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Yeşildere Sağlam H, Gürsoy E. Termination of pregnancy due to fetal anomaly: A qualitative study from Turkey on women's experiences. Midwifery 2024; 132:103957. [PMID: 38428136 DOI: 10.1016/j.midw.2024.103957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Termination of pregnancy due to fetal anomaly is an unexpected traumatic event for women. It can cause serious complications that can negatively affect both the physical and psychological health of women. AIM This study aims to examine the experiences of women who underwent medical termination for fetal anomaly in the second trimester. METHODS The study included 12 women whose pregnancies were terminated due to fetal anomaly. Data were collected through in-depth interviews until data sufficiency was reached. Thematic analysis method was used to analyze the data. This study was conducted using an inductive qualitative design. The women's statements were examined and double-coded. By examining the codes, main themes were created after sub-themes. RESULTS Women's experiences were analyzed in five themes: difficulty in decision-making (1), emotional impact (2), stigmatization (3), dilemma between hope and anxiety (4), and post-termination care and support needs (5). Participants stated that they experienced many emotions such as indecision, sadness, helplessness, guilt, and remorse during the medical termination process. Hope, anxiety, fear, social pressure and support needs were also frequently experienced in this process. CONCLUSION Termination of pregnancy in the second trimester due to fetal anomaly caused significant psychological symptoms. In order to prevent long-term health complications, it will be important for health professionals to provide interventions designed to meet the demands of women diagnosed with fetal anomaly.
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Affiliation(s)
- Havva Yeşildere Sağlam
- Faculty of Health Sciences, Department of Nursing, Kütahya Health Sciences University, Kütahya, Turkey.
| | - Elif Gürsoy
- Faculty of Health Sciences, Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey
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2
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Footman K. The illusion of treatment choice in abortion care: A qualitative study of comparative care experiences in England and Wales. Soc Sci Med 2024; 348:116873. [PMID: 38615614 DOI: 10.1016/j.socscimed.2024.116873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
Treatment choice is a key component of quality, person-centred care, but policies promoting choice often ignore how capacity to choose is unequally distributed and influenced by social structures. In abortion care, the choice of either medication or a procedure is limited in many countries, but the structuring of treatment choice from the perspective of people accessing abortion care is poorly understood. This qualitative study explored comparative experiences of abortion treatment choice in England and Wales, using in-depth interviews with 32 people who recently accessed abortion care and had one or more prior abortions. A codebook approach was used to analyse the data, informed by a multidisciplinary framework for understanding the relationship between choice and equity. Abortion treatment choice was structured by multiple intersecting mechanisms: limitations on the supply of abortion care, incomplete or unbalanced information from providers, and participants' socio-economic environments. Long waiting times or travel distances could reduce choice of both treatment options. In interactions with providers, participants described not being offered procedural abortions or receiving information that favoured medication abortion. Participants' socio-economic environments impacted the way they navigated decision-making and their ability to manage the experience of either treatment option. Individual preferences for care were shaped in part by the interplay between these structural barriers, creating an illusion of choice, as the health system bias towards medication abortion reinforced some participants' negative perceptions of procedural abortion. The erosion of choice, to the point it is rendered illusory, has unequal impacts on quality of care. People's needs for their abortion care are complex and diverse, and access to varied service models is required to meet these needs. Treatment choice could be expanded by integrating public and private non-profit sector provision, aligning time limits and workforce requirements for abortion care with international standards, addressing financial pressures on service delivery, and revising the language used to depict each treatment option.
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Affiliation(s)
- Katy Footman
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE, UK.
