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Dalmijn EW, Visse MA, van Nistelrooij I. Decision-making in case of an unintended pregnancy: an overview of what is known about this complex process. J Psychosom Obstet Gynaecol 2024; 45:2321461. [PMID: 38469857 DOI: 10.1080/0167482x.2024.2321461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/16/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a 'sense of knowing' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.
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Affiliation(s)
- Eline W Dalmijn
- Faculty of Philosophy, Theology and Religious Studies, Radboud University, Nijmegen, The Netherlands
- Fiom, Centre of Expertise in Unwanted Pregnancy and Ancestry, 's-Hertogenbosch, The Netherlands
| | - Merel A Visse
- Caspersen School of Graduate Studies, Medical and Health Humanities, Drew University, Madison, Wisconsin, USA
| | - Inge van Nistelrooij
- Care Ethics and Policy, University of Humanistic Studies, Utrecht, The Netherlands
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Dozier JL, Burke AE, McMahon HV, Berger BO, Quasebarth M, Sufrin C, Bell SO. "Maybe if we weren't in the pandemic, I would have reconsidered": Experiences of abortion care-seeking during the COVID-19 pandemic in Maryland. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:124-135. [PMID: 38655782 DOI: 10.1111/psrh.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To understand the COVID-19 pandemic's impact on abortion care-seeking in Maryland, a state with Medicaid coverage for abortion, high service availability, and laws supporting abortion rights. METHODS We conducted semi-structured telephone interviews with 15 women who had an abortion between January 2021 and March 2022 at a hospital-based clinic in a mid-sized Maryland city. We purposively recruited participants with varied pandemic financial impacts. Interview questions prompted participants to reflect on how the pandemic affected their lives, pregnancy decisions, and experiences seeking abortion care. We analyzed our data for themes. RESULTS All participants had some insurance coverage for their abortion; over half paid using Medicaid. Many participants experienced pandemic financial hardship, with several reporting job, food, and housing insecurity as circumstances influencing their decision to have an abortion. Most women who self-reported minimal financial hardship caused by the pandemic indicated they sought an abortion for reasons unrelated to COVID-19. In contrast, women with economic hardship viewed their pregnancies as unsupportable due to COVID-19 exacerbating financial instability, even when they desired to continue the pregnancy. All participants expressed that having an abortion was the best decision for their lives. Yet, when making decisions about their pregnancy, the most financially disadvantaged women weighed their desires against the pandemic's constraints on their reproductive self-determination. CONCLUSIONS The pandemic changed abortion care-seeking circumstances even in a setting with minimal access barriers. Financial hardship influenced some women to have an abortion for a pregnancy that-while unplanned-they may have preferred to continue.
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Affiliation(s)
- Jessica L Dozier
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne E Burke
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hayley V McMahon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Blair O Berger
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Madeline Quasebarth
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Napier-Raman S, Hossain SZ, Mpofu E, Lee MJ, Liamputtong P, Dune T. Abortion Experiences and Perspectives Amongst Migrants and Refugees: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:312. [PMID: 38541311 PMCID: PMC10970391 DOI: 10.3390/ijerph21030312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 07/23/2024]
Abstract
(1) Background: Access to abortion care is a crucial reproductive health right. Refugees and migrants may have restricted access to and utilisation of abortion care, associated with histories of displacement, precarious migrant and citizenship status and difficulty navigating unfamiliar host country healthcare systems. However, there is limited evidence on the abortion experiences and perspectives of refugees and migrants. Moreover, existing research has not been synthesised to identify trends informing sexual and reproductive care access among this marginalised population. This systematic review aimed to address this gap in the cumulative evidence on refugee and migrant experiences and perspectives of abortion in host countries. (2) Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the following databases for studies on refugee and migrant abortion attitudes, decision making and experiences: Embase, Medline, CINAHL, Web of Science, Sociological Abstracts, and Scopus. We also searched the grey literature on the same. Inclusion criteria specified qualitative studies involving migrant and/or refugee populations, examining their abortion experiences, attitudes or perspectives, written in English, published between January 2000 and December 2022. Two reviewers screened titles, abstracts and full-text articles, resulting in 27 articles included in the review, following consensus checks by two co-authors. The included studies were assessed for methodological quality using the Critical Appraisal Skills Programme tool. (3) Results: Abortion was stigmatised and generally considered impermissible and undesirable. However, participants discussed socioculturally determined 'exceptions' to this, positing circumstances where abortion was acceptable. There were striking differences in experiences between participants in higher-income settings and those in lower- and middle-income settings. Difficulties accessing care were ubiquitous but were heightened in lower-resource settings and among participants with precarious citizenship, financial and legal statuses. (4) Conclusions: The findings highlight the need for an international convention to guide policy and programming that acknowledges the specific abortion requirements of migrant and refugee communities, with attention to their financial, legal and social precarity.
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Affiliation(s)
- Sharanya Napier-Raman
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (S.Z.H.); (E.M.); (M.-J.L.)
| | - Syeda Zakia Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (S.Z.H.); (E.M.); (M.-J.L.)
| | - Elias Mpofu
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (S.Z.H.); (E.M.); (M.-J.L.)
| | - Mi-Joung Lee
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (S.Z.H.); (E.M.); (M.-J.L.)
| | - Pranee Liamputtong
- College of Health Sciences, VinUniversity, Gia Lam District, Hanoi 100000, Vietnam;
| | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Campbeltown, NSW 2150, Australia;
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Koiwa Y, Shishido E, Horiuchi S. Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:288. [PMID: 38541288 PMCID: PMC10970290 DOI: 10.3390/ijerph21030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Globally, about half of all induced abortions have been estimated to be unsafe, which results in 13% of maternal deaths yearly. Of these induced abortions, 41% of unsafe abortions have been reported in young women who are dependent on their parents for their livelihood. They are often left in a vulnerable position and may have difficulty in making a decision regarding abortion. This study aimed to (1) characterize and map factors that influence abortion decision-making of adolescents and young women, and (2) identify the care and support that they need in their decision-making process. METHODS We conducted a scoping review following the JBI method and PRISMA-ScR checklist. We comprehensively searched MEDLINE (PubMed), Embase, Cochrane Library, CINAHL, and PsycInfo, and hand searched publications in the Google Scholar database between November 2021 and October 2023. The search included all English language qualitative and mixed methods research articles published on the database up to October 2023 that included participants aged 10-24 years. The CASP checklist was used as a guide for the qualitative analysis. NVivo was used to synthesize the findings. RESULTS There were 18 studies from 14 countries (N = 1543 young women) that met the inclusion criteria. Three domains and eleven categories were included as follows: personal (desire for self-realization and unwanted pregnancy), interpersonal (parental impact, reaction of partner, roles of peers and friends, existence of own child, and lack of support), and social circumstances (sexual crime, financial problem, limitation of choice, and underutilized healthcare services). Decision-making factors regarding abortions were also found across all three domains. CONCLUSION The abortion decision-making of young women is influenced by various external factors regardless of country. Parents are especially influential and tend to force their daughters to make a decision. Young women experienced suffering, frustration, and lack of autonomy in making decisions based on their preference. This emphasizes the importance of autonomous decision-making. In this regard, healthcare services should be used. However, there are barriers to accessing these services. To improve such access, the following are required: staff training to provide adolescent and youth-friendly health services, counseling based on women's needs, counseling including the parents or guardians that is confidential and ethical, promotion of decision aids, and affordable accessible care.
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Affiliation(s)
- Yui Koiwa
- Makita General Hospital, Nishikamata, Ota-ku, Tokyo 144-8501, Japan;
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
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Wojcicki J, Wawrysiuk S, Sochacki-Wojcicka N, Podlinska O, Pietrych L, Szpotanska-Sikorska M. More than a hundred thousand respondents within 48 h: How the power of social media helped to understand pregnancy loss in Poland - A retrospective population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 289:29-35. [PMID: 37625286 DOI: 10.1016/j.ejogrb.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Miscarriage is defined as the loss of pregnancy before 20-24 weeks of gestation, and it is the most common complication of early pregnancy. The aim of the study was to determine the prevalence and risk factors of spontaneous abortion in the population of Polish females to provide a reference for clinical work. METHODS A cross-sectional self-administered on-line survey was distributed between 4th and 5th of October 2019 in the social media across Poland. A total of 100,026 recipients responded to the questionnaire and 93,636 valid respondents were included in the analyses. RESULTS Among respondents who had ever been pregnant, 31.2% reported at least one spontaneous abortion. The prevalence of miscarriage varied based on age, parity, place of residence and the education level. The first symptom of miscarriage was a vaginal bleeding (56.2%) and abdominal cramps (25.8%), while 43% of respondents had no symptoms and found out during doctor's visit. No medical assistance was required after complete spontaneous abortion in 39.2% of cases. CONCLUSIONS Miscarriage is a common complication of pregnancy, but it is not yet fully understood. The goal of future medicine is to minimize the medicalization of spontaneous abortion and excessive medical intervention by raising awareness about natural miscarriage route.
