experience is presented as a practice approach for reducing and eliminating trauma and trauma triggers. We then present the potential benefits of this approach. The article concludes with some additional recommendations for a trauma-informed approach to aspects of social work advocacy.

Experience of clandestine use of medical abortion among university students in Chile: a qualitative study

ObjectivesTo explore the ways in which medical abortion pills are obtained and used by university students in Chile in a clandestine context. Study designUsing a qualitative approach, we conducted in-depth interviews with 30 young women who had had a medical abortion between 2006 and 2016 while attending university. We recorded the details of their pathways to abortion and their experience of abortion, and how they used networks in the university to find the pills and learn how to use them. The interviews were analyzed using narrative content analysis. ResultsThe findings show that medical abortion did not take place completely outside the healthcare system for these students, who accessed ultrasound scans pre- and post-abortion and post-abortion care. However, even with help and support from contacts, partners and friends, the clandestine situation created uncertainty and fear, which dominated the whole process, from finding and purchasing the pills, to uncertainty about correct doses and whether the abortion was going as it should and was complete or not. There was a high perception that failure and complications might be occurring, which led many of them to seek post-abortion care. The process was very demanding, requiring information, time, privacy to have the abortion, support and resources, and the ability to deal with risk. ConclusionsMedical abortion allowed these young women to have safe abortions in terms of reduced risks to health and autonomy through self-management. However, clandestinity made them physically, socially and emotionally vulnerable and exposed them to the risk of normative, violent judgments during post-abortion care. ImplicationsAccess to medical abortion has transformed the experience of abortion in Chile, where abortion is illegal, because it is possible to use it safely and effectively outside healthcare settings. However, uncertainty, fear and risk will continue to dominate the experience, which can only be transformed by making abortion legal and available.

Measuring Texas women’s experiences with abortion self-induction using a list experiment

Objectives: Self-reported data suggest that women in the United States self-induce abortions; however, these data likely suffer from underreporting given the sensitive nature of the topic. We explore whether the list experiment, a method previously employed to reduce underreporting of abortion experiences, might moderately improve the accuracy of self-induction estimates.

A good abortion experience: A qualitative exploration of women's needs and preferences in clinical care

What do women ending their pregnancies want and need to have a good clinical abortion experience? Since birth experiences are better studied, birth stories are more readily shared and many women who have had an abortion have also given birth, we sought to compare women's needs and preferences in abortion to those in birth. We conducted semi-structured intensive interviews with women who had both experiences in the United States and analyzed their intrapartum and abortion care narratives using grounded theory, identifying needs and preferences in abortion that were distinct from birth. Based on interviews with twenty women, three themes emerged: to be affirmed as moral decision-makers, to be able to determine their degree of awareness during the abortion, and to have care provided in a discreet manner to avoid being judged by others for having an abortion. These findings suggest that some women have distinctive emotional needs and preferences during abortion care, likely due to different circumstances and sociopolitical context of abortion. Tailoring services and responding to individual needs may contribute to a good abortion experience.

“I kind of feel like sometimes I am shoving it under the carpet”: Documenting women’s experiences with post-abortion support in Ontario

Background: Abortion has been available without criminal restriction in Canada since 1988, and approximately 33 000 terminations take place in Ontario each year. Objectives: This study aimed to explore women’s expressed desire for post-abortion support services, document the priorities expressed by women in seeking post-abortion support, and identify actionable strategies to improve post-abortion support services in Ontario. Methods: Between 2012 and 2014 we conducted in-depth, open-ended interviews with 60 Anglophone women from across Ontario who had recently had an abortion. We aimed to rigorously explore the compounding issues of age and geography on women’s abortion experiences. We analyzed our data for content and themes and reported on the findings related to post-abortion support. Results: One third of our participants expressed a desire for post-abortion support, yet few were able to access a timely, affordable, non-directive service. Women were uncertain about how to find services; most contacted a provider recommended by the clinic or searched online. Women were enthusiastic about a talkline format citing anonymity and convenience as the main advantages. Conclusion: Our results suggest that exploring ways to expand post-abortion support services in Ontario is warranted. A talkline format could provide an anonymous, convenient, non-judgmental, and non-directive way to address this unmet need.