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Irmscher L, Marx R, Linke M, Zimmermann A, Drössler S, Berth H. Anxiety, depression, somatization and psychological distress before and 2-6 years after a late termination of pregnancy due to fetal anomalies. BMC Womens Health 2024; 24:255. [PMID: 38658921 PMCID: PMC11040822 DOI: 10.1186/s12905-024-03082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND For many women, a late termination of pregnancy (TOP) can be an enormous psychological burden. Few studies have investigated the long-term psychological impact of late TOP. METHODS N = 90 women answered a questionnaire containing questions about anxiety, depression and somatization (Brief-Symptom Inventory, BSI-18) shortly before (T1) and 2-6 years after (T4) their late termination of pregnancy. RESULTS Prior to the late TOP, 57.8% of participants showed above-average levels of overall psychological distress (66.7% anxiety, 51.1% depression, 37.8% somatization). This number decreased significantly over time for all scales of the BSI-18. 2-6 years later, only 10.0% of women still reported above-average levels (17.8% anxiety, 11.1% depression, 10.0% somatization). CONCLUSIONS Our results support those of previous research showing that late TOP has a substantial psychological impact on those experiencing it in the short-term. In the long-term, most women return to normal levels of psychological distress, although some still show elevated levels. Limitations of the study include monocentric data collection, drop-out between T1 and T4, and the relatively wide range of two to six years after TOP. Further research should be conducted in order to identify factors that impact the psychological processing of the experience.
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Affiliation(s)
- Lisa Irmscher
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany.
| | - Romy Marx
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
| | - Maike Linke
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
| | - Anja Zimmermann
- Charité Universitätsmedizin Berlin, Referat für Studienangelegenheiten, 10115, Berlin, Germany
| | - Stephanie Drössler
- Freistaat Sachsen, Landesamt für Schule und Bildung, Beratungsstelle zur Begabtenförderung, 01445, Berlin, Germany
| | - Hendrik Berth
- Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische Psychologie und Medizinische Soziologie, Technische Universität Dresden, 01307, Dresden, Germany
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McKetta S, Chakraborty P, Gimbrone C, Soled KRS, Hoatson T, Beccia AL, Reynolds CA, Huang AK, Charlton BM. Restrictive abortion legislation and adverse mental health during pregnancy and postpartum. Ann Epidemiol 2024; 92:47-54. [PMID: 38432536 PMCID: PMC10983835 DOI: 10.1016/j.annepidem.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To determine the impact of abortion legislation on mental health during pregnancy and postpartum and assess whether pregnancy intention mediates associations. METHODS We quantified associations between restrictive abortion laws and stress, depression symptoms during and after pregnancy, and depression diagnoses after pregnancy using longitudinal data from Nurses' Health Study 3 in 2010-2017 (4091 participants, 4988 pregnancies) using structural equation models with repeated measures, controlling for sociodemographics, prior depression, state economic and sociopolitical measures (unemployment rate, gender wage gap, Gini index, percentage of state legislatures who are women, Democratic governor). RESULTS Restrictive abortion legislation was associated with unintended pregnancies (β = 0.127, p = 0.02). These were, in turn, associated with increased risks of stress and depression symptoms during pregnancy (total indirect effects β = 0.035, p = 0.03; β = 0.029, p = 0.03, respectively, corresponding <1% increase in probability), but not after pregnancy. CONCLUSIONS Abortion restrictions are associated with higher proportions of unintended pregnancies, which are associated with increased risks of stress and depression during pregnancy.
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Affiliation(s)
- Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States.