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Affiliation(s)
- Jakub Wojcicki
- Ernest Foundation - The Prenatal Medicine Foundation, Algierska 19W, 03-977 Warszawa, Poland
| | - Sara Wawrysiuk
- 2nd Department of Gynaecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland.
| | - Nicole Sochacki-Wojcicka
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. S. Starynkiewicza 1/3, 02-015 Warszawa, Poland
| | - Olga Podlinska
- Ernest Foundation - The Prenatal Medicine Foundation, Algierska 19W, 03-977 Warszawa, Poland
| | - Lukasz Pietrych
- Department of Econometrics and Statistics, Warsaw University of Life Sciences - SGGW, Nowoursynowska 166, 02-787 Warszawa, Poland
| | - Monika Szpotanska-Sikorska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. S. Starynkiewicza 1/3, 02-015 Warszawa, Poland
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Kc S, Gissler M, Heino A, Klemetti R. Factors influencing the risk of repeat termination of pregnancy: A register-based study in Finland. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100876. [PMID: 37307625 DOI: 10.1016/j.srhc.2023.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to assess how factors such as sociodemographic characteristics, termination of pregnancy (TOP) related factors and contraception affect the risk of repeat TOP. MATERIALS AND METHOD This is a nationwide register-based study of 193,741 women who had TOP(s) during 1987-2015, using the Finnish Register of Induced Abortions. The risk of various factors, such as age, marital status, residence, parity, TOP related factors and contraception, was assessed separately for each repeat TOP. Cox proportional hazard model was used to estimate risk of different factors for repeat TOPs. RESULTS 21% of the women having TOP had repeat TOPs during the years 1987-2015. Among women with repeat TOPs, more than 70% had one repeat TOP and the rest had two or more. Older, married and rural or semi-urban women had reduced risk of repeat TOPs. Adjusted risk for one repeat TOP was higher among parous women (HR 1.67, 95% CI 1.61-1.72). No significant risk for repeat TOP was observed by method in sub-analysis for the recent period after 2006. Women using less reliable (HR 1.14, 95% CI 1.06-1.23) and unreliable (HR 1.33, 95% CI 1.23-1.43) contraception had increased risk of repeat TOP than women using reliable contraception. CONCLUSION Older age, being married, residing in rural or semi-urban areas and using reliable contraception were found to be protective factors for repeat TOPs whereas, parous women had higher risk for repeat TOPs. Proper counselling regarding contraception and use of reliable contraception immediately after TOP should be encouraged.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland.
| | - Mika Gissler
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden and Region Stockholm, Academic Primary Health Care Centre, S-14183 Stockholm, Sweden
| | - Anna Heino
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
| | - Reija Klemetti
- Department of Public Welfare, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
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Pike GK. Coerced Abortion - The Neglected Face of Reproductive Coercion. New Bioeth 2023; 29:85-107. [PMID: 36260375 DOI: 10.1080/20502877.2022.2136026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Reproductive coercion encompasses a collection of pregnancy promoting and pregnancy avoiding behaviours. Coercion may vary in severity and be perpetrated by intimate partners or others. Research is complicated by the inclusion of behaviours that do not necessarily involve an intention to influence reproduction, such as contraceptive sabotage. These behaviours are the most common, but are not always included in survey instruments. This may explain why the prevalence of reproductive coercion varies widely. Prevalence also varies when coerced abortion is included in survey instruments. When it is, it seems roughly comparable in prevalence to coercion intended to impregnate. The extent and nature of coerced abortion can also be derived from studies that explore the reasons why women access abortion, the relationship between abortion and intimate partner violence, and online blogs and forums. This narrative review of reproductive coercion examines the evidence and attempts to comprehend why coerced abortion has been neglected.
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Ong I, Zulkarnain ADM, Lim KZQ, Teh DBL, Tam W, Huang Z. The global impact of COVID-19 on abortion care. Heliyon 2023; 9:e16094. [PMID: 37200575 PMCID: PMC10165865 DOI: 10.1016/j.heliyon.2023.e16094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023] Open
Abstract
Background The COVID-19 pandemic placed unprecedented strain on healthcare globally, which exacerbated factors leading to unplanned pregnancies. Objectives The primary objective was to analyze the effect of COVID-19 on abortion services globally. Secondary objectives were to discuss issues regarding access to safe abortion and provide recommendations on continued access during pandemics. Search strategy A search for relevant articles was conducted by utilizing multiple databases (PubMed, Cochrane, etc.). Selection criteria Studies on COVID-19 and abortion were included. Data collection & analysis The legislation governing abortion services across the globe was examined, inclusive of modifications to service provision during the pandemic. Global data on abortion rates and analyses of selected articles were also included. Main results 14 countries instituted legislative changes related to the pandemic, 11 relaxed abortion regulations, while three restricted abortion access. An increase in abortion rates was seen particularly where telemedicine was available. Where abortions were postponed, second-trimester abortions increased after services resumed. Conclusions Legislation, risk of exposure to infection, and access to telemedicine affect access to abortion. The use of novel technologies, maintaining existing infrastructure and enhancing the roles of trained manpower for safe abortion access is recommended to avoid the marginalization of women's health and reproductive rights.
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Affiliation(s)
- Isabella Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, 119228, Singapore
| | - Aqilah Dariah Mohd Zulkarnain
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, 119228, Singapore
| | - Kelly Zhi Qi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, 119228, Singapore
| | - Daniel Boon Loong Teh
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 117456, Singapore
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, MD 11, 10 Medical Drive, 117597, Singapore
| | - Zhongwei Huang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 12, 119228, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Brown BP, Watson K. No Substitute: The False Promise of Artificial Womb Technology as an Alternative to Abortion. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:87-89. [PMID: 37130386 DOI: 10.1080/15265161.2023.2191032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | - Katie Watson
- Northwestern University Feinberg School of Medicine
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Jones A, Huslage M, Dalton M. "Any Reason is Valid:" How an Unexpected Abortion Disclosure is Received by an Online Community. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:85-94. [PMID: 35796351 DOI: 10.1080/19371918.2022.2096736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study utilized a social media post by a well-known social media influencer and the accompanying 63 responses to explore feelings and experiences related to abortion. This study employed qualitative thematic analysis and identified three themes related to reasons for abortion (i.e., relationship issues, not being ready for pregnancy, and other reasons) and one supplemental theme of bystander support. Findings highlight the efforts of many respondents to normalize abortion as an issue of women's health and women's rights. In fact, in response to the original post's discussion regarding valid reasons for an abortion, most respondents remarked similarly that any reason is valid. While study limitations include concerns regarding generalizability, this study provides access to abortion experiences outside of a traditional health clinic survey and insight into the abortion beliefs of women, both who have and have not experienced an abortion. Findings are in line with previous studies which found that multiple reasons are cited for obtaining an abortion, but also revealed a more supportive climate than the divisive discourse typically portrayed in the media. This suggests the timing may be conducive for efforts aiming to normalize abortion and reduce stigma, including potential avenues for interventions (e.g., social networks and platforms). Lastly, the innovative use of social media to inform this study should be considered by others as they seek to understand and explore topics that can be challenging to study.
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Affiliation(s)
- Aubrey Jones
- College of Social Work, The University of Kentucky, Lexington, Kentucky, USA
| | - Melody Huslage
- College of Social Work, The University of Tennessee, Knoxville, Tennessee, USA
| | - Miranda Dalton
- College of Social Work, The University of Tennessee, Knoxville, Tennessee, USA
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Smith MH, McGowan M, Chakraborty P, Hood RB, Field MP, Bessett D, Norwood C, Norris AH. Kentucky's abortion landscape, 2010 to 2019: an analysis of pre- Dobbs abortion disparities in a rural, restrictive state. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100441. [PMID: 36852333 PMCID: PMC9958464 DOI: 10.1016/j.lana.2023.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Abstract
Background Since 2010, many US states have passed laws restricting abortion providers' ability to provide care. Such legislation has no demonstrated health benefits and creates inequitable barriers for patients. Methods To examine how Kentucky's abortion policies coincided with facility closures and abortion utilisation, we conducted a review of state abortion policies from 2010 to 2019 using newspapers and websites. We calculated abortion rates (abortions per 1000 women ages 15-44) by state of residence and provision for Kentucky, the South, and the US using data from the CDC and Kentucky Department of Health. We calculated percentages leaving and from out-of-state, and analysed abortions by race, pregnancy duration, and method. Findings Of 17 policies passed between 2010 and 2019, ten were enacted, including 20-week and telemedicine bans. One of Kentucky's two abortion facilities closed in 2017. The pooled average abortion rate in Kentucky (4.1) and for Kentuckians (5.8) was lower than national averages (11.8 and 11.1). An average of 38% of Kentuckians left their state for care, compared to 7% nationally. In 2019, the abortion rate in Kentucky was 5.8 times higher for Black patients than White patients (compared to 4.8 times nationally). The majority (62%) of abortions in Kentucky took place at 7-13 weeks' gestation. Interpretation Abortions in Kentucky were less frequent than in the South and US. The larger Black-White abortion rate gap reflects race- and class-based structural inequities in healthcare. Without federal protections, abortion access in Kentucky will continue waning. Funding This study was supported by a philanthropic foundation that makes grants anonymously.
