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.

Reproductive justice in context: South African and Zimbabwean women’s narratives of their abortion decision

The abortion decision-making process is embedded within overlapping power relations. Using a post-colonial feminist framework, we analyse South African and Zimbabwean women’s narratives regarding their abortion decision. As neighbouring countries, South Africa and Zimbabwe provide a useful counterpoint as they have common and differing social histories and very different abortion legislation. In our analysis, we unpick transversal commonalities and divergences in the discursive resources deployed by the women in their narratives in the two sites. Commonalities included the women feeling compelled to justify their abortion decision in the interactive interview space, an absence of a reproductive rights discourse, and the deployment of relationship embedded discourses in the justificatory work performed by the women. The “conjugalisation of reproduction”, “imperative of good mothering”, and “unstable partner relationships” discourses featured across both sites but the manner in which these were deployed differed. These discursive resources allowed the women to position themselves as making responsible decisions. The Zimbabwean women spoke of shame and hiding, a discursive resource that was explicitly absent in the South African women’s accounts. We conclude by arguing that our post-colonial feminist approach allows for a contextualised reproductive justice stance to abortion decision-making that identifies both transnational and context-specific power relations.

Women's embodied experiences of second trimester medical abortion

Abortions in general, and second trimester abortions in particular, are experiences which in many contexts have limited sociocultural visibility. Research on second trimester abortion worldwide has focused on a range of associated factors including risks and acceptability of abortion methods, and characteristics and decision-making of women seeking the procedure. Scholarship to date has not adequately addressed the embodied physicality of second trimester abortion, from the perspective of women's lived experiences, nor how these experiences might inform future framings of abortion. To progress understandings of women's embodied experiences of second trimester abortion, we draw on the accounts of 18 women who had recently sought second trimester abortion in Scotland. We address four aspects of their experiences: later recognition of pregnancy; experiences of a second trimester pregnancy which ended in abortion; the "labour" of second trimester abortion; and the subsequent bodily transition. The paper has two key aims: Firstly, to make visible these experiences, and to consider how they relate to dominant sociocultural narratives of pregnancy; and secondly, to explore the concept of "liminality" as one means for interpreting them. Our findings contribute to informing future research, policy and practice around second trimester abortion. They highlight the need to maintain efforts to reduce silences around abortion and improve equity of access.