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States
| | - Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States; Department of Pediatrics, Harvard Medical School, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, United States
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Zhao L. Effect of Wuyan click on psychological elasticity and coping style of women of childbearing age after induced abortion. Minerva Surg 2024; 79:238-241. [PMID: 34792321 DOI: 10.23736/s2724-5691.21.09285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Limin Zhao
- Department of Obstetrics and Gynecology, People's Hospital of Jingning She Autonomous County, Jingning County, Zhejiang, China -
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Koiwa Y, Shishido E, Horiuchi S. Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. Int J Environ Res Public Health 2024; 21:288. [PMID: 38541288 PMCID: PMC10970290 DOI: 10.3390/ijerph21030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Globally, about half of all induced abortions have been estimated to be unsafe, which results in 13% of maternal deaths yearly. Of these induced abortions, 41% of unsafe abortions have been reported in young women who are dependent on their parents for their livelihood. They are often left in a vulnerable position and may have difficulty in making a decision regarding abortion. This study aimed to (1) characterize and map factors that influence abortion decision-making of adolescents and young women, and (2) identify the care and support that they need in their decision-making process. METHODS We conducted a scoping review following the JBI method and PRISMA-ScR checklist. We comprehensively searched MEDLINE (PubMed), Embase, Cochrane Library, CINAHL, and PsycInfo, and hand searched publications in the Google Scholar database between November 2021 and October 2023. The search included all English language qualitative and mixed methods research articles published on the database up to October 2023 that included participants aged 10-24 years. The CASP checklist was used as a guide for the qualitative analysis. NVivo was used to synthesize the findings. RESULTS There were 18 studies from 14 countries (N = 1543 young women) that met the inclusion criteria. Three domains and eleven categories were included as follows: personal (desire for self-realization and unwanted pregnancy), interpersonal (parental impact, reaction of partner, roles of peers and friends, existence of own child, and lack of support), and social circumstances (sexual crime, financial problem, limitation of choice, and underutilized healthcare services). Decision-making factors regarding abortions were also found across all three domains. CONCLUSION The abortion decision-making of young women is influenced by various external factors regardless of country. Parents are especially influential and tend to force their daughters to make a decision. Young women experienced suffering, frustration, and lack of autonomy in making decisions based on their preference. This emphasizes the importance of autonomous decision-making. In this regard, healthcare services should be used. However, there are barriers to accessing these services. To improve such access, the following are required: staff training to provide adolescent and youth-friendly health services, counseling based on women's needs, counseling including the parents or guardians that is confidential and ethical, promotion of decision aids, and affordable accessible care.
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Affiliation(s)
- Yui Koiwa
- Makita General Hospital, Nishikamata, Ota-ku, Tokyo 144-8501, Japan;
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
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Bruce TC, Hutchens K, Cowan SK. The "abortion imaginary": Shared perceptions and personal representations among everyday Americans. Sci Adv 2024; 10:eadj3135. [PMID: 38416827 PMCID: PMC10901374 DOI: 10.1126/sciadv.adj3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/23/2024] [Indexed: 03/01/2024]
Abstract
Drawing upon 217 in-depth interviews and the concept of the "social imaginary," we introduce the "abortion imaginary"-a set of shared understandings regarding abortion and abortion patients. We identify four interrelated facets of the U.S. abortion imaginary pertaining to who gets an abortion and why: maternal inevitability, economic decision-making, relationship precarity, and emotional fragility. We then show how shared perceptions of abortion patients diverge into polarized opinions, revealing how those who know someone who has had an abortion differ from those who do not. Centering personal "exemplars," we integrate conceptual work on social imaginaries with contact theory to illuminate how divergent opinions coexist with shared cultural understandings.
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Affiliation(s)
- Tricia C. Bruce
- Center for the Study of Religion and Society, University of Notre Dame, Holy Cross Dr., Notre Dame, IN 46556, USA
| | - Kendra Hutchens
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sarah K. Cowan
- Department of Sociology, New York University, New York, NY 10012, USA
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Alexopoulos J, Tmej A, Naderer A, Grussmann M, Tordy K, Stammler-Safar M, Feichtinger K, Gipperich A, Leithner K. Men don't cry: The supporting role as necessary for women's well-being after termination of pregnancy. Int J Gynaecol Obstet 2024; 164:1205-1211. [PMID: 37922219 DOI: 10.1002/ijgo.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The present study investigated similarities and differences of grief between men and women as part of the parental couple 1 year after termination of pregnancy (TOP) following a diagnosis of fetal anomaly. METHODS We applied a method triangulation approach. We assessed several aspects of perinatal grief, depressive symptoms, posttraumatic stress, and anxiety as well as health-related quality of life. In addition, we conducted qualitative interviews with the men to explore the fathers' roles in the partnership during pregnancy, the time of the diagnosis, TOP, and afterwards. RESULTS Women showed a more elevated grief response compared with men. Qualitative data revealed that men in our sample were mainly concerned with their partners' well-being and concentrated on supporting their partners rather than on their own emotions. In addition, the supportive role of the male partner plays a central role in the well-being of women and the man's coping with the situation. CONCLUSION In clinical work, but also when developing new questionnaires, the specific role of the male partners needs to be considered more thoroughly. Particular attention should be paid to identify the men who find it difficult to assume the supporting role.