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Affiliation(s)
- Mikaela H. Smith
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA,Corresponding author.
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert B. Hood
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, OH, USA
| | - Carolette Norwood
- Department of Sociology and Criminology, Howard University, Washington, DC, USA
| | - Alison H. Norris
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA
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13
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Makenzius M, Obern C, Tydén T, Larsson M, Gemzell-Danielsson K, Sundström-Poromaa I, Ekstrand Ragnar M. Women's decision-making related to induced abortion - a cross sectional study during a period of Covid-19 pandemic, in Sweden. EUR J CONTRACEP REPR 2023; 28:44-50. [PMID: 36459054 DOI: 10.1080/13625187.2022.2150047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To investigate women's decision-making on induced abortion. MATERIALS AND METHODS A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]). RESULTS About half (n = 322;52%) scored 1-4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5-7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner's hesitance (OR = 3.18, CI:1.76-5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28-3.87), having discussed the decision with someone (OR = 2.42, CI:1.67-3.50), age ≥30 (OR = 2.22, CI:1.03-4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20-3.59), and the desire to have children in the future (OR = 1.96, CI:1.18-3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5-7 (n = 140;47.9%) compared to those who scored 1-4 (n = 122;37.9), p = .029. CONCLUSION Women's decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines.
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Affiliation(s)
- M Makenzius
- Department of Health Care Sciences, Mid Sweden University, Östersund, Sweden.,Department of Global Public Health, Karolinska institutet, Stockholm, Sweden
| | - C Obern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - T Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - K Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska University Hospital, Karolinska institutet, Stockholm, Sweden
| | - I Sundström-Poromaa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Ekstrand Ragnar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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Fernández-Basanta S, Romero-González G, Coronado C, Movilla-Fernández MJ. The decision-making experiences of women who legally aborted: A meta-ethnography. Nurs Ethics 2023; 30:106-120. [PMID: 36278419 DOI: 10.1177/09697330221113060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Abortion is one of the most common gynaecological procedures. It is related to personal, social, and economic reasons under a legal term that is recognised as a common sexual and reproductive right in most of countries. However, making the decision to abort is complex, because it is politicised and is often framed in public discourse related to moral or ethical issues beyond women's experiences. Therefore, it is subject to medical criteria, religious evaluations, and sociological analysis. PURPOUSE The aim of this synthesis of qualitative studies was to synthesise the decision-making experiences of women who legally aborted. RESEARCH DESIGN AND METHOD The Noblit and Hare's interpretive meta-ethnography was conducted, and it was written in accordance with the eMERGe meta-ethnography reporting guidance. Ten studies met the research objective and inclusion criteria, after a comprehensive systematic search strategy in five databases. FINDINGS The metaphor "The wrestling between why and what will happen next" and three themes emerged from the data analysis: (1) Forces that incite the arm wrestling; (2) Facing social stigma; and (3) Defeated by a greater rival. The metaphor provided interpretive experiences of the moral conflict experienced by women who decided to have an abortion and emerged from the confrontation of the reasons why they decided to abort and the social repercussions that making the decision entails. The result of the struggle was loneliness and vulnerability. CONCLUSION The lines of action impact policy makers, the media, and health professionals. Actions should focus on the de-stigmatisation and normalisation of abortion, the use of appropriate language, and the training and sensitisation of health professionals.
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15
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Reardon DC, Longbons T. Effects of Pressure to Abort on Women's Emotional Responses and Mental Health. Cureus 2023; 15:e34456. [PMID: 36874642 PMCID: PMC9981219 DOI: 10.7759/cureus.34456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
Background Women who feel pressured to agree to abortion are more likely to experience negative emotional and mental health reactions. But relatively little research has been conducted to explore the types and degree of pressures women face and their associated effects. Our study aims to investigate five types of pressure women may face and a sample of effects that may be associated with unwanted abortions. Methods A retrospective survey was distributed through a marketing research firm and completed by 1000 females aged 41 to 45, inclusive, living in the United States. The survey instrument included demographic questions and analog scales for respondents to rate the pressure to abort arising from male partners, family members, other persons, financial concerns, and other circumstances and 10 variables related to both positive and negative outcomes. Results Among 226 respondents who reported a history of abortion, perceived pressure to abort was significantly associated with more negative emotions; more disruption of daily life, work, or relationships; more frequent thoughts, dreams, or flashbacks to the abortion; more frequent feelings of loss, grief or sadness about the abortion; more moral and maternal conflict over the abortion decision; a decline in overall mental health that they attribute to their abortions; more desire or need for help to cope with negative feelings about the abortion. Overall, 61% reported high levels of pressure on at least one scale. Women with a history of abortion were four times more likely to quit the survey than women who did not have abortions, and those with a history of feeling pressured to abort also reported higher levels of stress related to completing the survey. Discussion Perceived pressures to choose abortion should be assessed before an abortion to better guide risk assessments, decision-making, and analyses of post-abortion adjustments in light of these risk factors. A history of abortion, especially when there was pressure to abort, is associated with more stress completing questionnaires touching on abortion experiences and with a higher dropout rate, a finding that is consistent with the view that abortion surveys are likely to underrepresent the experiences of the women who experience the most stress and negative reactions to their abortions. Abortion providers should screen for perceived pressures to abort and be prepared to offer counseling and services that will help women to avoid unwanted abortions.
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Graham M, McKenzie H, Lamaro Haintz G, Dennis C. Who do Australian women seek social support from during the reproductive decision-making process? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4028-e4040. [PMID: 35302266 PMCID: PMC10078729 DOI: 10.1111/hsc.13785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/03/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Limited evidence exists about women's experiences of social support for reproductive decision-making, particularly who women seek social support from during decision-making. Using a concurrent mixed methods approach, this research explored who women aged 25-35 years living in Victoria, Australia, seek social support from during reproductive decision-making. Women seek social support for reproductive decision-making from multiple sources. However, through exploring women's support seeking for reproductive decision-making, rather than once a reproductive decision had been made, the study highlights the nuanced and contextual nature of support seeking for reproductive decision-making demonstrating support seeking is influenced by: type of reproductive decision; women's relationships with members of their social network; previous experiences of support seeking for reproductive decisions; expectations of the support they would receive; homophily; and temporality. This research provides important insight into who women seek support from for reproductive decision-making. Understanding this will help inform future social and public health interventions.
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Affiliation(s)
- Melissa Graham
- School of Psychology and Public HealthDepartment of Public HealthLa Trobe UniversityBundooraVictoriaAustralia
| | - Hayley McKenzie
- School of Health and Social DevelopmentDeakin UniversityBurwoodVictoriaAustralia
| | | | - Carly Dennis
- School of Health and Social DevelopmentDeakin UniversityBurwoodVictoriaAustralia
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17
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Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health 2022; 112:1290-1296. [PMID: 35969820 PMCID: PMC9382171 DOI: 10.2105/ajph.2017.304247r] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Dozier JL, Sufrin C, Berger BO, Burke AE, Bell SO. COVID-19 impacts on abortion care-seeking experiences in the Washington, DC, Maryland, and Virginia regions of the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:68-79. [PMID: 35790127 PMCID: PMC9349554 DOI: 10.1363/psrh.12202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Many people wanted to avoid or delay childbearing during the COVID-19 pandemic. This study sought to examine the extent COVID-19 influenced abortion care-seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion-restrictive policies. METHODOLOGY We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic-related life changes by whether COVID-19 influenced abortion care-seeking. RESULTS Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID-19 influenced their decision to have an abortion. These individuals were significantly more likely to report "not financially prepared" (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID-19. They were also more likely to have lost or changed their health insurance due to pandemic-related employment changes (15% vs. 2%), report substantial money difficulties due to COVID-19 (59% vs. 33%), and report that paying for their abortion was "very difficult" (25% vs. 2%). CONCLUSION COVID-19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises.