Relationship between heavy metal concentration and number of spontaneous abortion experiences in Korean women: a retrospective study of the 6th Korean national health and nutrition examination survey

To evaluate the association between serum concentration of heavy metals and number of spontaneous abortions in Korean women in the reproductive age. Retrospective cohort study. We analyzed data of women aged 20-49 years and recruited during the sixth Korean National Health and Nutrition Examination Survey 2010-2012 (KNHANES VI). The study population was divided into four groups based on the number of spontaneous abortion (SA) experiences (SA=0, 1, 2, and ≥3). The relationships between serum concentration of each pair of three heavy metals (lead, mercury, and cadmium) and number of spontaneous abortion experiences were calculated using univariable and multivariable models. Covariates included women’s age at the time of survey, body mass index, status of alcohol consumption, status of smoking, level of education, and coexistence of chronic diseases. Among a total of 8812 women participants, 6535 were married and with a history of at least one pregnancy. The mean serum lead level was increased with higher number of SA experiences. Increase of serum lead level by one unit increased the risk for SA≥3 (adjusted OR=1.62, 95% CI: 1.06, 2.48) in the multivariable model. In contrast, an inverse relationship was found between cadmium concentration and SA=2 and SA≥3 (OR=0.57 and 0.52, respectively). This relationship was not observed for mercury. The serum lead level is associated with a history of higher number of SAs in women within normal reference. A paradoxical effect of cadmium in early pregnancy was observed. Further studies would be needed to identify potential embryo-toxic effect of lead exposure, which has been presumed to be safe.

Mixed-methods investigation of women’s experiences with second-trimester abortion care in the Midwest and Northeast United States

Objective(s)We studied women's experiences seeking and receiving second-trimester abortion care in two geographically and legislatively different settings to inform ways to improve abortion care access and services. Study designWe conducted in-depth interviews with women who obtained second-trimester abortion care. Themes from the interviews were then used to inform a self-administered survey, which was completed by 108 women who received second-trimester abortion care in the Northeast and Midwest. We calculated descriptive statistics and used chi-squared and t-tests to compare responses. ResultsWe interviewed eight women and surveyed 108 women. Most interviewees and 65.2% of survey respondents reported difficulties accessing care. Although most interview and survey respondents had insurance, a slight majority reported difficulty funding care. All interviewees and 57.9% of survey respondents reported positive experiences with providers, with many interviewees and 62.0% of survey respondents saying their abortion care was better than their usual health care. Most interviewees and 75.8% of survey respondents reported pain as low to moderate, and the majority of participants reported it was the same or less than expected. Knowledge about abortion restrictions was low. Most interviewees and 68.4% survey respondents disagreed with restrictions on insurance coverage of abortion. Common recommendations to improve experiences were to ensure travel and financial support and to decrease wait times at clinics. There were few regional differences among outcomes. Conclusion(s)Women seeking second-trimester abortion in these locations reported positive abortion experiences. However, they had to overcome significant obstacles to obtain care. ImplicationsThis is the first study to systematically research women's second-trimester care experiences in two different regions of the United States. Regardless of location, women experienced barriers due to policies that impose gestational age restrictions, limit provider availability (consequently increasing wait times), and increase costs. Policy change to reduce these barriers is critical to improve access to and experiences with second trimester abortion care.

The relationships of school-based sexuality education, sexual knowledge and sexual behaviors\u2014a study of 18,000 Chinese college students

BackgroundA growing prevalence of unexpected pregnancies and younger age of sexual debut is observed among Chinese young people, while they lack formal sexuality education from schools and parents. It is necessary to measure their knowledge level of sexual and reproductive health, and how such knowledge associates with their sexual behaviors and reproductive health outcomes, which would shed light on the effectiveness of sexuality education in China.MethodsAn Internet-based questionnaire survey was conducted from January to August, 2015. 130 colleges were selected from eastern, central, and western parts China with a good balance of geographic distributions. The survey link was subsequently delivered to the focal points in each college for voluntary participation, targeting on undergraduates aged 18 ~ 25. Information on demographics, experience of school-based sexuality education (defined as any course introducing information on sexual and reproductive health) and SRH knowledge quiz was collected. Multivariate linear regression and logistic regression were applied to explore the relationship between students’ SRH knowledge, sexual behaviors and reproductive health outcomes, such as sexual intercourse (penetrative sex by vaginal or anal), unprotected sex, pregnancy and abortion, etc.ResultsA total sample of 17,966 Chinese college students (mean age = 20.2, 60.4% female) eventually entered the analysis. Only 55.6% of the respondents self-reported having received sexuality education before, and they scored significantly higher (2.33/4.00) in the SRH knowledge quiz than those who had not (1.75/4.00). Among the sexually experienced students (n = 3639, 20.2%), both males and females with higher SRH knowledge were less likely to report having experience of (partner’s) pregnancy or abortion (OR < 1, p < 0.05). In the group of sexually experienced males, those with higher SRH knowledge had a slightly later age of sexual debut (coefficient = 0.28, p < 0.001), and were less likely to have unprotected sex during the last or in most sexual intercourses (OR = 0.82, 95%C.I.: 0.69 ~ 0.96).ConclusionStudents’ experience of school-based sexuality education may be positively associated with their SRH knowledge level as well as with their sexual behaviors and reproductive health outcomes, but such associations were stronger among males than females. A more effective implementation of school-based sexuality education needs to be scaled up, and a gender-sensitive education strategy to different needs is desirable for SRH promotion among Chinese young people.