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Affiliation(s)
- Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna Tmej
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Magdalena Grussmann
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Tordy
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Maria Stammler-Safar
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Gipperich
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Katharina Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Malek M, Homer CS, McDonald C, Hannon CM, Moore P, Wilson AN. Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences. BMC Pregnancy Childbirth 2024; 24:112. [PMID: 38321392 PMCID: PMC10845525 DOI: 10.1186/s12884-024-06299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. METHODS A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. RESULTS In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. CONCLUSIONS Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.
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Affiliation(s)
- Mary Malek
- Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | | | - Clare McDonald
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Catherine M Hannon
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paddy Moore
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Alyce N Wilson
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia.
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Lerma K, Arey W, Chatillon A, White K. Reasons for participation in abortion research in restrictive settings. Contraception 2024; 130:110324. [PMID: 37926363 DOI: 10.1016/j.contraception.2023.110324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Following the implementation of a restrictive abortion law in Texas (Senate Bill 8), we conducted in-depth interviews with pregnant people about their experiences seeking abortion care. In this analysis, we explore participants' motivations for taking part in a research study. STUDY DESIGN Between October 2021 and August 2022, we conducted 120 in-depth interviews with Texans (aged ≥15 years) who, after considering abortion, had a facility-based abortion, self-managed their abortion, experienced miscarriage or ectopic pregnancy, or continued their pregnancy. We asked all interviewees, "Why did you decide to participate in the interview?" For analysis, we used inductive and deductive coding approaches to explore motivations for and concerns about participation. RESULTS Most commonly, interviewees appreciated the opportunity to share their stories, frequently describing how their experiences highlight the nuance of abortion decision-making and challenge stigmatized views about abortion. Some described an emotional benefit of participating, as they had no one else to whom to disclose their experience without judgment. Many hoped to help others by participating, saying that access to other people's stories would have helped them feel less isolated. Relatedly, many viewed their participation as an opportunity to speak out against restrictive policies that caused them harm, hardship, and distress. Interviewees seldom cited the monetary incentive alone as motivation for participation. A few expressed concerns about participating out of fear of legal repercussions for others involved in their abortion process (e.g., ride-share driver). These themes were consistent across pregnancy outcomes. CONCLUSIONS Research volunteers are motivated to participate for altruistic and self-benefiting reasons. IMPLICATIONS This study provides insights into what people seeking abortion consider when deciding to participate in qualitative research. Research ethics committees evaluating and researchers conducting abortion research should weigh these motivations, perceived benefits, and concerns. Policies that enhance protections for participant data are needed to support knowledge generation from abortion research.
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Affiliation(s)
- Klaira Lerma
- Texas Policy Evaluation Project, Population Research Center, The University of Texas at Austin, Austin, Texas, USA.