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Affiliation(s)
- Jessica L. Dozier
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Carolyn Sufrin
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Blair O. Berger
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Anne E. Burke
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Suzanne O. Bell
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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19
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Li C, Gao J, Liu J. Repeat abortion and associated factors among women seeking abortion services in northwestern China: a cross-sectional study. BMC Public Health 2021; 21:1626. [PMID: 34488713 PMCID: PMC8422724 DOI: 10.1186/s12889-021-11653-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Repeat abortion is a significant public health problem in China. International knowledge about repeat abortion and its associated factors in Chinese women is scarce. This study aimed to analyze the prevalence of repeat abortion among women seeking abortion services with unintended pregnancies in northwestern China and to identify factors associated with the repeat abortion from both two perspectives of abortion seekers themselves and their sexual partners. Methods This cross-sectional survey was conducted from May 1st to May 31st, 2020, in 90 medical institutions in Xi’an, the largest city in northwestern China. All women seeking abortions within the first 12 weeks of pregnancy were invited to participate in this survey; however, only those abortion seekers with unintended pregnancies were extracted and included in this study. Pearson’s chi-squared tests, Kolmogorov-Smirnov tests, and binary logistic regression analysis were performed. Results Of 3397 abortion seekers, 56.6% (1924) were undergoing repeat abortions. Participants who were older than 30 years (OR: 1.37, 95% CI: 1.08–1.73 for 31–35 years; 1.82, 1.29–2.57 for ≥36 years), received a low-level education (1.86, 1.42–2.43 for ≤senior high school; 1.46, 1.17–1.83 for junior college), were jobless (2.46, 1.18–5.13), had one child (1.54, 1.10–2.17), had a general (1.60, 1.28–1.98) or no (2.51, 2.02–3.11) cognition of possible adverse health effects of having abortions, and had used contraception at the time of conception, i.e., condoms (1.33, 1.09–1.61), withdrawal (1.43, 1.12–1.84), and emergency measures (1.48, 1.09–1.99) were more likely to undergo a repeat abortion. Besides, participants whose sexual partners were older than 30 years (1.33, 1.06–1.68 for 31–35 years; 2.13, 1.56–2.91 for ≥36 years), attained a low-level education (1.66, 1.28–2.15 for ≤senior high school; 1.38, 1.10–1.74 for junior college), received a high-level monthly income (1.34, 1.08–1.65 for ≥6001 Yuan), and had a weak or very weak willingness to use contraception (6.84, 2.42–19.33) were more likely to have a repeat abortion. Conclusions The study findings highlight the problem of repeat abortion in China and suggest the need for government and civil society to increase efforts to reduce the risks of unintended pregnancy and repeat abortion in China. One approach may be to offer better access to reproductive health and contraception knowledge to women and their sexual partners and to promote their correct, consistent, and effective contraception practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11653-4.
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Affiliation(s)
- Chen Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Jianmin Gao
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China.,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Jinlin Liu
- School of Public Policy and Administration, Northwestern Polytechnical University, Xi'an, 710129, Shaanxi, China.
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20
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Kimport K, Littlejohn KE. What are We Forgetting? Sexuality, Sex, and Embodiment in Abortion Research. JOURNAL OF SEX RESEARCH 2021; 58:863-873. [PMID: 34080946 DOI: 10.1080/00224499.2021.1925620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Abortion has been alternately legalized and criminalized, tacitly approved of, and stigmatized, in various settings over time. The contours of its treatment are dependent on social and political contexts, including concern over women's sexuality, but it is not clear that existing conceptual frameworks enable expansive examination of the relationship between abortion and sexuality. We conduct a critical interpretive synthesis review of the literature that jointly engages with sexuality and abortion, focusing on the U.S., to highlight the frameworks that authors use to understand the relationship between the two. We find two conceptual frameworks of abortion and sexuality in operation: one that treats the two as discrete, causal variables that operate at the individual level; and another that focuses on how beliefs about what constitutes (in)appropriate sexuality explain ideological positions on abortion. We identify limitations of both frameworks and propose a new conceptual framework - one that highlights sexual embodiment - to inspire future research in this area and generate opportunities for knowledge extension. Such an approach, we contend, can elucidate broader social forces that shape both abortion and sexuality and bring research on abortion into conversation with recent scholarship on the important role of sexuality in other sexual and reproductive domains.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California
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21
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Ekholuenetale M, Ekholuenetale CE, Barrow A. Prognostic factors of time to first abortion after sexual debut among fragile state Congolese women: a survival analysis. BMC Public Health 2021; 21:525. [PMID: 33731079 PMCID: PMC7968319 DOI: 10.1186/s12889-021-10599-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to investigate the prevalence of abortion, the reasons women had abortions, median years to first abortion after sexual debut and examine the factors of time to first abortion among women of reproductive age in the Republic of Congo. METHODS We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p < 0.05. RESULTS The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women's age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34, 67, 86 and 94% higher risk of abortion respectively, when compared with women from poorest households (all p < 0.05). Women currently in union/living with a man and formerly in union had 41 and 29% reduction in the risk of abortion respectively, when compared with those never in union (all p < 0.05). In addition, women with primary and secondary+ education had 42 and 76% higher risk of abortion respectively, when compared with women with no formal education (all p < 0.05). CONCLUSION There was high prevalence of abortion with short years at first abortion. Abortion was associated with women's characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Amadou Barrow
- Department of Public and Environmental Health, School of Medicine and Allied Health Sciences, University of The Gambia, Kanifing, The Gambia.
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22
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Leung V, Bryant C, Stafford L. Psychological aspects of gestational cancer: A systematic review. Psychooncology 2020; 29:1734-1745. [PMID: 32779263 DOI: 10.1002/pon.5502] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Gestational cancer is defined as any type of cancer diagnosed during pregnancy or within 12 months of delivery. To date, existing studies on the psychological aspects of this type of cancer have not been evaluated for methodological quality. The aim of this systematic review was to identify the psychological aspects of gestational cancer. METHODS Five journal databases were searched to identify peer-reviewed articles reporting upon the psychological aspects of women with gestational cancer. Studies published from journal inception to December 2019 were included, and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The Mixed-Method Appraisal Bias Tool was used, to assess the methodological quality of the studies. A narrative description was developed for the psychological outcomes reported in quantitative studies. Qualitative data was synthesized using thematic analysis. RESULTS Five papers were eligible for inclusion (two qualitative and three quantitative studies). Factors that contributed to women's psychological distress during gestational cancer included disease characteristics, sociodemographic factors, the baby's health, pregnancy-related factors and cognitive emotion regulation. Four main themes emerged from the qualitative studies; concerns about the baby's health, lost opportunities, "not fitting in," and healthcare decision-making. CONCLUSIONS These findings suggest that (a) women with gestational cancer experience psychological distress that is associated with concerns about their babies' health, and (b) their healthcare experiences are affected by communication within multidisciplinary care teams.
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Affiliation(s)
- Vivien Leung
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Women's Mental Health, The Royal Women's Hospital, Parkville, Victoria, Australia
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McCarthy MA, Upadhyay U, Ralph L, Biggs MA, Foster DG. The effect of receiving versus being denied an abortion on making and achieving aspirational 5-year life plans. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:177-183. [PMID: 32098771 DOI: 10.1136/bmjsrh-2019-200456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/19/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Popular support for access to abortion and contraceptive services is often based on the idea that they will help women determine the trajectory of their life course. This study examined whether receiving versus being denied an abortion affects aspirational life goal setting and attainment 5 years later. METHODS We compared women who sought and were denied an abortion because they were 3 weeks beyond the gestational limit ('Parenting-Turnaways') to those who received an abortion in the first trimester ('First-Trimesters'); received an abortion within 2 weeks of the facility's gestational limit ('Near-Limits'); and sought an abortion, were turned away and received an abortion elsewhere or placed their baby for adoption ('Non-Parenting-Turnaways'). We used mixed effects logistic regression analyses to estimate the odds of setting an aspirational plan and to estimate the odds of both setting and achieving an aspirational 5-year plan. RESULTS At 1 week post abortion-seeking, 791 women reported 1864 5-year plans, most of which were aspirational (n=1692, 91%). Parenting-Turnaways had lower odds of setting an aspirational 5-year plan than Near-Limits (OR 0.36, 95% CI 0.18 to 0.73). There were no differences by group in achieving aspirational 5-year plans among those who had them. CONCLUSIONS Soon after abortion-seeking, women denied a wanted abortion were less optimistic about their long-term futures than women who received a wanted abortion. Abortion access can help women set positive long-term goals.
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Affiliation(s)
- Molly A McCarthy
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ushma Upadhyay
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - Lauren Ralph
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - M Antonia Biggs
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), UCSF, Oakland, California, USA
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Fix L, Seymour JW, Grossman D, Johnson DM, Aiken AR, Gomperts R, Grindlay K. Abortion Need among U.S. Servicewomen: Evidence from an Internet Service. Womens Health Issues 2020; 30:161-166. [PMID: 31859189 PMCID: PMC10372809 DOI: 10.1016/j.whi.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/05/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION U.S. servicewomen have high rates of unintended pregnancy, but federal policy prohibits abortion provision at military treatment facilities and military insurance coverage of abortion, except in cases of rape, incest, or a life-endangering pregnancy. Such restrictions pose challenges to abortion access for servicemembers, particularly during deployment. We aimed to explore the experiences of U.S. servicewomen when accessing abortion during overseas tours and deployment. METHODS We reviewed de-identified data from email inquiries and online consultation forms from U.S. servicewomen or military spouses seeking medication abortion from the telemedicine service Women on Web between January 2010 and December 2017. We used descriptive statistics and inductively coded textual responses to describe client characteristics, circumstances of pregnancy, reasons for abortion, and barriers to abortion care. RESULTS Our sample included data for 323 individuals. Reasons for abortion related to military service included disruption of deployment, fear of military reprimand, and potential career impacts. Additionally, servicemembers faced barriers to abortion access related to overseas military deployment or tour, including a lack of legal abortion in-country, limited financial resources, language barriers, travel restrictions, and a lack of confidentiality. CONCLUSIONS U.S. military servicewomen stationed in countries where safe, legal abortion is restricted or unavailable face deployment-related barriers to abortion care, which compound those barriers they may face regardless of deployment status. Removal of federal bans on the provision and coverage of abortion care and improved education about existing regulations could improve access to timely abortion care and in some cases allow servicewomen who wish to obtain abortion care to remain deployed.
