The Long-Term Phenomena of Women’s Postabortion Experiences

Features of Prolonged Grief Symptoms in Chinese and Swiss Bereaved Parents

This study investigates clinical expressions of prolonged grief in samples of 32 Chinese and 33 Swiss bereaved parents, according to the proposed International Classification of Diseases, 11th Revision model of prolonged grief disorder (PGD). Sex differences and predictors (cultural attitudes, sense of coherence, and posttraumatic growth) of PGD were analyzed. In result, after controlling for sociodemographic and loss-related sample differences, both samples showed similar PGD symptom profiles, with Swiss parents exhibiting more severe grief-related preoccupation and Chinese parents exhibiting some accessory symptoms and functional impairment to a greater extent. Multivariate analyses revealed for the Chinese sample primary predictions of PGD by life satisfaction, general health and one's world view (social cynicism) and for the Swiss sample by female sex, sense of coherence, and life satisfaction. The findings substantiate the basic appropriateness of the International Classification of Diseases, 11th Revision PGD in distinct cultural groups and may contribute to a better understanding of grief expression and its potential predictors across different cultures.

Exploring pregnancy termination experiences and needs among Malaysian women: a qualitative study

BACKGROUND

Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion.

METHODS

Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women's experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically.

RESULTS

Thirty-one women, with ages ranging from 21-43 years (mean 30.16 ± 6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2-8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband's agreement. In terms of the women's needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up.

CONCLUSIONS

The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.

Stigma, abortion, and disclosure--findings from a qualitative study

INTRODUCTION

This study qualitatively explores perceptions of women who have experienced abortion care. It explores women's journey through abortion from confirmation of pregnancy to post-abortion.

AIM

The study seeks to understand the implications of these perceptions for policy and practice.

MAIN OUTCOME MEASURES

A qualitative study involving in-depth semi-structured interviews with 17 women, aged between 22 and 57 years, who had undergone legal induced abortion in the UK when they were 16 years or older. Participants were not recruited under the age of 16 because of the ethical and legal complexities of interviewing minors. Additionally, 16 years was deemed to be the most appropriate age as this is the legal age of consent in the UK.

METHODS

Participants were recruited from 12 community contraception and sexual health clinics in two NHS trusts, one in England and one in Wales. Participant recruitment was set at a minimum of 12 and participants were recruited on a "first come first served basis" (i.e., the first 12 who contacted the researcher). The number of participants was raised to seventeen as this was the number deemed to be the most suitable for data saturation in this particular qualitative research.

RESULTS

Women in this study understood abortion as highly taboo and a potentially personally stigmatizing event. These perceptions continued to affect disclosure to others, long after the abortion, and affected women's perceptions of the response of others, including society in general, significant others, and health professionals.

CONCLUSIONS

Women's experiences of abortion may be influenced by perceived negative social attitudes. Health professionals and abortion service providers might combat the perceived isolation of women undergoing abortion by attending not only to clinical/technical aspects of the procedure but also to women's psychological/emotional sensitivities surrounding the event.

Service provision for women undergoing termination of pregnancy: progress in Wales, UK

BACKGROUND

This audit established a recent picture of termination of pregnancy services in Wales, UK using the Royal College of Obstetricians and Gynaecologists' Guidelines as a baseline. The context of abortion is rapidly changing and services need to be adaptable to meet women's needs.

METHODS

A questionnaire survey was sent to all National Health Service (NHS) Trusts in Wales; 10 out of 13 responded.

RESULTS

In the nine Trusts performing abortions in Wales, medical abortions accounted for 57% and surgical abortions for 43%. Doctors in training were involved in six Trusts. All but one Trust complied with referral times. Five Trusts provided a dedicated clinic. Written information provided prior to abortion varied in accessibility and quality. Choice of abortion within gestation bands was limited in some Trusts with some only providing medical termination. Essential abortion aftercare was performed by Trusts, whereas follow-up and counselling were less comprehensive.

DISCUSSION

Trusts are willing to adapt to new methods of working with an increasing number of medical terminations, although this advantage was offset by a lack of choice of abortion methods offered by some Trusts. Doctors in training should be offered exposure to abortion procedures in all Trusts as this has been shown elsewhere to improve attitudes. Providing dedicated abortion clinics, quality written information and comprehensive abortion aftercare should improve compliance with the guidelines.

CONCLUSION

Overall, in Wales there is compliance with national guidelines, although for a number of the guideline recommendations there remains room for improvement.

Nurses in abortion care: identifying and managing stress

The psychological impact of abortion on the women undergoing the procedure is well researched, but little is known about the potential psychological impact on nurses working in abortion care. The proportion of medical abortions in the UK is rising compared to surgical abortions. A recent research study found that being more directly involved in the procedure places more emotional demands on the nurses. This emotional labour required by nurses working in abortion care may increase their stress levels. This paper examines the potential increase in stress in nurses caused by medical abortions. A model of stress comprising stressors, moderators and stress outcomes was used as a framework for this examination. Research on abortion and mental health nursing was applied to managing stress in abortion care; this included coping mechanisms, prevention and intervention strategies. This showed that stress, burnout and coping are important issues in abortion care. On this basis, recommendations for practice have been formulated to inform practice for nurses and managers in abortion care.