| | - Whitney Arey
- Texas Policy Evaluation Project, Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Anna Chatillon
- Texas Policy Evaluation Project, Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Kari White
- Texas Policy Evaluation Project, Population Research Center, The University of Texas at Austin, Austin, Texas, USA; Department of Sociology, The University of Texas at Austin, Austin, Texas, USA; Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
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11
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Steinberg JR. Mental Health Symptoms When Abortion Access Is Restricted. JAMA 2024; 331:289-291. [PMID: 38261058 DOI: 10.1001/jama.2023.26816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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12
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Thornburg B, Kennedy-Hendricks A, Rosen JD, Eisenberg MD. Anxiety and Depression Symptoms After the Dobbs Abortion Decision. JAMA 2024; 331:294-301. [PMID: 38261045 PMCID: PMC10807253 DOI: 10.1001/jama.2023.25599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/20/2023] [Indexed: 01/24/2024]
Abstract
Importance In 2022, the US Supreme Court abolished the federal right to abortion in the Dobbs v Jackson Women's Health Organization decision. In 13 states, abortions were immediately banned via previously passed legislation, known as trigger laws. Objective To estimate changes in anxiety and depression symptoms following the Dobbs decision among people residing in states with trigger laws compared with those without them. Design, Setting, and Participants Using the nationally representative repeated cross-sectional Household Pulse Survey (December 2021-January 2023), difference-in-differences models were estimated to examine the change in symptoms of depression and anxiety after Dobbs (either the June 24, 2022, Dobbs decision, or its May 2, 2022, leaked draft benchmarked to the baseline period, prior to May 2, 2022) by comparing the 13 trigger states with the 37 nontrigger states. Models were estimated for the full population (N = 718 753), and separately for 153 108 females and 102 581 males aged 18 through 45 years. Exposure Residing in states with trigger laws following the Dobbs decision or its leaked draft. Main Outcomes and Measures Anxiety and depression symptoms were measured via the Patient Health Questionnaire-4 ([PHQ-4]; range, 0-12; scores of more than 5 indicate elevated depression or anxiety symptoms; minimal important difference unknown). Results The survey response rate was 6.04% overall, and 87% of respondents completed the PHQ-4. The population-weighted mean age was 48 years (SD, 17 years), and 51% were female. In trigger states, the mean PHQ-4 scores in the baseline period and after the Dobbs decision were 3.51 (95% CI, 3.44 to 3.59) and 3.81 (95% CI, 3.75 to 3.87), respectively, and in nontrigger states were 3.31 (95% CI, 3.27 to 3.34) and 3.49 (95% CI, 3.45 to 3.53), respectively. There was a significantly greater increase in the mean PHQ-4 score by 0.11 (95% CI, 0.06 to 0.16; P < .001) in trigger states vs nontrigger states. From baseline to after the draft was leaked, the change in PHQ-4 was not significantly different for those in trigger states vs nontrigger states (difference-in-differences estimate, 0.09; 95% CI, -0.03 to 0.21; P = .15). From baseline to after the Dobbs opinion, there was a significantly greater increase in mean PHQ-4 scores for those in trigger states vs nontrigger states among females aged 18 through 45 years (difference-in-differences estimate, 0.23; 95% CI, 0.08 to 0.37; P = .002). Among males aged 18 through 45 years, the difference-in-differences estimate was not statistically significant (0.14; 95% CI, -0.08 to 0.36; P = .23). Differences in estimates for males and females aged 18 through 45 were statistically significant (P = .02). Conclusions and Relevance In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.
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Affiliation(s)
- Benjamin Thornburg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Joanne D. Rosen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Center for Law and the Public’s Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Matthew D. Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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13
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Fleurant E, McCloskey L. Medication Abortion: A Comprehensive Review. Clin Obstet Gynecol 2023; 66:706-724. [PMID: 37910067 DOI: 10.1097/grf.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This chapter provides an overview of evidence-based guidelines for medication abortion in the first trimester. We discuss regimens, both FDA-approved and other clinical-based protocols, and will briefly discuss novel self-managed abortion techniques taking place outside the formal health care system. Overview of patient counseling and pain management are presented with care to include guidance on "no touch" regimens that have proven both feasible and effective. We hope that this comprehensive review helps the health care community make strides to increase access to abortion in a time when reproductive health care is continuously restricted.
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Affiliation(s)
- Erin Fleurant
- Department of Obstetrics and Gynecology, Northwestern McGaw Medical Center, Chicago, Illinois
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14
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Oviedo J, Denny CC. Pain Management in Abortion Care. Clin Obstet Gynecol 2023; 66:665-675. [PMID: 37750662 DOI: 10.1097/grf.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Both medication and procedural abortion are associated with pain. The experiences of pain depend on both physical and emotional factors. Several pain management options are available for abortion, depending on abortion type, clinical setting, and patient considerations, and a comprehensive approach is necessary to optimize pain management.
