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Demont C, Dixit A, Foster AM. Later Gestational Age Abortion in Canada: A Scoping Review. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2023. [DOI: 10.3138/cjhs.2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Since the decriminalization of abortion in Canada in 1988, there have been no legal restrictions on when in pregnancy an abortion can take place. However, abortion care is only consistently available in Canada up to 23 weeks and 6 days; women, transgender men, and gender non-binary individuals who need abortion care after 24 weeks typically obtain services in the United States. Furthermore, abortion care beyond 16 weeks is unavailable in some regions of the country. The authors undertook this scoping review to explore what is currently known about later gestational age abortion in Canada. Using a six-stage framework, they identified 32 relevant sources that were published in the last 30 years, and they consulted with seven topic experts to validate the findings from our document synthesis. The limited body of literature on abortion after 16 weeks in Canada sheds light on the safety of both medical and instrumentation procedures, the type and training of abortion-providing clinicians, the characteristics of those obtaining abortion care after the first trimester, and geographic disparities in service availability. These topic experts emphasized the need for future research on patient experiences and developing and implementing strategies to help provinces and territories expand abortion care to later gestational ages and improve comprehensive reproductive health services.
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Affiliation(s)
- Carly Demont
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Anvita Dixit
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- National Abortion Federation, Victoria, British Columbia, Canada
| | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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Heinsen LL. Shouldering Death: Moral Tensions, Ambiguity, and the Unintended Ramifications of State-sanctioned Second-trimester Selective Abortion in Denmark. Med Anthropol Q 2022; 36:515-533. [PMID: 35819201 PMCID: PMC10084180 DOI: 10.1111/maq.12717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article is based on an ethnographic study of pregnant couples' embodied, emotional, and moral experiences of second-trimester selective abortion in Denmark. Drawing on 16 selective abortion stories, I unpack the intense, often highly accelerated, days that follow from the moment a fetal aberration is detected to the moment of fetal disposal or burial. I show that although prenatal screening and diagnostics have come to occupy a routinized part of pregnancy in Denmark, when women and their partners opt for termination, they are faced with a series of bodily events and actions they are entirely unprepared for while at the same time feeling essentially alone in grappling with the moral confusion that ensues. I argue that despite widespread medico-legal sanctioning and social endorsement of selective abortion, the specificities of how such terminations are done in Denmark in ambiguous, and conflicted, ways situate women and their partners in a series of moral tensions around how to relate to the abortion, the dead fetus, their grief, and their entitlement to such mourning. By chronicling the core struggles that the process of termination catalyzes, I point to the social and moral ramifications of the embodied practices and medico-legal choreographing of selective abortion in Denmark. [selective abortion, moral tensions, embodied practices, responsibility, death].
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Heaney S, Tomlinson M, Aventin Á. Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents. BMC Pregnancy Childbirth 2022; 22:441. [PMID: 35619067 PMCID: PMC9137204 DOI: 10.1186/s12884-022-04770-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/16/2022] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly. REVIEW QUESTION What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly? METHODS A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis. RESULTS A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience. CONCLUSION Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service. TRIAL REGISTRATION PROSPERO registration number: CRD42020175970 .
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland.
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland
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Lou S, Hvidtjørn D, Jørgensen ML, Vogel I. "I had to think: This is not a child." A qualitative exploration of how women/couples articulate their relation to the fetus/child following termination of a wanted pregnancy due to Down syndrome. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100606. [PMID: 33618259 DOI: 10.1016/j.srhc.2021.100606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Termination of a wanted pregnancy due to fetal anomaly may generate complex feelings of grief and loss. The aim of this study was to explore the different ways that women/couples articulated their relation to the fetus/child following a termination of pregnancy due to a prenatal diagnosis of Down syndrome. METHOD Qualitative interview study with 21 women/couples who had recently terminated a wanted pregnancy. Data were analyzed using thematic analysis. RESULTS The analysis identified how some women detached themselves from the fetus/child following the diagnosis by mentally separating from the fetus/child, by acting as if they were not pregnant (e.g., by drinking wine), or by deliberately using the term 'fetus' to designate the fetus/child as a biological entity. The analysis also identified accounts of attachment such as singing a lullaby to the fetus/child or using the term 'our child' or 'my baby'. However, accounts of detachment and attachment often intermingled and changed over time. Following the termination, many women/couples felt ambiguous about the sonogram as a symbol of the potential child. Overall, the analysis showed that the relation to and the meaning of the fetus/child was ambiguous and open to reinterpretation. CONCLUSION The main contribution of this study is the identification of how articulations of attachment and detachment are not mutually exclusive but coexist and may change over time. Furthermore, we argue that detachment does not equal indifference. Thus, healthcare professionals must support the couple in finding a terminology and a narrative that are meaningful for them.