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Ples L, Popescu I, Margarit I, Ionescu CA, Cazaceanu A, Moga MA, Popescu M, Tomescu DR, Sima RM. Factors affecting the decision to undergo abortion in Romania: Experiences at our clinic. J Eval Clin Pract 2020; 26:484-488. [PMID: 31368205 DOI: 10.1111/jep.13250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/20/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES It is estimated that 25% of pregnancies worldwide end in induced abortion. In Romania, the abortion situation shows a specific pattern. Following the fall of the communist regime, first-trimester abortions were legalized, and between 1990 and 1992, the country's abortion rate was the highest in the world, with 182 abortions per 1000 women of reproductive age. However, there are currently no statistically reliable data, as some abortions are not reported. The purpose of this study was to identify the main circumstances that determine the choice to undergo abortion with all related potential risks, rather than using contraception. METHOD We conducted a prospective type 1 cohort study based on a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement that included women who presented at Bucur Maternity, Saint John Hospital, Bucharest, for abortion during the first trimester, between July and December 2018. The patients were asked to complete a 21-item questionnaire based on psychosocial data. RESULTS The study included 119 patients, with a mean age of 29.57 years. Their educational level was average (ie, 51.3%, 4.2%, and 8.4% had completed high school, elementary school, and college or university, respectively). Most women were married (46.2%), and 47.9% were unemployed. The main reason for deciding to undergo an abortion was poverty (P = .014), and guilt was correlated with this decision (P = .004). CONCLUSION The profiles of the women who chose to undergo an abortion as a family planning method were as follows: in the third decade of life, resident of urban areas, married, unemployed, and with a low family income. The main reasons for abortion were financial status, advanced maternal age, incompatibility of pregnancy with future plans, and the desire to postpone conception.
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Affiliation(s)
- Liana Ples
- Department of Obstetrics and Ginecology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Bucur Maternity, St. John Hospital, Bucharest, Romania
| | - Ina Popescu
- Department of Obstetrics and Ginecology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Cringu Antoniu Ionescu
- Department of Obstetrics and Ginecology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Obstetrics Gynecology, St. Pantelimon Emergency Hospital, Bucharest, Romania
| | | | - Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
| | - Mihai Popescu
- Department of Obstetrics and Ginecology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
| | - Dana-Rodica Tomescu
- Department of Obstetrics and Ginecology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
| | - Romina-Marina Sima
- Department of Obstetrics and Ginecology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Bucur Maternity, St. John Hospital, Bucharest, Romania
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Bowling J, Simmons M, Dodge B, Sundarraman V, Lakshmi B, Dharuman ST, Herbenick D. Family Formation Goals Among Sexual and Gender Minority Individuals in Urban India. Stud Fam Plann 2019; 50:357-373. [PMID: 31482573 DOI: 10.1111/sifp.12102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sexual and Gender Minority (SGM) individuals' (nonheterosexual or noncisgender) desires and intentions to form families have been under-researched. Further, research on family formation among SGM individuals is even more scant in India. Family formation, a significant milestone for many individuals, has important implications for overall health. Using data from interviews (n=25) and focus group discussions (8 participants) with SGM individuals in Bangalore, Chennai, and Kolkata, we explore desires and intentions related to parenting. Pressure to have children was ubiquitous, though participants' parenting-related desires varied. Participants considering parenting noted many priorities including their financial stability, relationships with partners, and the legality and legitimacy of their partnerships. Adoption and assisted biological reproduction (e.g., IVF) were the preferred methods of family formation. Experiences and expectations of stigma for themselves and their children shaped participants' limited control over parenting-related decisions. However, they exerted agency as they navigated achieving their ideals for family formation.
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The Health and Social Service Needs of Pregnant Women Who Consider but Do Not Have Abortions. Womens Health Issues 2019; 29:364-369. [DOI: 10.1016/j.whi.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/24/2022]
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Rogers C, Sapkota S, Paudel R, Dantas JAR. Medical abortion in Nepal: a qualitative study on women's experiences at safe abortion services and pharmacies. Reprod Health 2019; 16:105. [PMID: 31307474 PMCID: PMC6632190 DOI: 10.1186/s12978-019-0755-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. Methods Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. Results Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women’s personal, social and economic empowerment. Conclusions While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women. Electronic supplementary material The online version of this article (10.1186/s12978-019-0755-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Rogers
- International Health Programme, Faculty of Health Sciences, Curtin University, Perth, 6102, Western Australia.
| | | | - Rasmita Paudel
- Independent Health Research Consultant, Kathmandu, Nepal
| | - Jaya A R Dantas
- International Health Programme, Faculty of Health Sciences, Curtin University, Perth, 6102, Western Australia
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Liu N, Vigod SN, Farrugia MM, Urquia ML, Ray JG. Physician procedure volume and related adverse events after surgically induced abortion: a population-based cohort study. CMAJ 2019; 191:E519-E528. [PMID: 31085561 DOI: 10.1503/cmaj.181288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Induced abortion is a common procedure performed by physicians with varying degrees of clinical experience. We aimed to determine whether a physician's procedure volume influences complications after induced abortion. METHODS We obtained population-based retrospective data on surgically induced abortion procedures in Ontario between 2003 and 2015 from Ontario health administrative databases held at ICES. Physician procedure volume was defined as the number of surgically induced abortions performed in the 1-year period preceding the index procedure date, categorized as low (< 10th percentile of yearly volume) or higher (≥ 10th percentile). The primary outcome was a severe adverse event (maternal end organ damage, severe maternal morbidity, intensive care unit admission or death) within 42 days after an induced abortion. The secondary outcome was any adverse event within 42 days. RESULTS Among 529 141 surgical abortion procedures, we found 850 severe adverse events (1.6 per 1000 procedures, 95% confidence interval [CI] 1.5-1.7), and 5664 any adverse events (10.7 per 1000 procedures, 95% CI 10.4-11.0). Severe adverse events occurred in 194 out of 52 889 procedures in the low-volume group (3.7 per 1000 procedures, 95% CI 3.2-4.2) compared with 656 out of 476 252 procedures in the higher-volume group (1.4 per 1000 procedures, 95% CI 1.3-1.5), an adjusted odds ratio (OR) of 1.91 (95% CI 1.41-2.59). The odds of any adverse event were also higher in the low-volume versus higher-volume group (adjusted OR 1.19, 95% CI 1.02-1.40). INTERPRETATION Low physician procedure volumes are associated with an elevated risk of a complication after surgically induced abortion. Future investigation should compare processes of care between low- and higher-volume physicians to facilitate quality improvement in abortion care.
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Affiliation(s)
- Ning Liu
- Institute of Health Policy Management and Evaluation (Liu, Vigod, Ray), University of Toronto; ICES (Liu, Vigod, Urquia, Ray); Women's College Hospital and Department of Psychiatry (Vigod), University of Toronto; Mount Sinai Hospital (Farrugia); Department of Obstetrics and Gynaecology (Farrugia), University of Toronto; Dalla Lana School of Public Health (Urquia), University of Toronto; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Simone N Vigod
- Institute of Health Policy Management and Evaluation (Liu, Vigod, Ray), University of Toronto; ICES (Liu, Vigod, Urquia, Ray); Women's College Hospital and Department of Psychiatry (Vigod), University of Toronto; Mount Sinai Hospital (Farrugia); Department of Obstetrics and Gynaecology (Farrugia), University of Toronto; Dalla Lana School of Public Health (Urquia), University of Toronto; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - M Michèle Farrugia
- Institute of Health Policy Management and Evaluation (Liu, Vigod, Ray), University of Toronto; ICES (Liu, Vigod, Urquia, Ray); Women's College Hospital and Department of Psychiatry (Vigod), University of Toronto; Mount Sinai Hospital (Farrugia); Department of Obstetrics and Gynaecology (Farrugia), University of Toronto; Dalla Lana School of Public Health (Urquia), University of Toronto; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Marcelo L Urquia
- Institute of Health Policy Management and Evaluation (Liu, Vigod, Ray), University of Toronto; ICES (Liu, Vigod, Urquia, Ray); Women's College Hospital and Department of Psychiatry (Vigod), University of Toronto; Mount Sinai Hospital (Farrugia); Department of Obstetrics and Gynaecology (Farrugia), University of Toronto; Dalla Lana School of Public Health (Urquia), University of Toronto; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Joel G Ray
- Institute of Health Policy Management and Evaluation (Liu, Vigod, Ray), University of Toronto; ICES (Liu, Vigod, Urquia, Ray); Women's College Hospital and Department of Psychiatry (Vigod), University of Toronto; Mount Sinai Hospital (Farrugia); Department of Obstetrics and Gynaecology (Farrugia), University of Toronto; Dalla Lana School of Public Health (Urquia), University of Toronto; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
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Loll D, Hall KS. Differences in abortion attitudes by policy context and between men and women in the World Values Survey. Women Health 2019; 59:465-480. [PMID: 30257149 PMCID: PMC6435427 DOI: 10.1080/03630242.2018.1508539] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
We explored whether abortion attitudes differed by respondents' sex and country-level abortion policy context. Data were collected between 2010 and 2014 from 69,901 respondents from 51 countries. Abortion attitudes were scored on a ten-point Likert scale (1 = "never justifiable"; 10 = "always justifiable"). Country-level abortion policy context was dichotomized as "less restrictive" or "more restrictive." We conducted linear regression modeling with cluster effects by country to assess whether respondents' sex and abortion policy context were associated with abortion attitudes, controlling for sociodemographic characteristics. On average, women had more supportive abortion attitude scores than men (Mean = 3.38 SD = 2.76 vs. Mean = 3.24 SD = 2.82, p < .001). Respondents in countries with more restrictive policy contexts had less supportive attitudes than those in less restrictive contexts (Mean = 2.55 SD = 2.39 vs. Mean = 4.09 SD = 2.96, p < .001). In regression models, abortion attitudes were more supportive among women than men (b = 0.276, p < .001) and in less restrictive versus more restrictive countries (b = 0.611, p < .001). Younger, educated, divorced, non-religious, and employed respondents had more supportive scores (all p < .05). Systematic differences were observed in abortion attitudes by respondents' sex and policy context, which have potential implications for women's autonomy and abortion access, which should be explored in future research.