Early abortion as narrated by young Swedish women

AIM

The aim of the study was to illuminate meanings of having had an induced abortion among young Swedish women.

METHODS

Narrative interviews were conducted with ten 18-20-year-old women 2-6 weeks after a medical or surgical abortion in the sixth to twelfth week of pregnancy. Data were analysed according to a phenomenological hermeneutic method.

RESULTS

The study disclosed a multitude of complex meanings in the young women's lived experiences of induced abortion. Four themes were revealed: having cared for and protected the unimagined pregnancy, taking the life of my child-to-be with pain, being sensitive to the approval of others and imagining the taken away child-to-be. The results are discussed in light of Nussbaum's theory of development ethics. The young women's ability to be responsible for their choices regarding their own welfare and others' well-being in a life cycle perspective was disclosed, despite the pain inherent in the responsibility of taking the life of their own child-to-be.

CONCLUSIONS

The young women's narratives were replete with ethical reasoning regarding existential matters related to their responsibility of choosing between induced abortion and parenthood and how to live their lives with this experience. Health-care professionals could promote young women's capability to be responsible, as well as the development of trust in their own fertility and constructive relationships with significant others. In the development of the prevention of unintended pregnancies and the sexual education of young people in Sweden existential dimensions of undergoing an abortion should be given attention.

Alcohol relapse and its relationship to the lived experience of adult liver transplant recipients

Abstinence from alcohol after liver transplantation is an important outcome for all adult liver transplant recipients to attain. Currently, there is no clear explanation for why some recipients consume alcohol after transplantation, whereas others do not, and the predictors of alcohol relapse after liver transplantation have not been clearly explained. It often is believed that nurses do not have sufficient knowledge of alcohol abuse and that addiction specialists are needed to assess alcohol relapse after transplantation. As a result, the contributions of nursing to abstinence counseling for adult liver transplant recipients are unknown. For this study, a mixed method approach was used that combined the qualitative research method known as phenomenology with statistical findings to illuminate the lived experience of adult liver transplant recipients and to discover whether a relationship exists between the recipients' lived experiences and alcohol relapse after transplantation. Five clinical themes emerged from the data, two of which had positive relationships with alcohol relapse. Nursing implications related to abstinence counseling for all adult liver transplant recipients are addressed.

Women's stories of abortion in southern Gabon, Africa

The purpose of this study was to explore the reasons women in rural, southern Gabon, Africa, chose to terminate their pregnancies, the methods used to induce abortions, and postabortion effects experienced by these women. Abortion is illegal in this country. A descriptive qualitative design guided the methodology for this study. Five women with a history of induced abortion were interviewed in-depth for their abortion story. Reasons cited for an abortion included lack of financial and partner support. Abortion methods included oral, rectal, and vaginal concoctions of leaves, bark, and water and over-the-counter medications, including misoprostol. Affects were physical, spiritual, and relational. Health care professionals need to provide women with guidance for appropriate contraceptive usage. Abortion after-care of women with physical and spiritual needs is important. Future research is suggested on the use of misoprostol in Gabon to understand its affects on women's reproductive health.

Women and abortion: the past reaches into the present

AIM

This paper reports a study of women's responses to abortion over an extended time.

BACKGROUND

Most studies of postabortion responses do not portray what women experience over an extended time period, since many only use a 24 month follow-up period. Results from previous studies indicate that women have thoughts about their abortion that they suppress or find intrusive.

METHOD

Sixteen women who had chosen to terminate a pregnancy for non-medical reasons at least 15 years previously were interviewed during the years 1999-2001. This phenomenological study revealed their responses to and thoughts about their abortion(s).

FINDINGS

Each of the women spoke about thinking of their abortion(s) at varied times. The abortion(s) was/were not a time-limited event; instead thoughts, emotions, and insights about the meaning of these experiences were on-going, as life events unfolded. The past reached into the present in varied ways and at unplanned times. Difficulties with subsequent pregnancies, life milestones, and mundane occurrences involving friends' children were common triggers for recurring thoughts about past abortions. These recurrent thoughts had characteristics of avoidance or suppression and intrusion.

CONCLUSION

When taking an obstetric history, nurses and midwives should be sensitive when inquiring about discrepancies between the number of times a woman has been pregnant and the number of living children. Opportunity should be given for a woman to discuss in a safe, non-judgmental environment any emotions or thoughts she may express. Providers of women's healthcare services must reflect about ways to reassure women of the common nature of recurrent thoughts and the spectrum of emotional responses that, even years later, is normal.