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Affiliation(s)
- Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
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15
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Pearlman Shapiro M, Stowers P, Raidoo S. Contraception After Abortion. Clin Obstet Gynecol 2023; 66:749-758. [PMID: 37750667 DOI: 10.1097/grf.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
After a spontaneous or induced abortion, people may desire to delay or prevent a future pregnancy and many desire to use contraceptive methods to do so. Contraception counseling and provision at the time of abortion care are important components to improve contraceptive access and convenience for people undergoing abortion care. The majority of hormonal and barrier contraceptive methods may be safely initiated at the time of medication or procedural abortion or shortly thereafter, although delayed initiation may be necessary in certain circumstances. A patient-centered approach to contraceptive counseling can identify patients' priorities and mitigate provider coercion or pressure.
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Affiliation(s)
- Marit Pearlman Shapiro
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Paris Stowers
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii
| | - Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii
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16
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VandeVusse AJ, Mueller J, Kirstein M, Strong J, Lindberg LD. "Technically an abortion": Understanding perceptions and definitions of abortion in the United States. Soc Sci Med 2023; 335:116216. [PMID: 37741188 PMCID: PMC10552775 DOI: 10.1016/j.socscimed.2023.116216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
Anti-abortion legislation in the United States exploits misinformation and ignores medical definitions to curtail access to essential healthcare. Little is known about how individuals most likely to need this care define abortion, in general or as distinct from miscarriage, and how this might impact access to, utilization of, and experiences of care. Using mixed-method card sort and vignette data from cognitive interviews (n = 64) and a national online survey (n = 2009), we examined individuals' understandings of pregnancy outcomes including abortion and miscarriage. Our findings show that people hold varying ideas of what constitutes an abortion. Many respondents considered 'intent' when classifying pregnancy outcomes and focused on intervention to distinguish between miscarriages and abortions. Particularly, medical intervention was found as a defining feature of abortion. Lack of knowledge regarding pregnancy experiences and ambiguity surrounding early stages of pregnancy also influenced respondents' understanding of abortion. We find that abortion and miscarriage definitions are socially constructed and multi-layered. Advancing our understanding of abortion and miscarriage definitions improves reproductive health research by elucidating potential areas of confusion that may lead to misreporting of reproductive experiences as well as highlighting ways that blurred definitions may be exploited by abortion opponents.
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Affiliation(s)
| | - Jennifer Mueller
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, USA
| | | | - Joe Strong
- London School of Economics, Department of Social Policy, Houghton Street, London, WC2A 2AE, UK
| | - Laura D Lindberg
- Rutgers School of Public Health, 1 Riverfront Plaza, Suite 1010, Newark, NJ, 07102, USA
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17
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Slade L, Obst K, Deussen A, Dodd J. The tools used to assess psychological symptoms in women and their partners after termination of pregnancy for fetal anomaly: A scoping review. Eur J Obstet Gynecol Reprod Biol 2023; 288:44-48. [PMID: 37423121 DOI: 10.1016/j.ejogrb.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
Termination of pregnancy for fetal anomaly (TOPFA) represents a uniquely distressing and challenging situation for women and their partners. Having appropriate screening tools that best highlight the psychological symptoms experienced by women and their partners is important to be able to guide care. Many validated screening tools for pregnancy and psychological distress exist, with variation in the ease of application and the domains addressed in each. We undertook a scoping review of tools used to assess psychological symptoms in women and/or partners after TOPFA. Of 909 studies, 93 studies including 6248 women and 885 partners were included. Most of the included studies assessed symptoms within six months of TOPFA and highlighted high rates of distress, grief and trauma symptoms. There was broad variation in the tools used between studies and the timing of their implementation. Focusing the care of women and families who undergo TOPFA to validated, broadly available and easily applied screening tools that assess a range of psychological symptoms is key in being able to identify the potential interventions that may be of benefit.
