Women's embodied experiences of second trimester medical abortion

Regulating Abortion Later in Pregnancy: Fetal-Centric Laws and the Erasure of Women's Subjectivity

CONTEXT

In the United States, fetal development markers, including "viability" and the point when a fetus can "feel pain," have permeated the social imaginary of abortion, affecting public support for abortion and the legality and availability of care, but the extent to which these markers describe and orient the experience of abortion at later gestations is unclear.

METHODS

Using interviews with 30 cisgender women in the United States who obtained an abortion after 24 weeks of pregnancy, the authors investigated whether and how notions of fetal viability and/or pain operated in the women's lived experiences of pregnancy and abortion.

FINDINGS

According to respondents' accounts, fetal development-based laws restricting abortion based on purported points of fetal development operated as gestational limits, privileged the viability and pain status of the fetus over that of the prospective neonate, and failed to account for the viability and pain of the pregnant person.

CONCLUSIONS

The discursive practice of centering fetal development in regulating abortion access makes denial of abortion care because of the fetus's status conceptually available-even at the point of fertilization-and naturalizes the erasure of the subjectivity of women and others who can become pregnant.

Making Sense of a Prenatal Detection of Trisomy 16 Mosaicism in the Placenta: A Qualitative Study of Pregnant Women's Decision Making

OBJECTIVE

Prenatal detection of Trisomy 16 mosaicism (MosT16) in a Chorionic Villus Sample (CVS) results may cause significant anxiety for expectant parents due to the risk of fetal malformation and fetal growth restriction (FGR). The aim of this study was to investigate the experiences and decision-making of women receiving a MosT16 results during pregnancy.

METHODS

In-depth, semi-structured interviews with eight Danish women who received a MosT16 CVS results. Interviews were analyzed using reflexive thematic analysis.

RESULTS

Four women terminated pregnancy following the MosT16 CVS result, emphasizing the emotional burden of waiting for amniocentesis and concerns about fetal involvement and FGR risk. Four women opted to await amniocentesis following which one terminated pregnancy due to fetal involvement, while three continued their pregnancies (one normal result, two low-percentage fetal involvement results). During pregnancy, all three fetuses were small for gestational age, and the concerns about their growth were burdensome for expectant parents. Two women delivered prematurely, but all three described their babies as healthy.

CONCLUSION

The prenatal MosT16 CVS result represents a critical decision point, requiring consideration of both fetal involvement and FGR risk. Thus, genetic counseling should be combined with counseling from obstetrics/fetal medicine specialists.

Abortion Trajectory, Timing, and Access Study (ATTAS): study protocol

BACKGROUND

This study protocol outlines the phased construction of a questionnaire, data collection, and a strategy for analysis within the framework of the ATTAS project. This study has two primary objectives. First, it allows us to map the duration of the various phases of the abortion trajectory for women presenting for abortion in Flanders, Belgium. Second, it identifies barriers that cause delays within these phases.

METHODS

The questionnaire was distributed to all women seeking abortion care at one of the five Flemish abortion centers; specifically, the LUNA centers, which are located in Ostend, Ghent, Antwerp, and Hasselt, as is the VUB-Dilemma center in Brussels during the fall and winter of 2023-2024. Ethical clearance for the described research was obtained from the University of Antwerp's Ethics Committee for the Social Sciences and Humanities (reference numbers: SHW_2023_48_1 and SHW_2023_48_2).

DISCUSSION

The collected data provide a dataset on the abortion trajectories of Flanders women who presented for abortion. This study protocol outlines the ATTAS project's rationale, phased development, and implementation of the questionnaire, as well as the upcoming data analyses. To our knowledge, this is the first study within the Flemish context to investigate abortion trajectories, timing, and access. Furthermore, this study protocol provides a phased and systematic approach to adapt validated research instruments to fit within diverse legal and cultural contexts. Building on this protocol, future research will seek to advance reproductive justice for all women in Belgium.

Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine

Patient choice of medical or surgical abortion is a standard of quality abortion care, but the choice of surgical abortion is constrained in England and Wales, particularly since the COVID-19 pandemic and introduction of telemedicine. This qualitative study explored the perspectives of abortion service providers, managers, and funders on the need to offer a choice of methods within early gestation abortion services in England and Wales. Twenty-seven key informant interviews were conducted between August and November 2021, and framework analysis methods were used. Participants presented arguments both for and against offering method choice. Most participants felt that it was important to maintain choice, although they recognised that medical abortion suits most patients, that both methods are very safe and acceptable, and that the priority for abortion services is to maintain timely access to respectful care. Their arguments related to practicalities around patient needs, the risk of reinforcing inequalities in access to patient-centred care, potential impacts on patients and providers, comparisons to other services, costs, and moral issues. Participants argued that constraining choice has a greater impact on those who are less able to advocate for themselves and there were concerns that patients may feel stigmatised or isolated when unable to choose their preferred method. In conclusion, although medical abortion suits most patients, this study highlights arguments for maintaining the option of surgical abortion in the era of telemedicine. More nuanced discussion of the potential benefits and impacts of self-management of medical abortion is needed.