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Affiliation(s)
- Dana Loll
- L4000 Women’s Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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31
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Uzoigwe CE. Abortion in Argentina. Lancet 2019; 393:744-745. [PMID: 30799009 DOI: 10.1016/s0140-6736(18)32766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/19/2018] [Indexed: 11/18/2022]
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Pereira J, Pires R, Canavarro MC. Decision-making trajectories leading to termination of an unplanned pregnancy: specificities among adolescent and adult women. J Reprod Infant Psychol 2019; 37:242-255. [PMID: 30664356 DOI: 10.1080/02646838.2019.1566596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To describe the decision-making trajectories leading to termination of an unplanned pregnancy and to explore the differences according to women's age. Background: Although decision-making regarding abortion has been conceptualised as a multiphase event, the different trajectories leading to termination of an unplanned pregnancy remain unexplored. Methods: In this cross-sectional study, 422 women (248 adolescents, 174 adults) who had an abortion were recruited. Data were collected through self-report questionnaires at 16 Portuguese healthcare services. Results: Eight decision-making trajectories leading to termination of an unplanned pregnancy were identified according to the sequence: consideration (or not) to continue the pregnancy, conceal (or not) the decision from the family, the main decision-maker, and reasons for abortion. The most frequent trajectory included women who did not consider its continuation, did not conceal the reproductive decision from their family, were the main decision-maker and referred as reasons for abortion 'education/job would be more difficult to continue'. Adolescents more frequently not considering pregnancy continuation, not concealing the decision from their family and referred as reasons for abortion the prioritisation of their academic plans and immaturity; or considering its continuation, but were pressured into abortion by their parents. Adults more frequently (not) considering pregnancy continuation, concealed the decision from their family and reported economic reasons for abortion; or considering its continuation, but were pressured into abortion by their partners. Conclusion: Our study may contribute to more informed intervention by healthcare providers involved in supporting women's decisions, highlighting the need to promote an informed, weighted, developmentally adapted and free decision-making process.
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Affiliation(s)
- Joana Pereira
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Raquel Pires
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
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Kjelsvik M, Sekse RJT, Moi AL, Aasen EM, Nortvedt P, Gjengedal E. Beyond autonomy and care: Experiences of ambivalent abortion seekers. Nurs Ethics 2019; 26:2135-2146. [PMID: 30630395 DOI: 10.1177/0969733018819128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While being prepared for abortions, some women experience decisional ambivalence during their encounters with health personnel at the hospital. Women's experiences with these encounters have rarely been examined. OBJECTIVE The objective of this study was to explore ambivalent abortion-seeking women's experiences of their encounters with health personnel. RESEARCH DESIGN The data were collected in individual interviews and analysed with dialogical narrative analyses. PARTICIPANTS AND RESEARCH CONTEXT A total of 13 women (aged 18-36 years), who were uncertain of whether to terminate their pregnancies during the first trimester, were interviewed before and after they made their decisions. The participants were recruited at six Norwegian outpatient clinics. ETHICAL CONSIDERATIONS Approval was granted by the Regional Committee for Medical and Health Research Ethics. FINDINGS The ambivalent pregnant women sought to make autonomous decisions while simultaneously involving their closest confidants and health personnel in the process. The following three types of narratives of women's experiences with encounters with health personnel were identified: the respected women; the identified women; and the abandoned women. DISCUSSION The findings are discussed in terms of the ambivalent pregnant woman's autonomous responsibility in considering an abortion and how her autonomy can be enabled or impaired during encounters with health personnel. CONCLUSION AND IMPLICATION Although the women considered themselves autonomous and responsible for their final decisions, they wished health personnel were involved in their situations. The health personnel contributed by enabling or disabling the possibility of decision-making in accordance with the women's values. The findings indicate that health personnel who care for women considering abortions must be trained in dialogical competence.
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Affiliation(s)
- Marianne Kjelsvik
- University of Bergen, Norway; Norwegian University of Science and Technology (NTNU), Norway
| | | | - Asgjerd Litleré Moi
- Western Norway University of Applied Sciences (HVL), Norway; Haukeland University Hospital, Norway
| | - Elin M Aasen
- Norwegian University of Science and Technology (NTNU), Norway
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Scott J, Onyango MA, Burkhardt G, Mullen C, Rouhani S, Haider S, Albutt K, Greiner A, VanRooyen M, Bartels S. A qualitative analysis of decision-making among women with sexual violence-related pregnancies in conflict-affected eastern Democratic Republic of the Congo. BMC Pregnancy Childbirth 2018; 18:322. [PMID: 30089448 PMCID: PMC6083512 DOI: 10.1186/s12884-018-1942-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual violence is prevalent in conflict-affected settings and may result in sexual violence-related pregnancies (SVRPs). There are limited data on how women with SVRPs make decisions about pregnancy continuation or termination, especially in contexts with limited or restricted access to comprehensive reproductive health services. METHODS A qualitative study was conducted in Bukavu, Democratic Republic of the Congo (DRC) as part of a larger mixed methods study in 2012. Utilizing respondent-driven sampling (RDS), adult women who self-reported sexual violence and a resultant SVRP were enrolled into two study subgroups: 1) women currently raising a child from an SVRP (parenting group) and 2) women who terminated an SVRP (termination group). Trained female research assistants conducted semi-structured interviews with a subset of women in a private setting and responses were manually recorded. Interview notes were translated and uploaded to a qualitative software program, coded, and thematic content analysis was conducted. RESULTS A total of 55 women were interviewed: 38 in the parenting group and 17 in the termination group. There were a myriad of expressed attitudes, beliefs, and emotional responses toward SVRPs and the termination of SVRPs with three predominant influences on decision-making, including: 1) the biologic, ethnic, and social identities of the fetus and/or future child; 2) social reactions, including fear of social stigmatization and/or rejection; and 3) the power of religious beliefs and moral considerations on women's autonomy in the decision-making process. CONCLUSION Findings from women who continued and women who terminated SVRPs reveal the complexities of decision-making related to SVRPs, including the emotional reasoning and responses, and the social, moral, and religious dimensions of the decision-making processes. It is important to consider these multi-faceted influences on decision-making for women with SVRPs in conflict-affected settings in order to improve provision of health services and to offer useful insights for subsequent programmatic and policy decisions.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3rd Floor, Boston, MA 02215 USA
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
| | - Monica A. Onyango
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 USA
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02115 USA
- Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5582, Albuquerque, NM 87131 USA
| | - Colleen Mullen
- Department of Psychiatry, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118 USA
| | - Shada Rouhani
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Sadia Haider
- Department of Obstetrics & Gynecology, University of Chicago, 5837 S. Maryland Avenue, Chicago, IL 60615 USA
| | - Katherine Albutt
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Ashley Greiner
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215 USA
| | - Michael VanRooyen
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Susan Bartels
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Department of Emergency Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
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Smith BEY, Bartz D, Goldberg AB, Janiak E. "Without any indication": stigma and a hidden curriculum within medical students' discussion of elective abortion. Soc Sci Med 2018; 214:26-34. [PMID: 30138842 DOI: 10.1016/j.socscimed.2018.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 07/01/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
Pregnancy termination is a common, beneficial medical procedure, but abortion care in the United States is stigmatized. Language, including categorization of some abortions as elective, may both reflect and convey stigma. We present a history of the term "elective" in reference to abortion, followed by data demonstrating its use by a sample of contemporary medical trainees and an analysis of the term's relationship to abortion stigma, medical training, and patient access to abortion care. We analyzed interviews with 41 U.S. medical students who had applied to residency programs in obstetrics and gynecology. Participants discussed experiences with, and attitudes toward, abortion before and during medical school, and plans to perform abortions in future practice. We inductively coded participants' use of "elective" in reference to abortion and analyzed their meanings. Participants did not use "elective" according to its medical definition, which conveys an absence of urgency for surgery. Instead, "elective" identified a subset of abortions that lacked maternal or fetal medical indications. "Elective" negatively marked and isolated some abortions, and participants used the term to convey judgment about patients' social and reproductive histories. Participants saw medical and psychosocial indications as mutually exclusive, and became confused when interrelated factors influenced patients' abortion decisions. They ignored the voluntary nature of abortion in the setting of medical illness, sexual violence, or fetal complications, and accepted discrimination against women seeking abortion for psychosocial indications as normal and ethical. The term "elective" enables the creation and perpetuation of abortion stigma, and contributes to a hidden curriculum for abortion training in medical education that distracts from core content, incorporates social judgment of patients into medical practice, and promotes normative gender concepts. Our findings support calls to improve the language of abortion care to ensure policies and training environments are consistent with professional standards.
