The decision-making experiences of women who legally aborted: A meta-ethnography

BACKGROUND

Abortion is one of the most common gynaecological procedures. It is related to personal, social, and economic reasons under a legal term that is recognised as a common sexual and reproductive right in most of countries. However, making the decision to abort is complex, because it is politicised and is often framed in public discourse related to moral or ethical issues beyond women's experiences. Therefore, it is subject to medical criteria, religious evaluations, and sociological analysis.

PURPOUSE

The aim of this synthesis of qualitative studies was to synthesise the decision-making experiences of women who legally aborted.

RESEARCH DESIGN AND METHOD

The Noblit and Hare's interpretive meta-ethnography was conducted, and it was written in accordance with the eMERGe meta-ethnography reporting guidance. Ten studies met the research objective and inclusion criteria, after a comprehensive systematic search strategy in five databases.

FINDINGS

The metaphor "The wrestling between why and what will happen next" and three themes emerged from the data analysis: (1) Forces that incite the arm wrestling; (2) Facing social stigma; and (3) Defeated by a greater rival. The metaphor provided interpretive experiences of the moral conflict experienced by women who decided to have an abortion and emerged from the confrontation of the reasons why they decided to abort and the social repercussions that making the decision entails. The result of the struggle was loneliness and vulnerability.

CONCLUSION

The lines of action impact policy makers, the media, and health professionals. Actions should focus on the de-stigmatisation and normalisation of abortion, the use of appropriate language, and the training and sensitisation of health professionals.

'Defending the unborn', 'protecting women' and 'preserving culture and nation': anti-abortion discourse in the Polish right-wing press

Poland has one of the strictest abortion laws in Europe, and anti-abortion discourse shapes the debate and social attitudes towards the issue. The paper aims to reconstruct the way in which this discourse, as exemplified in the Polish right-wing press, constructs negative views about abortion and to identify the legitimation mechanisms it employs to sustain its interpretations. Based on our findings, resulting from a content analysis of articles from two right-wing weekly magazines, we distinguish three interrelated frames organising Polish anti-abortion discourse, centred on 'defending the unborn', 'protecting women', and 'preserving culture and nation'. While the first two have occurred in the liberal contexts of Anglophone countries, with one replacing the other, in Polish anti-abortion discourse they co-exist. The construction of abortion as a threat to culture and nation is specific to Poland. We argue that by blending together community-related and individualistic arguments, Polish anti-abortion discourse adapts to wider societal changes observable in the country, thereby sustaining its power to define debate.

Medical abortion ratios and gender equality in Europe: an ecological correlation study

Medical abortion (MA) is recommended by the WHO as a safe and effective pregnancy termination method in the first trimester. From a feminist perspective, it is a non-medicalised, self-managed, emancipating procedure allowing persons seeking abortion to be more in control of their abortion, as opposed to surgical procedures. In European countries where MA is legal, the proportion of MA (relative to surgical abortions) varies greatly. We hypothesised that this ratio may be partly explained by country-level dimensions of gender equality. We assessed the association between MA ratios and gender equality in Europe in correlation and regression analyses, using several country-level gender equality indices. The relevance of other factors, i.e. date of introduction of MA and pregnancy week until which MA is permitted, was also investigated. MA ratios ranged from 24.4% (Italy) to 97.7% (Finland). MA was more frequent relative to surgical abortion in countries with higher levels of gender equality. All gender equality indices were associated with MA ratios (e.g. Global Gender Gap Index corr. coeff: 0.761, p < 0.0001). Specifically, markers of economic and political gender equality seemed to drive the correlations. The pregnancy week until which MA is permitted was associated with both gender equality and MA ratios. Our study suggests that women’s participation in the economic and political sphere may have repercussions on the methods offered and used through abortion services. It highlights the link between feminist perspectives, reproductive health policies and practices, and gender equality, especially in terms of access to economic resources and political representation.

Intersectional discourses of reproductive agency in the Philippines: A mixed methods analysis of classed constructions of pregnancy resolution

Women negotiate gendered discourses of reproductive agency in resolving unplanned pregnancies. Invoking an intersectional lens, this paper examines how these discursive dynamics differentiate across social class in the Global South context of the Philippines. Utilizing a novel mixed methods strategy, we triangulate quantitative findings from a Q sort task and qualitative accounts of pregnancy resolution to identify classed discourses of reproductive agency as (a) reclaiming maternal virtue and (b) asserting autonomous choice. Statistical analysis reveals significant discursive divergence across class, wherein working-class women primarily adopt maternal virtue discourses while middle-class women disproportionately subscribe to autonomous choice. Interpretative analysis of women’s accounts complicates this bifurcated characterization by surfacing the diverse ways by which women negotiate both discourses in narratives of abortion and carrying to term. We discuss our contributions to the literature in terms of multilevel theoretical engagement with classed complexity in gendered issues like reproductive agency as well as innovating mixed methods in intersectional research. We conclude with reflections on advancing reproductive justice, especially in Global South societies like the Philippines.

Psychological knowledge production about abortion: the politics of location and representation

BACKGROUND

Despite considerable psychology research being conducted on abortion, there has been no study of the history of psychological knowledge production on the topic. The aim of our research was to analyse journal articles published in English language psychology journals using a politics of location and of representation analytical lens.

STUDY DESIGN

A systematic search for articles published on abortion in psychology journals from 1960 to 2015 was conducted. A mixed-method approach (content analysis and narrative review) was used to analyse the dataset. Articles were coded according to: decade of publication, region, types of research conducted, and main issues focused on. A narrative review of the dominant issue researched - psychological consequences - in two decades (the 1970s and 2000s) was conducted.

RESULTS

Knowledge production began in the 1970s in most regions featured in the dataset and in the 1990s in South Africa. Research is dominated by quantitative studies conducted in North America and Europe concerning the demarcation of psychological consequences of abortion performed under safe conditions. In the 1970s, abortion was viewed as leading to benign psychological consequences, but by the 2000s traumatology talk was firmly entrenched. Only one article, emanating from South Africa, addressed the question of unsafe abortion.

CONCLUSIONS

Knowledge production in psychology needs to move beyond a narrow focus on the psychological consequences of abortion and attitudes to abortion. Nuanced, contextualised research of the psychology of both safe and unsafe abortion is necessary.

Trajectories of women's abortion-related care: A conceptual framework

We present a new conceptual framework for studying trajectories to obtaining abortion-related care. It assembles for the first time all of the known factors influencing a trajectory and encourages readers to consider the ways these macro- and micro-level factors operate in multiple and sometimes conflicting ways. Based on presentation to and feedback from abortion experts (researchers, providers, funders, policymakers and advisors, advocates) (n = 325) between 03/06/2014 and 22/08/2015, and a systematic mapping of peer-reviewed literature (n = 424) published between 01/01/2011 and 30/10/2017, our framework synthesises the factors shaping abortion trajectories, grouped into three domains: abortion-specific experiences, individual contexts, and (inter)national and sub-national contexts. Our framework includes time-dependent processes involved in an individual trajectory, starting with timing of pregnancy awareness. This framework can be used to guide testable hypotheses about enabling and inhibiting influences on care-seeking behaviour and consideration about how abortion trajectories might be influenced by policy or practice. Research based on understanding of trajectories has the potential to improve women's experiences and outcomes of abortion-related care.