The male partner involved in legal abortion

Abortion and sex-related conditions in substance-dependent Brazilian patients

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.

Enacted abortion stigma in the United States

RATIONALE

Abortion is a common medical procedure at the center of political debate. Yet, abortion stigma at the individual level is under-researched; the nascent research on abortion stigma has not yet documented enacted (experienced) stigma instead capturing anticipated or internalized stigma.

OBJECTIVE

This study documents how women and men who disclosed abortions perceived others' reactions and determinants of those perceptions.

METHOD

The study uses the American Miscarriage and Abortion Communication Survey, a survey representative of American-resident adults. Data from the sub-sample who had personal experience with abortion were analyzed (total sample, N = 1640; abortion disclosure sub-sample, n = 179). The survey captured each disclosure of the most recent abortion. Respondents had eight possible choices for articulating how the listener reacted. Cluster analyses grouped these reactions. Multinomial logistic regression identified predictors of the perceived reactions. Ordinal logistic regression revealed which disclosers perceived exclusively negative reactions, exclusively positive reactions, and a mix of negative and positive reactions.

RESULTS

Each disclosure fell into one of three clusters: negative reaction, supportive reaction or sympathetic reaction. The majority of abortion disclosures received largely positive reactions (32.6% were characterized as supportive and 40.6% were characterized as sympathetic). A substantial minority of disclosures received a negative reaction (26.8%). The perceived valence of the reaction is predicted, in part, by to whom the disclosure was made and why. Across all their disclosures, most people disclosing an abortion history perceived only positive reactions (58.3%). A substantial minority of people perceived either exclusively negative reactions (7.6%) or a mix of negative and positive reactions (34.1%). Ordinal logistic regression (with people as the unit of analysis) showed perceived reactions are predicted by the number of disclosures made and the revealer's race and income.

CONCLUSION

Whereas most people disclosing an abortion received support or sympathy, a substantial minority received stigmatizing reactions, which could plausibly have a negative impact on health.

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.

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.

[Decision making for termination of pregnancies and the pre-abortion period in the context of women's mental health]

Based on statistical figures of the past 30 years, the number of induced abortions in Hungary is constantly decreasing. However, compared to the number of live births, even today approximately one third of pregnancies conceived eventuate in termination. Various international studies confirm the negative consequences of the intervention exerting influence on women's mental health. The aim of this publication is to give a summary on the psychological aspects of the decision making process in the pre-abortion period, from the diagnosis of pregnancy to the surgical intervention. The authors present a detailed overview on the background for the reasons of the decision, the stages of the period from conception until termination, as well as factors related to difficulties in decision making, and possible psychological consequences.

Knowledge and attitudes of Swedish politicians concerning induced abortion

OBJECTIVE

Induced abortion is more frequent in Sweden than in many other Western countries. We wanted to investigate attitudes and knowledge about induced abortion among politicians responsible for healthcare in three Swedish counties.

METHOD

A study-specific questionnaire was sent to all 375 elected politicians in three counties; 192 (51%) responded.

RESULTS

The politicians stated that they were knowledgeable about the Swedish abortion law. More than half did not consider themselves, in their capacity as politicians, sufficiently informed about abortion-related matters. Most politicians (72%) considered induced abortion to be primarily a 'women's rights issue' rather than an ethical one, and 54% considered 12 weeks' gestational age an adequate upper limit for induced abortion. Only about a third of the respondents were correctly informed about the number of induced abortions annually carried out in Sweden.

CONCLUSION

Information and knowledge on induced abortion among Swedish county politicians seem not to be optimal. Changes aimed at reducing the current high abortion rates will probably not be easy to achieve as politicians seem to be reluctant to commit themselves on ethical issues and consider induced abortion mainly a women's rights issue.

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.

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.

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.

Decision-making about reproductive choices among individuals at-risk for Huntington's disease

We explored how individuals at-risk for HD who have or have not been tested make reproductive decisions and what factors are involved. We interviewed 21 individuals (8 with and 4 without the mutation, and 9 un-tested) in-depth for 2 hours each. At-risk individuals faced a difficult series of dilemmas of whether to: get pregnant and deliver, have fetal testing, have pre-implantation genetic diagnosis, adopt, or have no children. These individuals weighed competing desires and concerns: their own desires vs. those of spouses vs. broader moral concerns (e.g., to end the disease; and/or follow dictates against abortion) vs. perceptions of the interests of current or future offspring. Quandaries arose of how much and to whom to feel responsible. Some changed their perspectives over time (e.g., first "gambling," then being more cautious). These data have critical implications for genetic counselors and other health care workers and future research, particularly as more genetic tests become available.

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.

Abortion rate and contraceptive practices in immigrant and native women in Sweden

AIM

The aim of this study was to analyse whether immigrant women request induced abortion more frequently than Swedish-born women and, if so, to study possible explanations, including contraceptive practices and attitudes.

METHODS

All women who requested induced abortion during a period of one year were included in the study. The 1289 women, of whom 36% were born outside Sweden, were interviewed by a nurse-midwife who, using a structured protocol, gathered information on socioeconomic factors, reasons for abortion, experience of contraceptive methods, and family planning counselling. The proportion of women with non-Swedish origin in the study population was compared with the official demographic statistics of the corresponding area.

RESULTS

The number of women born outside Sweden who requested induced abortion was larger than expected from their proportion in the population. The immigrant women originated from 77 countries and four continents, the largest subgroup, 11%, coming from Iran. Immigrant women had less experience of contraceptive use, more previous pregnancies and more induced abortions than women born in Sweden. In a multivariate analysis, immigrant status and educational level were found to be independent risk factors for repeat abortion.