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Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.
| | - Dorte Hvidtjørn
- Perinatal Loss Unit, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Research, Health, University of Southern Denmark, Odense, Denmark
| | - Mathilde L Jørgensen
- Perinatal Loss Unit, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Jørgensen ML, Prinds C, Mørk S, Hvidtjørn D. Stillbirth - transitions and rituals when birth brings death: Data from a danish national cohort seen through an anthropological lens. Scand J Caring Sci 2021; 36:100-108. [PMID: 33576029 DOI: 10.1111/scs.12967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many parents bereaved of a stillborn baby spend time with the child. In this time frame, different acts with the child in focus may occur. Some parents invite others to see the child too. Parents who suffer the loss of a newborn are vulnerable, and understanding acts and practices surrounding the dead newborn is important knowledge for caretakers. AIMS This article aims to enlighten the amount of time Danish parents spend with their stillborn in hospital settings that encourage this practice. Furthermore, it aims to transcend the mere quantitative numbers through a theoretical approach that frames the analysis and discussion of possible layers of meaning imbedded in time spent with a dead newborn. STUDY DESIGN Data from a Danish cohort of bereaved parents were collected using web-based questionnaires. These numbers were successively interpreted through an anthropological lens within the perspective of transition and ritualisation. Knowledge from existing empirical literature was also fused. RESULTS FROM THE COHORT Danish parents spend hours or days with their stillborn child. They feel supported in this by healthcare professionals. Mainly close relatives join the parents while admitted to the hospital to see the stillborn child, followed by other family members and friends. CONCLUSION Danish parents engage to a very high degree in contact with their dead baby. The analysis points out that 'Time' and 'Others' are needed to create a socially comprehensible status for parents and child when birth brings death. In liminal space during the transition, healthcare professionals act as ritual experts, supporting parents and their relatives to ascribe social status to the dead body of the child through ritualised acts. Instead of only thinking of this period as 'memory-making', we suggest regarding it as a time of ontological clarification as well.
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Affiliation(s)
| | | | - Sofie Mørk
- University of Southern Denmark, Odense, Denmark
| | - Dorte Hvidtjørn
- Unit for Perinatal Loss: Aarhus University Hospital, Aarhus N, Denmark.,University of Southern Denmark, Odense, Denmark
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Middlemiss A. Pregnancy remains, infant remains, or the corpse of a child? The incoherent governance of the dead foetal body in England. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/13576275.2020.1787365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aimee Middlemiss
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
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Zaręba K, Commodari E, La Rosa VL, Makara-Studzińska M, Ciebiera M, Gierus J, Caruso S, Jakiel G. Religiosity among women undergoing pregnancy termination for medical reasons: the experiences and views of Polish women. EUR J CONTRACEP REPR 2020; 25:381-386. [PMID: 32643985 DOI: 10.1080/13625187.2020.1783652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The study aimed to determine the influence of religious and moral beliefs on contraceptive use, assisted reproduction and pregnancy termination in Polish women requesting a termination of pregnancy for medical reasons. METHODS Between 1 June 2014 and 31 May 2016, women deemed eligible for a termination of pregnancy for medical reasons at a Polish tertiary care centre received an anonymous questionnaire comprising 65 items. A total of 150 completed questionnaires were collected. RESULTS Of the respondents, 95% described themselves as Catholics, including 60% practising Catholics. The study revealed a discrepancy between respondents' beliefs and the teachings of the Catholic Church: an overwhelming majority of respondents used contraception, and 79% were in favour of in vitro fertilisation and believed the treatment should be refunded by the state. Interestingly, 66% of the respondents who attended confession did not perceive abortion as sinful. CONCLUSION The study detected a considerable discrepancy between declared religiosity and individual interpretations of the commandments and teachings of the Catholic Church. Despite stating they were Catholics, most women did not perceive abortion as sinful and did not follow the teachings of the Catholic Church regarding the sacraments for deceased children.
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Affiliation(s)
- Kornelia Zaręba
- I Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, Catania, Italy
| | | | - Marta Makara-Studzińska
- Faculty of Clinical Health Psychology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Ciebiera
- II Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jacek Gierus
- Faculty of Clinical Health Psychology, Jagiellonian University Medical College, Krakow, Poland
| | - Salvatore Caruso
- Obstetrics and Gynaecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Grzegorz Jakiel
- I Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Joseph KS, Basso M, Davies C, Lee L. Re-conceptualising stillbirth and revisiting birth surveillance. BJOG 2017; 125:104-106. [DOI: 10.1111/1471-0528.14851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- KS Joseph
- Department of Obstetrics and Gynaecology and the School of Population and Public Health; University of British Columbia; Vancouver BC Canada
- Children's and Women's Hospital and Health Centre of British Columbia; Vancouver BC Canada
| | - M Basso
- Children's and Women's Hospital and Health Centre of British Columbia; Vancouver BC Canada
| | - C Davies
- Children's and Women's Hospital and Health Centre of British Columbia; Vancouver BC Canada
| | - L Lee
- Perinatal Services BC; Provincial Health Services Authority; Vancouver BC Canada
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