Reactions and reflections in men, 4 and 12 months post-abortion

Men's and women's roles in decision making about abortion in the context of HIV

OBJECTIVE

Mother-to-child transmission of HIV is a matter of global concern but is particularly serious in Zimbabwe. A number of strategies have been identified to limit the risk of mother-to-child transmission, including abortion. The aim of the current study was to assess men's and women's roles in decision making about abortion in a setting with a high prevalence of HIV.

METHODS

Qualitative research based on eight focus group discussions was conducted among adult men and women in Gokwe North District, Zimbabwe.

RESULTS

Both men and women expressed strong, negative attitudes towards abortion. Often, HIV-infected women considered carrying their pregnancy to term so as to fulfil societal and cultural expectations of childbirth after marriage. Termination of pregnancy by HIV-infected women was discouraged due to the availability of highly active antiretroviral drugs. Fear of giving birth to a sick and HIV-infected child, however, remained high. Also, the restricted legal environment appeared to complicate HIV-positive women's decisions to abort. Male involvement in decision making about abortion was relatively limited; if women opted for termination of pregnancy they were likely to do so secretly without obtaining their partner's consent.

CONCLUSIONS

In the context of HIV, it is important for prevention programmes to target both men and women in order to reduce the risk of mother-to-child transmission.

Men and talk about legal abortion in South Africa: equality, support and rights discourses undermining reproductive 'choice'

Discursive constructions of abortion are embedded in the social and gendered power relations of a particular socio-historical space. As part of research on public discourses concerning abortion in South Africa where there has been a radical liberalisation of abortion legislation, we collected data from male group discussions about a vignette concerning abortion, and newspaper articles written by men about abortion. Our analysis revealed how discourses of equality, support and rights may be used by men to subtly undermine women's reproductive right to 'choose' an abortion. Within an Equal Partnership discourse, abortion, paired with the assumption of foetal personhood, was equated with violating an equal heterosexual partnership and a man's patriarchal duty to protect a child. A New Man discourse, which positions men as supportive of women, was paired with the assumption of men as rational and women as irrational in decision-making, to allow for the possibility of men dissuading women from terminating a pregnancy. A Rights discourse was invoked to suggest that abortion violates men's paternal rights.

Home abortion - experiences of male involvement

OBJECTIVE

To gain knowledge about the male partner's experience of being present during an induced home abortion.

METHODS

Twenty-three couples, whose male partner had been present when the woman aborted at home, were interviewed one to two weeks post-abortion.

RESULTS

Each of the men supported his partner in her decision to have a home abortion, as this gave him the possibility of being near and of caring for her needs on the expulsion day. All the men were present and all their partners confirmed that they had been supportive. Half the men had been anxious prior to the expulsion, but most considered that their experiences during the expulsion had been 'easier than expected' and their dominant feeling was one of relief.

CONCLUSIONS

Abortion is an important life event. When taking place at home, it increases the possibility for the couple to share the experience. Sharing an abortion may have a positive impact on those men who lack a sense of responsibility regarding reproductive issues, such as contraceptive use. This could facilitate society's efforts to involve men as a target group in this field. Designing an abortion policy that caters for the needs of both partners is a challenge.

Existential experiences and needs related to induced abortion in a group of Swedish women: a quantitative investigation

OBJECTIVE

To investigate the prevalence of existential experiences and needs among women who have requested an induced abortion.

METHODS

A questionnaire was used to collect information from 499 women who had requested an induced abortion. A principle component analysis resulted in three components of existential experiences and needs: existential thoughts, existential practices, and humanisation of the foetus. These components were analysed in relation to background data and other data from the questionnaire.

RESULTS

Existential experiences and needs were common. For 61% of women existential thoughts about life and death, meaning and morality were related to the abortion experience. Almost 50% of women reported a need for special acts in relation to the abortion; 67% of women thought of the pregnancy in terms of a child. A higher presence of existential components correlated to difficulty in making the abortion decision and poor psychological wellbeing after the abortion.

CONCLUSION

Women's experiences of abortion can include existential thoughts about life, death, meaning and morality, feelings of attachment to the foetus, and the need for symbolic expression. This presents a challenge for abortion personnel, as the situation involves complex aspects over and above medical procedures and routines.

Using Prolonged Exposure to Treat Abortion-Related Posttraumatic Stress Disorder in Alcohol Dependent Men: A Case Study

Men's reactions to a partner's abortion are an understudied area. Few studies have examined abortion as it relates to posttraumatic stress disorder (PTSD) in males, and no studies have examined the use of an empirically supported behavioral treatment for PTSD in this population. The current case study examines Prolonged Exposure for the treatment of abortion-related PTSD in a 46-year old Caucasian male who also has alcohol dependence. The patient was involved in a residential substance abuse treatment program at the time of treatment. After receiving 12 sessions of Prolonged Exposure, the patient experienced a decrease in PTSD symptoms as measured by the Clinician Administered PTSD Rating Scale (87%) and Impact of Event Scale-Revised (85%). The results of this study suggest that the literature supporting Prolonged Exposure as a first-line treatment for PTSD can be expanded to include men needing treatment for abortion-related PTSD. Implications for treatment and research are discussed.

Man's involvement in the experience of abortion and the dynamics of the couple's relationship: a clinical study

OBJECTIVES

To investigate the way men experience abortion from a psychodynamic perspective in order to understand better the impact of this experience on their own image as men and on the couple's relationship.