“It is just like having a period with back pain”: exploring women’s experiences with community-based distribution of misoprostol for early abortion on the Thailand–Burma border

IntroductionThe lack of economic development and longstanding conflict in Burma have led to mass population displacement. Unintended pregnancy and unsafe abortion are common and contribute to maternal death and disability. In 2011, stakeholders operating along the Thailand-Burma border established a community-based distribution program of misoprostol for early abortion, with the aim of providing safe and free abortion care in this low-resource and legally restricted setting. MethodsWe conducted 16 in-depth, in-person interviews with women from Burma residing on both sides of the border who accessed misoprostol through the community-based distribution initiative. We analyzed interviews for content and themes using deductive and inductive methods. ResultsOverall, women felt positively about their abortion experiences and the initiative. Previous abortion experiences and the recommendations of others shaped women's access. All participants, including those who remained pregnant after taking the misoprostol, would recommend the initiative to others. ConclusionCommunity-based distribution of misoprostol is an effective and culturally appropriate method of improving safe abortion care on the Thailand-Burma border. Supporting efforts to expand the harm reduction program to more communities and provide regular reproductive health and safe abortion trainings appears warranted. ImplicationsIn recent years, a number of organizations have launched programs dedicated to misoprostol-alone for early abortion. However, few have documented the experiences and perspectives of women. Our findings indicate providing misoprostol through lay provision in a legally restricted context is not only safe and effective but also culturally resonant.

Can stories reduce abortion stigma? Findings from a longitudinal cohort study

Women often hide or selectively disclose abortion experiences due to stigma. Secrecy can help women avoid stigma but may also result in isolation and a lack of social support and contribute to broader social silence. This study assesses whether a book-club intervention can support abortion disclosure among book club participants and improve participants’ affective responses towards women who have abortions and abortion providers. A total of 109 women from 13 all-female book clubs located in 9 US states read and discussed a non-fiction book that included stories about pregnancy and abortion, participated in a book club discussion and completed baseline, immediate post-intervention and endline surveys. In 10 out of the 13 book club discussions, at least one member disclosed having had a previous abortion. Overall, 15 of the 19 women who privately reported having a previous abortion self-disclosed one or more abortions during the book club discussion. Following the book club intervention, women reported having more positive feelings toward women who have abortions and abortion providers. Greater improvement and longer lasting effects were seen in groups where there was also an in-person disclosure of abortion experience. Findings suggest that exposure to the stories of women who have had abortions can reduce abortion stigma.

Towards a poststructural understanding of abortion and social class in England

ABSTRACTDespite previous research suggesting that social class influences experiences of and attitudes to abortion, there is a dearth of research which studies the intersection of abortion and social class in England. Across the UK, abortion rates and experiences differ by region and socio-economic status, reflecting broader health inequalities. Contemporary austerity in the UK creates an imperative for new research which contextualises the experience of abortion within this socio-historical moment, and the worsening inequalities which have accompanied it. Whilst work on abortion and social inequality exists, it has often approached class as an a priori category. I argue that contemporary post-structural work on class provides a framework to go beyond this approach by examining how these social classifications occur; who has the power to classify; and how these classifications might be resisted. This framework is demonstrated with emerging findings from a life history study of abortion experiences in England. The applications of this to the work on abortion are potentially rich, because the act of ending a pregnancy invites classification from many quarters, from the legal (legal/illegal) to the medical (early/late) to the moral (deserved/undeserved). This work, therefore, speaks to public health concerns about access to and stigma around abortion and social inequalities.

Lived Religion as Reproductive Decision-Making Resource Among Romanian Women Who Use Abortion as Contraception.

This article draws upon qualitative ethnographic data collected between 2005 and 2013 in southern Romania among women who have been consistently using abortion as a contraceptive method. It particularly considers the role that lived religion might have played in some individuals' strategies to render abortion a justifiable practice. Over the last seven decades, Romanian women's experiences of abortion have often been at odds with both secular and religious regulations. This study shifts the perspective from the biopolitics and the bioethics of abortion toward women's own reproductive decision-making strategies in a context of enduring traditional patriarchy. It explores the fluid and pragmatic ways in which some Romanians use the notions of "God's will," "sin," "redemption," "afterlife," and "Godparenting" to redefine abortion as a partially disembodied reproductive event. As a reproductive decision-making resource, lived religion empowers women to navigate the lived complexities of conception and contraception.