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Affiliation(s)
- Laura Slade
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia.
| | - Kate Obst
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea Deussen
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie Dodd
- Women's and Children's Hospital, North Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia
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18
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Doyle C, Che M, Lu Z, Roesler M, Larsen K, Williams LA. Women's desires for mental health support following a pregnancy loss, termination of pregnancy for medical reasons, or abortion: A report from the STRONG Women Study. Gen Hosp Psychiatry 2023; 84:149-157. [PMID: 37490825 DOI: 10.1016/j.genhosppsych.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE We report on women's mental health care desires following a miscarriage, medical termination, or abortion. METHOD 689 women completed a questionnaire on reproductive history, health care following miscarriage/medical termination/abortion, and current mental health. Descriptive statistics and logistic regression analyses examined: miscarriage/termination/abortion incidence, desires for mental health support following miscarriages/terminations/abortions, and current mental health. RESULTS Of 365 women with a pregnancy history, 37% reported ≥1 miscarriage, 9% ≥1 medical termination, 16% ≥1 abortion, and 3% endorsed all three. Current mental health did not differ between women with a history of miscarriage/termination/abortion and those with only live births (p = 0.82). Following miscarriage, 68% of women discussed options for the medical management of pregnancy loss with their provider, 32% discussed grief/loss, and 25% received mental health care recommendations. Engagement in mental health services was reported by 16% of women with a history of miscarriage, 38% after medical termination, and 19% following an abortion. Of women who became pregnant after their most recent miscarriage/termination/abortion and did not receive mental health care, 55% wished they had received services during the subsequent pregnancy. CONCLUSIONS Women desire mental health care after miscarriages, medical terminations, or abortions, warranting improved access to mental health care for these individuals.
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Affiliation(s)
- Colleen Doyle
- Women's Wellbeing Program, Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mambo Che
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Zhanni Lu
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Michelle Roesler
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Karin Larsen
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lindsay A Williams
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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19
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Armour S, Keedle H, Gilkison A, Dahlen HG. Midwifery care for late termination of pregnancy: Integrative review. Sex Reprod Healthc 2023; 37:100889. [PMID: 37454584 DOI: 10.1016/j.srhc.2023.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Midwives provide reproductive healthcare to women, including during termination of pregnancy (TOP) after 12 weeks (late TOP). Their expertise, knowledge and woman-centred care approach sees them ideally placed for this role. However, the medical, social and emotional complexities of late TOP can cause midwives significant distress. An integrative review methodology was used to examine the research on midwifery care for late TOP and identify support strategies and interventions available to midwives in this role. Five databases and reference lists were searched for relevant studies published between 2000 and 2021. A total of 2545 records were identified and 24 research studies included. Synthesis of research findings resulted in three themes: Positive aspects, negative aspects and carers need care. Midwives reported a high level of job satisfaction when caring for women during late TOP. Learning new skills and overcoming challenges were positive aspects of their work. Yet, midwives felt unprepared to deal with challenging aspects of late TOP care such as the grief and the psychological burden of the role. Caring for the baby with dignity had both positive and negative aspects. Midwives relied predominantly on close colleagues for help and debriefing as they felt poorly supported by management, judged by co-workers and lacked appropriate support to reduce the emotional effects of late TOP care. Midwives need support, although current evidence has not identified the most appropriate and effective strategy to support them in this role.
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Affiliation(s)
- Susanne Armour
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia.