METHODS

In-depth semi-structured interviews with 16 men in Belgium and 14 men in Greece.

RESULTS

Intrapsychic factors seem to play for men an important role in their experience of abortion, whatever their cultural context and contraceptive practices. Two-thirds of the men who agreed to participate in the research disagreed with their partner's decision to have an abortion. Such men may feel that it is impossible for them to fulfill themselves, in particular as potential fathers. This impossibility is, according to men, linked to women's attitudes, but may also be related to their own difficult identification with parental images and to socio-professional concerns.

CONCLUSIONS

Abortion can create tensions and/or conflicts between partners by revealing their contradictory desires. It is suggested that institutions where men and women are heard can help both partners to outlive this experience as a constructive step in their personal psychosocial evolution and in their relationship.

Induced abortion and intimate relationship quality in the Chicago Health and Social Life Survey

OBJECTIVES

To examine associations between abortion and relationship functioning.

STUDY DESIGN

Independent variables included abortion in a previous relationship and abortion in a current relationship. Perceptions of quality-of-life changes associated with terminating the relationship, conflict, aggressiveness and sexual dysfunction were the outcome measures.

METHODS

Data were derived from interviews with an ethnically diverse urban sample of men (n=658) and women (n=906). Surveys were conducted in person using computer-assisted personal interview technology by the National Opinion Research Center affiliated with the University of Chicago, USA.

RESULTS

For men and women, the experience of an abortion in a previous relationship was related to negative outcomes in the current relationship; perceptions of improved quality of life if the current relationship also ended and intimate partner violence. Experience of an abortion within a current relationship was associated with 116% and 196% increased risk of arguing about children for women and men, respectively. Among females, experience of an abortion within a current relationship was associated with increased risk for various forms of sexual dysfunction (122-182%), increased risk of arguments about money (75%), increased risk of conflict about the partner's relatives (80%), and increased risk of arguing about the respondent's relatives (99%). Men whose current partners had experienced an abortion were more likely to report jealousy (96% greater risk) and conflict about drugs (385% greater risk).

CONCLUSION

Abortion may play a vital role in understanding the aetiology of relationship problems.

Supporting the significant other in women undergoing abortion

Abortion remains an ethical, legal and professional challenge to nurses. In the last decade there have been many innovations in abortion care and nurses have developed woman-centred, responsive services. Despite this progress, the needs of significant others - particularly partners attending with women - have yet to be fully met. A significant other is encouraged to stay with the woman during certain parts of the procedure if it is a surgical abortion, or may remain with the woman continuously during a medical abortion. There are benefits in encouraging significant others to stay with the woman, including the provision of additional support during the procedure as well as health promotion opportunities. The nurse has a vital function in assisting them in their role, as it is essential that significant others are adequately prepared and supported throughout. Providing they are managed proactively, involving significant others in supporting the woman undergoing abortion is commended.

Experiences of abortion: a narrative review of qualitative studies

BACKGROUND

Although abortion or termination of pregnancy (TOP) has become an increasingly normalized component of women's health care over the past forty years, insufficient attention has been paid to women's experiences of surgical or medical methods of TOP.

OBJECTIVE

To undertake a narrative review of qualitative studies of women's experiences of TOP and their perspectives on surgical or medical methods.

METHODS

Keyword searches of Medline, CINAHL, ISI, and IBSS databases. Manual searches of other relevant journals and reference lists of primary articles.

RESULTS

Qualitative studies (n = 18) on women's experiences of abortion were identified. Analysis of the results of studies reviewed revealed three main themes: experiential factors that promote or inhibit the choice to seek TOP; experiences of TOP; and experiential aspects of the environment in which TOP takes place.

CONCLUSION

Women's choices about TOP are mainly pragmatic ones that are related to negotiating finite personal and family and emotional resources. Women who are well informed and supported in their choices experience good psychosocial outcomes from TOP. Home TOP using mifepristone appears attractive to women who are concerned about professionals' negative attitudes and lack of privacy in formal healthcare settings but also leads to concerns about management and safety.

Increased contraceptive use one year post-abortion

BACKGROUND

The aim of the study was to investigate the impact of abortion on contraceptive use, partner relationship and sexual satisfaction.

METHODS

In a longitudinal study, 58 women answered a pre-abortion questionnaire and participated in two interviews, one in connection with the abortion and a second 1 year later.

RESULTS

Most women (40/58) had retained the same partner 1 year after the abortion. More than half of these (22/40) experienced no change in the quality of the partner relationship, while the rest (18/40) had deepened their relationship. Furthermore, the majority of the women (45/58) had not experienced any negative influence on their sexual satisfaction. Most women who were sexually active 1 year post-abortion (42/47) used some contraceptive method; the number who used hormonal methods or intrauterine devices had, for example, increased from four to 35, although one-third of them had been doubtful about these methods before abortion. Conversely, 15 women had tried these methods during the follow-up year but had not continued because of negative effects. Overall, contraceptive use 1 year post-abortion had increased.

CONCLUSIONS

To achieve well-founded decisions about contraceptives, counsellors should be aware of women's ambivalence about the use of modern, effective contraceptive methods. In order to prevent abortion it is important to discuss gender differences in sexual behaviour and encourage communication with both sexes about the pros and cons of coitus-dependent and coitus-independent methods.