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Affiliation(s)
| | - Deborah Bartz
- Harvard Medical School/Brigham and Women's Hospital, USA.
| | | | - Elizabeth Janiak
- Harvard Medical School/Brigham and Women's Hospital, Planned Parenthood League of Massachusetts, USA.
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Steyn C, Govender I, Velaphi Ndimande J. An exploration of the reasons women give for choosing legal termination of pregnancy at Soshanguve Community Health Centre, Pretoria, South Africa. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2018.1432138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - Indiran Govender
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University , Pretoria, South Africa
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Kjelsvik M, Sekse RJT, Moi AL, Aasen EM, Chesla CA, Gjengedal E. Women's experiences when unsure about whether or not to have an abortion in the first trimester. Health Care Women Int 2018; 39:784-807. [DOI: 10.1080/07399332.2018.1465945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marianne Kjelsvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Sciences in Aalesund, Norwegian University of Science and Technology (NTNU), Aalesund, Norway
| | - Ragnhild J. Tveit Sekse
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences (HVL), Bergen, Norway
- Department of Plastic Surgery and Burn Center, Haukeland University Hospital, Bergen, Norway
| | - Elin M. Aasen
- Department of Health Sciences in Aalesund, Norwegian University of Science and Technology (NTNU), Aalesund, Norway
| | - Catherine A. Chesla
- Family Health Care Nursing, University of California San Francisco, California USA
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health 2018; 108:407-413. [PMID: 29345993 DOI: 10.2105/ajph.2017.304247] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the socioeconomic consequences of receipt versus denial of abortion. METHODS Women who presented for abortion just before or after the gestational age limit of 30 abortion facilities across the United States between 2008 and 2010 were recruited and followed for 5 years via semiannual telephone interviews. Using mixed effects models, we evaluated socioeconomic outcomes for 813 women by receipt or denial of abortion care. RESULTS In analyses that adjusted for the few baseline differences, women denied abortions who gave birth had higher odds of poverty 6 months after denial (adjusted odds ratio [AOR] = 3.77; P < .001) than did women who received abortions; women denied abortions were also more likely to be in poverty for 4 years after denial of abortion. Six months after denial of abortion, women were less likely to be employed full time (AOR = 0.37; P = .001) and were more likely to receive public assistance (AOR = 6.26; P < .001) than were women who obtained abortions, differences that remained significant for 4 years. CONCLUSIONS Women denied an abortion were more likely than were women who received an abortion to experience economic hardship and insecurity lasting years. Laws that restrict access to abortion may result in worsened economic outcomes for women.
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Affiliation(s)
- Diana Greene Foster
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - M Antonia Biggs
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - Lauren Ralph
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - Caitlin Gerdts
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - Sarah Roberts
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - M Maria Glymour
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
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Diehl A, Pillon SC, Santos MAD, Laranjeira R. Abortion and sex-related conditions in substance-dependent Brazilian patients. CAD SAUDE PUBLICA 2017; 33:e00143416. [PMID: 29166482 DOI: 10.1590/0102-311x00143416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/06/2017] [Indexed: 01/27/2023] Open
Abstract
Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men). The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked), and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76), (OR = 1.7; 95%CI: 1.09-2.75) of no condom use; (OR = 2.0; 95%CI: 1.35-3.23) of history of STI and (OR = 3.2; 95%CI: 1.29-5.73) use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.
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Affiliation(s)
- Alessandra Diehl
- Unidade de Pesquisa em Álcool e Drogas, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Sandra Cristina Pillon
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Manoel Antonio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | - Ronaldo Laranjeira
- Unidade de Pesquisa em Álcool e Drogas, Universidade Federal de São Paulo, São Paulo, Brasil
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Cutler A, McNamara B, Qasba N, Kennedy HP, Lundsberg L, Gariepy A. "I Just Don't Know": An Exploration of Women's Ambivalence about a New Pregnancy. Womens Health Issues 2017; 28:75-81. [PMID: 29108986 DOI: 10.1016/j.whi.2017.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to examine how ambivalence manifests in women's lives after confirmation of a new pregnancy by exploring women's feelings, attitudes, and experiences regarding pregnancy intentions, the news itself, and related pregnancy decision making. STUDY DESIGN We recruited women aged 15 to 44 and at less than 24 completed weeks of gestational age from urban, walk-in pregnancy testing clinics in New Haven, Connecticut, from June 2014 to June 2015. We obtained quantitative and qualitative data via an enrollment survey and face-to-face, semistructured interviews, respectively. Transcripts were analyzed using framework analysis. RESULTS The sample included 84 women. Participants had a mean age of 26 years and were on average 7 weeks estimated gestational age at enrollment. Most identified as Black (54%) or Hispanic (20%), were unmarried (92%), and had at least one other child (67%). More than one-half (55%) described feelings of ambivalence regarding their current pregnancy. We identified ambivalence as a frequent and complex thread that represented distinct but overlapping perspectives about pregnancy: ambivalent pregnancy intentions, ambivalent response to new diagnosis of pregnancy, and ambivalence as uncertainty or conflict over pregnancy decision-making. Sources of ambivalence included relationship status, pregnancy timing, and maternal or fetal health problems. CONCLUSIONS This study improves on previous findings that focus only on ambivalence related to pregnancy intention or to decision making, and explores women's mixed, fluctuating, or unresolved feelings and attitudes about pregnancy before many participants had completed pregnancy decision making. Acknowledging and exploring sources of ambivalence regarding pregnancy may help health providers and policymakers to comprehensively support women with respect to both their experiences and reproductive goals.
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Affiliation(s)
- Abigail Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
| | | | - Neena Qasba
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | | | - Lisbet Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Aileen Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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Peek-Asa C, Saftlas AF, Wallis AB, Harland K, Dickey P. Presence of children in the home and intimate partner violence among women seeking elective pregnancy termination. PLoS One 2017; 12:e0186389. [PMID: 29023582 PMCID: PMC5638511 DOI: 10.1371/journal.pone.0186389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/29/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Growing evidence identifies adverse health effects for children who witness intimate partner violence at home. Research has also identified that women seeking elective pregnancy termination are at high risk for partner violence. However, little is known about the risk for violence exposure among the children of women seeking elective pregnancy termination. Methods We conducted a cross-sectional study of 957 women seeking elective pregnancy termination at a large family planning clinic. All subjects completed a 10-minute, anonymous questionnaire administered by computer in a private room. Our main outcome was 12-month prevalence of physical and/or sexual violence by a current or former partner using the Abuse Assessment Screen instrument. The presence of children under the age of 18 living with the respondent was the main exposure variable. Results Women with children in the home had more than twice the odds of reporting physical and/or sexual IPV in the past year than women with no children, controlling for age (AOR: 2.23; 95% CI: 1.41–3.85). The increased odds of IPV among women with children as compared to women with no children was present across nearly all sociodemographic and lifestyle characteristics, and significantly higher for the youngest women (18–20 years). The highest odds for abuse occurred among women with children living at home, in a current relationship but not living with their current partner, and abused by a former partner (AOR = 10.9; 95% CI: 3.07–38.4). Conclusion Nearly one of every 14 children identified in this study lived in a home with IPV. These findings support the development of IPV interventions that are family-centered, as well as the integration of trauma-informed care into healthcare settings. Healthcare visits for contraception and pregnancy termination may be ideal opportunities for implementation of screening and family violence interventions.
