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

The role of change in fertility desire on change in family planning use: A longitudinal investigation in urban Uttar Pradesh, India

Background: Reproductive choice is one of the rights of any woman, but women are often ambivalent towards fertility desires and choice of contraception. Our study explores how the change in fertility desires influence the change in use of modern contraception over time in six cities of Uttar Pradesh, India. Methods : Data for this study comes from the Measurement, Learning and Evaluation (MLE) Project for Urban Health Initiative in six cities of Uttar Pradesh. Our study sample consists of 8735 women (weighted n=8655) who were fertile, non-sterilized and non-pregnant at the time of baseline survey. Potential bias due to lost to follow up was addressed using inverse probability weighing and then generalized estimating equations were applied to get odds for change in use of modern contraceptives.  Results: Contraceptive use increased by different magnitudes from baseline to endline across all six cities. At baseline and endline, women who desired no more children reported a higher use of modern contraception than those who desired more children over time. Women from all cities who desired no more children at baseline had higher odds of modern contraceptive use than that of women who desired more children. The tempo of change in use of modern contraception over time among women with different fertility desires differed across the considered cities. Conclusion : Although there were city-wise differences observed, women's fertility intentions have an impact on their use of modern contraceptives over the time period between baseline to endline. To obtain greater insight into city-level differences, mixed method studies will be more effective.

The role of change in fertility desire on change in family planning use: A longitudinal investigation in urban Uttar Pradesh, India

Background: Reproductive choice is one of the rights of any woman, but women are often ambivalent towards fertility desires and choice of contraception. Our study explores how the change in fertility desires influence the change in use of modern contraception over time in six cities of Uttar Pradesh, India. Methods: Data for this study comes from the Measurement, Learning and Evaluation (MLE) Project for Urban Health Initiative in six cities of Uttar Pradesh. Our study sample consists of 8735 women (weighted n=8655) who were fertile, non-sterilized and non-pregnant at the time of baseline survey. Potential bias due to lost to follow up was addressed using inverse probability weighing and then generalized estimating equations were applied to get odds for change in use of modern contraceptives.  Results: Contraceptive use increased by different magnitudes from baseline to endline across all six cities. At baseline and endline, women who desired no more children reported a higher use of modern contraception than those who desired more children over time. Women from all cities who desired no more children at baseline had higher odds of modern contraceptive use than that of women who desired more children. The tempo of change in use of modern contraception over time among women with different fertility desires differed across the considered cities. Conclusion: Although there were city-wise differences observed, women’s fertility intentions have an impact on their use of modern contraceptives over the time period between baseline to endline. To obtain greater insight into city-level differences, mixed method studies will be more effective.

Defence Mechanisms and Coping Strategies among Caregivers in Palliative Care Units

This article focuses on the relationship between defence mechanisms, coping strategies, palliative attitude, and the well-being of caregivers in palliative care units, who are confronted with death, suffering, and pain. They use many different defence mechanisms; however, studies linking their coping strategies and defence mechanisms are rare. This study uses a quantitative and qualitative design and is based on 18 caregivers (nurses) in 2 palliative care units in Belgium. Defence mechanisms are tested through a semi-structured interview, TAT, and DSQ-60. Coping strategies are evaluated through a semi-structured interview, COPE, and WCQ. To maximize our global approach, coping strategies and defence mechanisms are associated with measures of well-being and palliative attitude. We determined that defence mechanisms and coping strategies should not be seen as obstacles to professional practices. Palliative caregivers are more likely to adopt “mature” and “mental inhibition and compromise formation” defence mechanisms, as well as “emotion-focused” and “problem-focused” coping strategies. Defence mechanisms are more unconscious and constitute appropriate answers in extreme emotional situations. Coping strategies allow for more conscious processes of adaptation to the environment of palliative care units. This study shows positive relationships between different defence mechanisms and coping strategies, palliative attitudes, and caregivers’ well-being. Institutions should improve the conditions for group exchange and for caregivers’ individual introspection so that care-givers develop adapted capacities to cope with anxiety.