Medical tourism for late abortion: Women's profile and circumstances. A quantitative study among women who travelled within Europe for late abortion

BACKGROUND

In France, women seeking abortion must do so before the maximum legal limit of 12 weeks of pregnancy (14 Gestational Weeks). Women seeking abortion after the 12-week limit tend to travel to the Netherlands, where the maximum legal limit is 22 weeks of pregnancy. The purpose of this study was to identify the profile and circumstances of women who travel from France to the Netherlands for a late abortion.

METHODS

A descriptive, monocentric study was conducted in a Dutch abortion clinic, where a standardized, anonymous questionnaire was administered to women from France, holding an appointment for late abortion. Data was collected from July 2020 to December 2020. Data analysis was performed with R 4.0.3 software.

RESULTS

Thirty-seven women participated in the study. Most of the women were young (15-25 y. o.), without any prior pregnancy, single, in paid employment, with an educational level less than or equal to a high school degree. Most of the women had regular gynaecological follow-up, used contraception, mostly birth control pills, and had already discussed emergency contraception or abortion with a healthcare professional. The women had delayed awareness of their pregnancy and visited the clinic at 18 weeks of pregnancy or later, beyond the 12-week French legal limit for abortion.

CONCLUSION

Risk factors likely to lead to medical tourism for late abortion include young age (15-25 y. o.), first pregnancy, being insufficiently informed about available contraceptive methods.

Shouldering Death: Moral Tensions, Ambiguity, and the Unintended Ramifications of State-sanctioned Second-trimester Selective Abortion in Denmark

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].

What are We Forgetting? Sexuality, Sex, and Embodiment in Abortion Research

Abortion has been alternately legalized and criminalized, tacitly approved of, and stigmatized, in various settings over time. The contours of its treatment are dependent on social and political contexts, including concern over women's sexuality, but it is not clear that existing conceptual frameworks enable expansive examination of the relationship between abortion and sexuality. We conduct a critical interpretive synthesis review of the literature that jointly engages with sexuality and abortion, focusing on the U.S., to highlight the frameworks that authors use to understand the relationship between the two. We find two conceptual frameworks of abortion and sexuality in operation: one that treats the two as discrete, causal variables that operate at the individual level; and another that focuses on how beliefs about what constitutes (in)appropriate sexuality explain ideological positions on abortion. We identify limitations of both frameworks and propose a new conceptual framework - one that highlights sexual embodiment - to inspire future research in this area and generate opportunities for knowledge extension. Such an approach, we contend, can elucidate broader social forces that shape both abortion and sexuality and bring research on abortion into conversation with recent scholarship on the important role of sexuality in other sexual and reproductive domains.

Abortion stigma, class and embodiment in neoliberal England

Research on abortion stigma has given insight into how women experience abortion, tell stories about abortion, and make decisions about abortion. Stigma encompasses a range of feelings, experiences and discourses that can make having an abortion a negative experience or one that women might wish to conceal. This paper explores how abortion stigma is both classed and embodied, using the life stories of 15 middle-class women who have had abortions in England in 'neoliberal times'. It argues that the women's class position gave them access to various discursive resources with which to articulate their abortion stories, shaping their experiences and narration of stigma. It also draws attention to the ways in which both class and stigma are 'made through marking' on the body, and thus to the under-theorised embodied aspects of abortion stigma. In doing so, it argues that abortion stigma acts as a regulatory 'technology of the self' that is enabled by middle-class practices of self-control.

"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

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.

Toward normalising abortion: findings from a qualitative secondary analysis study

In most settings worldwide, abortion continues to be highly stigmatised. Whilst a considerable body of literature has addressed abortion stigma, what is less commonly examined are the ways in which those with experience of abortion describe it in non-negative terms which may resist or reject stigma. Drawing on qualitative secondary analysis of five UK datasets using a narrative inquiry approach, we explore: the use of non-negative language around abortion, potential components of a normalising narrative, and constraints on non-negativity. As such, we present the first empirical UK study to critically examine how a dominant negative abortion narrative might be disrupted.

Characteristics of Women Who Present for Abortion Beyond the Legal Limit in Flanders, Belgium

CONTEXT

Women who seek abortion care beyond the first trimester of gestation are often in a vulnerable socioeconomic position with limited social support, and in Belgium, the details of their circumstances are insufficiently understood. A better understanding of this group is essential to a critical evaluation of Belgian abortion policy, which restricts abortions on request after the first trimester.