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Affiliation(s)
- Corinne Peek-Asa
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, United States of America
- * E-mail:
| | - Audrey F. Saftlas
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Anne B. Wallis
- Department of Epidemiology and Population Health, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, United States of America
| | - Karisa Harland
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Penny Dickey
- Planned Parenthood of the Heartland, Des Moines, IA, United States of America
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Lince-Deroche N, Fetters T, Sinanovic E, Blanchard K. Accessing medical and surgical first-trimester abortion services: women's experiences and costs from an operations research study in KwaZulu-Natal Province, South Africa. Contraception 2017; 96:72-80. [DOI: 10.1016/j.contraception.2017.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/21/2017] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
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Chae S, Desai S, Crowell M, Sedgh G. Reasons why women have induced abortions: a synthesis of findings from 14 countries. Contraception 2017; 96:233-241. [PMID: 28694165 PMCID: PMC5957082 DOI: 10.1016/j.contraception.2017.06.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/21/2017] [Accepted: 06/25/2017] [Indexed: 11/18/2022]
Abstract
Objective Many reasons inform women’s reproductive decision-making. This paper aims to present the reasons women give for obtaining induced abortions in 14 countries. Study design We examined nationally representative data from 14 countries collected in official statistics, population-based surveys, and facility-based surveys of abortion patients. In each country, we calculated the percentage distribution of women who have abortions by main reason given for the abortion. We examined these reasons across countries and within countries by women’s sociodemographic characteristics (age, marital status, educational attainment, and residence). Where data are available, we also studied the multiple reasons women give for having an abortion. Results In most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women’s sociodemographic characteristics. Data from three countries where multiple reasons could be reported in the survey showed that women often have more than one reason for having an abortion. Conclusion This study shows that women have abortions for a variety of reasons, and provides a broad picture of the circumstances that inform women’s decisions to have abortions. Implications Future research should examine in greater depth the personal, social, economic, and health factors that inform a woman’s decision to have an abortion as these reasons may shed light on the potential consequences that unintended births can have on women’s lives.
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Affiliation(s)
- Sophia Chae
- Guttmacher Institute, 125 Maiden Lane, New York, NY, USA
| | - Sheila Desai
- Guttmacher Institute, 125 Maiden Lane, New York, NY, USA.
| | | | - Gilda Sedgh
- Guttmacher Institute, 125 Maiden Lane, New York, NY, USA
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Rowe H, Holton S, Kirkman M, Bayly C, Jordan L, McNamee K, McBain J, Sinnott V, Fisher J. Abortion: findings from women and men participating in the Understanding Fertility Management in contemporary Australia national survey. Sex Health 2017. [PMID: 28637579 DOI: 10.1071/sh17004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background There are few reliable Australian abortion data. The aim was to investigate prevalence, sexual experiences and socioeconomic characteristics of women and men who report having had or being a partner in an abortion. METHODS A cross-sectional survey of women and men aged 18-50 years randomly selected from the Australian Electoral Roll was used. Weighted multivariable analyses were conducted. RESULTS Data from 2235 returned (of 15480) mailed surveys were analysed. One in six women and one in 10 men had experienced or been a partner in an abortion. In adjusted analyses, for women, experience of sexual coercion [adjusted odds ratio (AOR) 2.18, 95% confidence interval (CI) 1.46, 3.24] was associated with significantly increased odds of abortion, and socioeconomic advantage (AOR=0.57; 95% CI 0.39, 0.84), being comfortable negotiating contraceptive use (AOR 0.26; 95% CI 0.09, 0.73) and importance of religion in fertility choices (AOR=0.55; 95% CI 0.35, 0.87) were associated with significantly reduced odds. For men, sexual coercion (AOR=3.05; 95% CI 1.51, 6.18) and metropolitan residence (AOR=1.70; 95% CI 1.06, 2.75) significantly increased the odds of reporting being a partner in an abortion. CONCLUSIONS The findings contribute to scarce information about abortion in Australia. The high prevalence of abortion suggests that effective contraceptive counselling and accessible contraception services are not sufficient, and that there is a continuing need for universal pregnancy advice and abortion services. The association between sexual coercion and abortion warrants further investigation.
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Affiliation(s)
- Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Sara Holton
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Christine Bayly
- The Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia
| | - Lynne Jordan
- Family Planning Victoria, 901 Whitehorse Road, Box Hill, Vic. 3128, Australia
| | - Kathleen McNamee
- Family Planning Victoria, 901 Whitehorse Road, Box Hill, Vic. 3128, Australia
| | - John McBain
- Melbourne IVF, 344 Victoria Parade, East Melbourne, Vic. 3002, Australia
| | - Vikki Sinnott
- Victorian Government Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553St Kilda Road, Melbourne, Vic. 3004, Australia
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Kaplan YC, Karadaş B, Küçüksolak G, Ediz B, Demir Ö, Sozmen K, Nordeng H. Counselling pregnant women at the crossroads of Europe and Asia: effect of Teratology Information Service in Turkey. Int J Clin Pharm 2017. [PMID: 28626851 DOI: 10.1007/s11096-017-0496-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Previous studies from western countries demonstrated the effectiveness of Teratology Information Service (TIS) counselling in reducing the teratogenic risk perception of pregnant women. Objective To assess whether TIS counselling would be effective in reducing the teratogenic risk perception of the Turkish pregnant women. Setting A TIS (Terafar) operating in a university hospital in Turkey. Methods A cross-sectional survey study. Pregnant women with non-teratogenic medication exposures were asked to assign scores on visual analogue scales (VAS) in response to the questions aiming to measure their teratogenic risk perception. The mean score before and after counselling were compared and the associations with maternal socio-demographic characteristics were analysed using SPSS (Version 20.0). Main outcome measures The differences in the mean scores of the perception regarding the baseline risk of pregnancy, own teratogenic risk and the likelihood of termination of pregnancy before and after counselling and their possible associations with maternal socio-demographic characteristics. Results 102 pregnant women participated in the study. The counselling significantly reduced the mean own teratogenic risk perception score and the mean score for the likelihood of termination of pregnancy whereas the mean baseline risk perception score was not significantly changed. Pregnancy week <8 and the exposed number of active ingredients <3 were significantly associated with the difference in the mean score for the likelihood of termination of pregnancy. Conclusions TIS counselling lowers the teratogenic risk perception of Turkish pregnant women and increases their likelihood to continue the pregnancy as it does in the western countries.
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Affiliation(s)
- Yusuf Cem Kaplan
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey. .,Izmir Katip Celebi University School of Medicine Department of Pharmacology, Izmir, Turkey.
| | - Barış Karadaş
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey.,Izmir Katip Celebi University School of Medicine Department of Pharmacology, Izmir, Turkey
| | - Gözde Küçüksolak
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey
| | - Bartu Ediz
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey
| | - Ömer Demir
- Cordoba Saglik ve Danismanlik Ltd. Sti., Istanbul, Turkey
| | - Kaan Sozmen
- Izmir Katip Celebi University School of Medicine Department of Public Health, Izmir, Turkey
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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Uzoigwe CE. Socio-economics: Reduce inequality to reduce abortion. Nature 2017; 544:35. [PMID: 28382995 DOI: 10.1038/544035d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kirkman M, Apicella C, Graham J, Hickey M, Hopper JL, Keogh L, Winship I, Fisher J. Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer. BMC Womens Health 2017; 17:26. [PMID: 28381301 PMCID: PMC5382471 DOI: 10.1186/s12905-017-0383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/30/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer. METHODS Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory. RESULTS It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion. CONCLUSIONS The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.
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Affiliation(s)
- Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jillian Graham
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
| | - Martha Hickey
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - John L. Hopper
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Winship
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Kirkman M, Stubber C, Rowe H, Holton S, Bayly C, Jordan L, McBain J, McNamee K, Sinnott V, Fisher J. Subjective meanings of 'unintended' pregnancy: interviews from understanding fertility management in contemporary Australia. CULTURE, HEALTH & SEXUALITY 2017; 19:179-193. [PMID: 27684303 DOI: 10.1080/13691058.2016.1214287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Unintended pregnancy can be difficult to identify and conceptualise. We aimed to understand how unintended pregnancies are constructed, explained and situated in a reproductive life. A total of 41 women and 7 men aged 20-50 years were interviewed in depth. Transcripts were analysed using iterative hermeneutic techniques informed by narrative theory. Of 34 participants who had been pregnant or had a partner in pregnancy, 12 women and 1 man described 23 'unintended' pregnancies, about half of which ended in abortion. Their accounts reveal that an unintended pregnancy is identified subjectively, that the same pregnancy may be identified by one partner in the pregnancy as unintended and by the other as intended, and that a researcher's supposedly objective assessment of an unintended pregnancy may be inconsistent with the assessment of the woman who experienced it. A pejorative discourse was evident, predominantly among participants who did not report having an unintended pregnancy: women use an 'unintended' pregnancy to entrap men. Accounts from five participants reporting an unintended pregnancy were selected for illustration. An appreciation of the role such a pregnancy might play in an individual life requires a nuanced understanding of the complexity of human experience and a resistance to simple binary categorisation.
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Affiliation(s)
- Maggie Kirkman
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Claire Stubber
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Heather Rowe
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Sara Holton
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Chris Bayly
- b Royal Women's Hospital , Melbourne , Australia
| | - Lynne Jordan
- c Family Planning Victoria , Melbourne , Australia
| | | | | | - Vikki Sinnott
- e Victorian Government Department of Health , Melbourne , Australia
| | - Jane Fisher
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
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Access, equity and costs of induced abortion services in Australia: a cross-sectional study. Aust N Z J Public Health 2017; 41:309-314. [DOI: 10.1111/1753-6405.12641] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/01/2016] [Accepted: 10/01/2016] [Indexed: 11/26/2022] Open
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