CONCLUSION

Immigrant status seems to be an independent risk factor for induced abortion. The immigrant women originated from a wide range of cultures. There is no reason to believe that the women in this heterogeneous group should have any cultural factor in common that could explain their higher proneness to seek induced abortion. The most probable cause is that immigrant status is associated more often with low education, weak social network, poverty, unemployment, and being outside common pathways to healthcare.

Wellbeing and mental growth—long-term effects of legal abortion

The present study aims to increase knowledge about coping with legal abortion by studying women's reasoning, reactions and emotions over a period of 1 year. The study comprises interviews focusing on the experiences and effects of abortion in 58 women, 4 and 12 months after the abortion. The women also answered a questionnaire before the abortion concerning their living conditions, decision-making process and feelings about the pregnancy and the abortion. Majority of the women did not experience any emotional distress post-abortion and almost all the woman reported that they had coped well at the 1-year follow-up, although 12 had had severe emotional distress directly post-abortion. Furthermore, almost all described the abortion as a relief or a form of taking responsibility and more than half reported only positive experiences such as mental growth and maturity of the abortion process. Those without any emotional distress post-abortion stated clearly before the abortion that they did not want to give birth since they prioritised work, studies and/or existing children. The study shows that women generally are able to make the complex decision to have an abortion without suffering any subsequent regret or negative effects, as ascertained at the 1-year follow-up.

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

BACKGROUND

in general, men involved in legal abortion constitute an invisible group and there is scarcely any knowledge about their experiences and opinions. Therefore, the aim of the present study was to increase knowledge about reactions and reflections by means of a prospective study of men's attitudes and feelings towards abortion.

METHODS

twenty-six men answered a questionnaire before abortion, and participated in interviews at the time of abortion and 4 and 12 months post-abortion.

RESULTS

nearly all of the men were happy with the women's decision to have an abortion at both follow-ups. They experienced the abortion as a relief and a responsible act. Simultaneously, abortion could also be experienced as a painful and ethically problematic act. Overall, most men had only positive experiences post- abortion, such as a feeling of maturity. More than half of those who accompanied their partners to the hospital felt that the staff did not have a welcoming attitude. It was also found that 1-year post-abortion, more than a third consistently did not use a reliable contraceptive method.

CONCLUSIONS

there is a need for further studies concerning men's experiences and reactions in the context of abortion and it is of fundamental importance that a gender perspective is incorporated into this specific field of reproductive health research.

Abortion and psychiatric practice

The subject of abortion is fraught with politics, emotions, and misinformation. A widespread practice reaching far back in history, abortion is again in the news. Psychiatry sits at the intersection of the religious, ethical, psychological, sociological, medical, and legal facets of the abortion issue. Although the religions that forbid abortion are more prominent in the media, many religions have more liberal approaches. While the basic right to abortion has been upheld by the U.S. Supreme Court, several limitations have been permitted, including parental notification or consent (with the possibility of judicial bypass) for minors, waiting periods, and mandatory provision of certain, sometimes biased, information. Before the Roe v. Wade decision legalizing abortion in 1973, many women were maimed or killed by illegal abortions, and psychiatrists were sometimes asked to certify that abortions were justified on psychiatric grounds. Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae. The psychiatric outcome of abortion is best when patients are able to make autonomous, supported decisions. Psychiatrists need to know the medical and psychiatric facts about abortion. Psychiatrists can then help patients prevent unwanted pregnancies, make informed decisions consonant with their own values and circumstances when they become pregnant, and find appropriate social and medical resources whatever their decisions may be.

Legal abortion: a painful necessity

This study was conducted to increase knowledge about the psychosocial background and current living conditions of Swedish women seeking abortion, along with their motives for abortion and their feelings towards pregnancy and abortion. Two hundred and eleven women answered a questionnaire when they consulted the gynaecologist for the first time. The study indicates that legal abortion may be sought by women in many circumstances and is not confined to those in special risk groups. For example, most women in the sample were living in stable relationships with adequate finances. The motives behind a decision to postpone or limit the number of children revealed a wish to have children with the right partner and at the right time in order to combine good parenting with professional career. The study shows that prevailing expectations about lifestyle render abortion a necessity in family planning. One-third of the women had had a previous abortion(s) and 12% had become pregnant in a situation where they had felt pressured or threatened by the man. Two-thirds of the women characterised their initial feelings towards the pregnancy solely in painful words while nearly all the others reported contradictory feelings. Concerning feelings towards the coming abortion, more than half expressed both positive and painful feelings such as anxiety, relief, grief, guilt, anguish, emptiness and responsibility, while one-third expressed only painful feelings. However, almost 70% stated that nothing could change their decision to have an abortion. Thus, this study highlights that contradictory feelings in relation to both pregnancy and the coming abortion are common but are very seldom associated with doubts about the decision to have an abortion.

Ambivalence--a logical response to legal abortion: a prospective study among women and men

The aim of the study was to elucidate ambivalence in relation to legal abortion by studying emotions, attitudes, motives for abortion and ethical reasoning in a strategic sample of women and men who, 1 year after abortion, expressed both positive and painful feelings in relation to the abortion. The study shows that social perspectives legitimate the decision to have an abortion whilst ethical perspectives complicate the decision. Nearly all women and men described having the abortion as an expression of responsibility. Almost one-half also had parallel feelings of guilt, as they regarded the abortion as a violation of their ethical values. The majority of the sample expressed relief while simultaneously experiencing the termination of the pregnancy as a loss coupled with feelings of grief/emptiness. In spite of the ambivalence, only one woman regretted the abortion. For the vast majority, the impact of the abortion had led to increased maturity and deepened self-knowledge. Thus, ambivalence might be regarded not only as problematic but also as indicating openness to the complexity of the abortion issue. Since incompatible values clash in connection with abortion, experiences of ambivalence become both logical and understandable.