METHODS

Anonymized patient records were collected between 2013 and 2016 from LUNA centers, which are non-hospital-based abortion clinics in Flanders. Logistic regression analyses were used to identify associations between women's characteristics and whether they presented within or beyond the legal limit, which was 13 weeks and 1 day at the time of the study.

RESULTS

A total of 28,741 women requested an abortion, and 972 individuals (3.4%) presented beyond the legal limit; 29% of these latter women were unable to receive abortion care as a result of the mandatory six-day waiting period. Characteristics positively associated with presenting beyond the limit, instead of beforehand, were being younger than 20, as opposed to 20-24 (odds ratio, 1.7); receiving a primary, lower secondary, upper secondary or special-needs education, rather than a higher education (1.8-3.1); being unemployed, rather than employed (1.3); and holding Belgian rather than a foreign nationality (0.8). Being accompanied by someone to the LUNA center (0.8), having irregularly (0.6) or regularly used contraceptives (0.7), and having ever had an abortion (0.8) were negatively associated with presenting beyond, rather than before, the limit.

CONCLUSIONS

A fuller consideration of patients' characteristics when evaluating Belgian abortion policy is needed to ensure that the needs and rights of socioeconomically vulnerable women are addressed.

The patient perspective: perceptions of the quality of the abortion experience

PURPOSE OF REVIEW

Abortion services are essential in sexual and reproductive health and should be held to the same standards as other health services. Patient (or person)-centeredness is a key dimension of healthcare quality that incorporates the perspectives of patients in care provision. The purpose of this review is to summarize studies published in the last year examining women's experiences with abortion care and to describe facilitators and barriers to person-centered care.

RECENT FINDINGS

Considering person-centeredness in abortion care using dimensions of dignity, autonomy, privacy, communication, social support, supportive care and health facility environment allows for critical evaluation of data describing women's experiences with abortion and postabortion services. Review of the available literature shed light on the impact of social stigma, health policy and abortion restrictions on women's abortion experiences.

SUMMARY

Considering multiple domains and varied settings, current data suggest abortion services worldwide generally fail to provide person-centered care. Institutions and providers may be limited in their ability to provide patient-centered abortion care because of deeply embedded social stigma, institutional regulations and legal restrictions.

Disgust, stigma, and the politics of abortion

Despite the growing body of research on the emotion of disgust – including its relationship to political ideology, moral judgment, matters of sex and sexuality, and death – the global reproductive rights movement has paid relatively little attention to the role disgust plays in the debate over abortion. By focusing on the right of a woman to make her own decision about an unwanted pregnancy, the pro-choice community has allowed anti-choice groups to define and frame the abortion procedure, abortion providers, and women who have abortions in terms associated with disgust. This commentary encourages further examination of what triggers disgust, its measurement, and ways of mitigating it, which could be useful for reducing abortion stigma, in future legal cases and in abortion research, advocacy, and communications.

Framing a 'social problem': Emotion in anti-abortion activists' depiction of the abortion debate

Social psychological research on activism typically focuses on individuals' social identifications. We complement such research through exploring how activists frame an issue as a social problem. Specifically, we explore anti-abortion activists' representation of abortion and the abortion debate's protagonists so as to recruit support for the anti-abortion cause. Using interview data obtained with UK-based anti-abortion activists (N = 15), we consider how activists characterized women having abortions, pro-abortion campaigners, and anti-abortion campaigners. In particular, we consider the varied ways in which emotion featured in the representation of these social actors. Emotion featured in different ways. Sometimes, it was depicted as constituting embodied testament to the nature of reality. Sometimes, it was depicted as blocking the rational appraisal of reality. Our analysis considers how such varied meanings of emotion shaped the characterization of abortion and the abortion debate's protagonists such that anti-abortion activists were construed as speaking for women and their interests. We discuss how our analysis of the framing of issues as social problems complements and extends social psychological analyses of activism.

Internalised abortion stigma: Young women’s strategies of resistance and rejection

This paper examines the ways in which young women articulated strategies of resistance to internalised abortion stigma. It does so through secondary analysis of young women’s narratives from two qualitative studies in England and Wales. Whilst participants felt stigmatised by their abortion[s] in different ways, many also resisted stigmatisation. They did this through different stigma resistance strategies that were shaped by a number of different interactions: their socio-economic situations, family and relationships contexts, the circumstances in which they became pregnant, and their beliefs and values with respect to abortion and motherhood. Being able to construct their abortion decision as morally sound was an important element of stigma resistance. Although socio-cultural norms and values on abortion, reproduction, and motherhood were shown to constrain women’s reproductive choices, these norms were all open to challenge. The women were more likely to struggle with their abortion decision-making when they had internalised negativity around abortion.