The decision to have an abortion from both partners' perspectives: a dyadic analysis

OBJECTIVES

Male partners are often involved in induced abortion although they have no legal rights. It is, however, unknown how women's thoughts and feelings regarding the decision for abortion are associated with the decisional experiences of the involved male partners and vice versa.

METHODS

Flemish women and their involved male partners (IMP) filled out a questionnaire on abortion motives and feelings of decisiveness in the abortion centre waiting room (N = 106 couples). Actor Partner Interdependence Models investigated whether the decisiveness of one partner was associated with a subjective feeling of autonomy (high internal, low external abortion motivation) and decisiveness of the other partner, above and beyond the own feeling of autonomy and personal vulnerabilities for being uncertain.

RESULTS

Partner congruence in motivation and decisiveness was substantial (r= 0.23 to 0.42), especially for cohabiting partners. The IMPs were less internally motivated for the abortion than the women but both partners reported more internal than external motives, and they both tended to feel certain. In contrast to the women, a higher subjective feeling of autonomy in the IMPs was not associated with feeling more certain. When accounting for partners' living situation, levels of uncertainty were not only associated with personal vulnerabilities for being uncertain, but were also related to the degree of uncertainty and subjective level of autonomy of the other partner.

CONCLUSIONS

Partners' thoughts and feelings regarding the decision for abortion partially have an interpersonal basis and mostly run parallel despite an inherent gender difference in level and importance of decision autonomy.

Men’s Perceptions Concerning Disclosure of a Partner’s Abortion: Implications for Counseling

Utilizing an online survey, adult male partners of women who underwent induced abortion were queried concerning the men’s disclosure of the experience to others. Responses were obtained from 101 men who identified positive and negative aspects related to their disclosure. Positive aspects included: relief, spiritual benefits, support, acceptance, empathy, forgiveness, helping others, acknowledgment of child, and increased understanding. Negative aspects included: lack of empathy, pain of facing reality, lack of resolution, and condemnation. For this group of men, disclosure was perceived positively more often than negatively. Implications for counseling are discussed.

Abortion attitudes in context: a multidimensional vignette approach

The effects of relationship status, rationale for considering abortion (life circumstance versus health issue), and the male partner's wishes on abortion attitudes were examined using a multiple-segment factorial vignette with a probability sample of 532 Kentucky households. Respondents expressed strong opinions in the absence of contextual details, yet many shifted the direction of their strongly-held positions once contextual information was revealed that challenged their initial assumptions. Results confirm and extend prior research by indicating that attitudes are strongly held but are simultaneously highly responsive to context. The validity of surveys and polls that attempt to measure global attitudes toward abortion, such as pro-choice versus pro-life, in the absence of contextual details is therefore questioned. The full context of one's life and situation is weighed in the abortion decision-making process, and our findings indicate that attitudes toward abortion are largely responsive and reflective of that context as well.

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.

'Without a plan' but 'keeping on track': views on contraception, pregnancy and abortion in Mexico City

Despite increased use of modern contraception among Mexican women, there has been a significant increase in abortions. Little is known about the experiences behind these trends. This study examines decision-making around contraception, pregnancy, childbearing and abortion. We carried out 26 in-depth interviews with 23- to 35-year-old females and males in Mexico City. Interviewees described reproductive planning 'without a plan' and sporadic contraceptive use. Linking of reproductive preferences and contraceptive use occurred only after raising a child for a few years or after experiencing an abortion. Interviewees described side effects of hormonal contraceptives and the intrauterine device (IUD) and problems with condoms. Only 8% of participants disagreed with abortion completely. Those with mixed views opposed abortion for pregnancies resulting from lack of responsibility or due to personal problems or concerns about one's future. However, these more controversial reasons were the primary motivations for terminating pregnancies. Females and males expressed that females made most decisions related to contraception, pregnancy and abortion. Further research could explore the reasons behind reproductive planning 'without a plan', 'on and off' contraceptive use and abortion beliefs and experiences that are somewhat contradictory.

Managing unplanned pregnancies in five countries: perspectives on contraception and abortion decisions

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.