Perspectives on a Quality Abortion Care Experience: A Patient Centered Approach [9F

INTRODUCTION: A third of US women have an abortion—often a painful and emotional experience—during their reproductive years. Few studies have examined patients’ experience in abortion care, resulting in limited evidence to guide clinicians on aspects of abortion care most important to women. Similarly, providers’ perceptions of the patient experience have not been studied. Our study objective was to better understand women’s and providers’ perspectives on a high quality abortion experience to inform patient-centered abortion care. METHODS: We conducted semi-structured interviews with 10 abortion providers at the University of New Mexico Center for Reproductive Health, and 25 women seeking first-trimester surgical abortion. Participants underwent a pre-procedure in-person interview as well as a post-procedure phone interview. New participant interviews were performed until thematic saturation was achieved. Interviews were transcribed and coded using Dedoose.™ RESULTS: Women and providers value similar aspects of abortion care. When evaluating perspectives, an inverse hierarchy of priorities was observed. Providers consistently cited health metrics such as safety, procedure length, and pain control as primary determinants of providing quality abortion care. In contrast, patients desired empathy, a genuine connection with their abortion provider and clinic staff, as well as feeling heard and understood in a non-judgmental environment. CONCLUSION: Women and providers valued somewhat different but complementary aspects of abortion care. The global clinical care, including all clinic personnel’s attention to women’s psychosocial needs, is integral to high quality abortion care.

Analisis Faktor Risiko Kehamilan Ektopik

Introduction: Ectopic pregnancy is a pregnancy with extrauterine implantation. This situation is gynecologic emergency that contributes to maternal mortality. Therefore, early recognition, based on identification of the causes of ectopic pregnancy risk factors, is needed.Methods: The design descriptive observational. The samples were pregnant women who had ectopic pregnancy at Maternity Room, Emergency Unit, Dr. Soetomo Hospital, Surabaya, from 1 July 2008 to 1 July 2010. Sampling technique was total sampling using medical records.Result: Patients with ectopic pregnancy were 99 individuals out of 2090 pregnant women who searched for treatment in Dr. Soetomo Hospital. However, only 29 patients were accompanied with traceable risk factors.Discussion:. Most ectopic pregnancies were in the age group of 26-30 years, comprising 32 patients (32.32%), then in age groups of 31–35 years as many as 25 patients (25.25%), 18 patients in age group 21–25 years (18.18%), 17 patients in age group 36–40 years (17.17%), 4 patients in age group 41 years and more (4.04%), and the least was in age group of 16–20 years with 3 patients (3.03%). A total of 12 patients with ectopic pregnancy (41.38%) had experience of abortion and 6 patients (20.69%) each in groups of patients with ectopic pregnancy who used family planning, in those who used family planning as well as ectopic pregnancy patients with history of surgery. There were 2 patients (6.90%) of the group of patients ectopic pregnancy who had history of surgery and history of abortion. The incidence rate of ectopic pregnancy was 4.73%, mostly in the second gravidity (34.34%), whereas the nulliparous have the highest prevalence of 39.39%. Acquired risk factors, i.e. history of operations was 10.34%, patients with family planning 20.69%, patients with history of abortion 41.38%, patients with history of abortion and operation 6.90% patients with family and history of abortion was 20.69%.

Women’s embodied experiences of second trimester medical abortion

Abortions in general, and second trimester abortions in particular, are experiences which in many contexts have limited sociocultural visibility. Research on second trimester abortion worldwide has focused on a range of associated factors including risks and acceptability of abortion methods, and characteristics and decision-making of women seeking the procedure. Scholarship to date has not adequately addressed the embodied physicality of second trimester abortion, from the perspective of women’s lived experiences, nor how these experiences might inform future framings of abortion. To progress understandings of women’s embodied experiences of second trimester abortion, we draw on the accounts of 18 women who had recently sought second trimester abortion in Scotland. We address four aspects of their experiences: later recognition of pregnancy; experiences of a second trimester pregnancy which ended in abortion; the “labour” of second trimester abortion; and the subsequent bodily transition. The paper has two key aims: Firstly, to make visible these experiences, and to consider how they relate to dominant sociocultural narratives of pregnancy; and secondly, to explore the concept of “liminality” as one means for interpreting them. Our findings contribute to informing future research, policy and practice around second trimester abortion. They highlight the need to maintain efforts to reduce silences around abortion and improve equity of access.

Incarceration and exposure to internally displaced persons camps associated with reproductive rights abuses among sex workers in northern Uganda

BackgroundWhile female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in...