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| | - Andrea Gilkison
- Auckland University of Technology, School of Clinical Sciences, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
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20
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Sufrin CB, Devon-Williamston A, Beal L, Hayes CM, Kramer C. "I mean, I didn't really have a choice of anything:" How incarceration influences abortion decision-making and precludes access in the United States. Perspect Sex Reprod Health 2023; 55:165-177. [PMID: 37394626 DOI: 10.1363/psrh.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To understand how the punitive, rights-limiting, and racially stratified environment of incarceration in the United States (US) shapes the abortion desires, access, and pregnancy experiences of pregnant women, transgender men, and gender non-binary individuals. METHODS From May 2018-November 2020, we conducted semi-structured, qualitative interviews with pregnant women in prisons and jails in an abortion supportive and an abortion restrictive state. Interviews explored whether participants considered abortion for this pregnancy; attempted to obtain an abortion in custody; whether and how incarceration affected their thoughts about pregnancy, birth, parenting, and abortion; and options counseling and prenatal care experiences, or lack thereof, in custody. RESULTS The conditions of incarceration deeply shaped our 39 participants' abortion and pregnancy decisions, with some experiencing pregnancy continuation as punishment. Four themes emerged: (1) medical providers' overt obstruction of desired abortions; (2) participants assuming that incarcerated women had no right to abortion; (3) carceral bureaucracy constraining abortion access; and (4) carceral conditions made women wish they had aborted. Themes were similar in supportive and restrictive states. CONCLUSIONS Incarceration shaped participants' thoughts about pregnancy and their abilities to access abortion, consider whether abortion was an attainable option, and make pregnancy-related decisions. These subtle carceral control aspects presented more frequent barriers to abortion than overt logistical ones. The carceral environment played a more significant role than the state's overall abortion climate in shaping abortion experiences. Incarceration constrains and devalues reproductive wellbeing in punitive ways that are a microcosm of broader forces of reproductive control in US society.
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Affiliation(s)
- Carolyn B Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Crystal M Hayes
- Department of Maternal and Child Health Center of Excellence, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Camille Kramer
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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21
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Jefford E, Marsden J, Ebert L. The impact of abortion doulas on women and providers' outcomes: An integrative review of the evidence. Sex Reprod Healthc 2023; 37:100888. [PMID: 37506666 DOI: 10.1016/j.srhc.2023.100888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
The aim of this integrative review is to map the literature on the impact of abortion doulas on women and abortion care providers. This review followed a modified Whittemore and Knafl framework and PRISMA guidelines. Electronic databases (Medline, PubMed, CINAHL, the Cochrane Library, Scopus, Proquest, EMBASE, and PsycINFO) were searched using key terms: abortion and doula. Search was limited by date (2012-2022), type (primary research only), and language (English only). Of the 99 papers found, only 4 met inclusion criteria. The four papers - drawn from 2 studies - were analysed using NICE Appraisal checklists. In total, data from 328 participants (n = 314 women, n = 5 physicians, n = 5 staff members, n = 4 abortion doulas) was analysed. Of the 314 women, 160 women received doula support and 154 did not. Two qualitative papers showed women and abortion providers reported a beneficial impact of abortion doulas, but the two quantitative (RCTs) papers showed null impact for a doula support intervention vs. usual care on women's physical and psychological outcomes. Women reported wanting support during the abortion; however, the evidence is not yet clear on whether a doula is required to address this need for women undergoing a surgical abortion in clinic. It may be that abortion support is important in ways that are difficult to measure.
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Affiliation(s)
- Elaine Jefford
- School of Health, University of the Sunshine Coast, Australia.
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22
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Rongkapich R, Poolkumlung R, Sinthuchai N, Limsirorat P, Chiemchaisri N, Santibenchakul S, Jaisamrarn U. Knowledge, attitude, and intended practice of abortion among pharmacy students in Thailand after the amendment of the Thai Abortion Law. BMC Med Educ 2023; 23:533. [PMID: 37496054 PMCID: PMC10373229 DOI: 10.1186/s12909-023-04526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The recently amended Thai abortion law allows pregnant women to undergo abortions up to the gestational age of 12 weeks. Medical abortion is significant because it has revolutionized access to safe abortion care-abortion medicine can now be safely and effectively administered outside of a healthcare facility to women in early pregnancy. This contribution supports the pharmacists' role in interprofessional safe abortion teamwork. Adequate knowledge of the current laws regarding safe abortion services will increase pharmacists' competence in providing services. However, safe abortions as a subject have not been formally incorporated into the curriculum for Thai pharmacy students. Therefore, this study aimed to evaluate the knowledge, attitude, and intended practice of fifth-year pharmacy students at Chulalongkorn University. METHODS A cross-sectional study was conducted using an electronic self-administered questionnaire adapted from previously published studies to evaluate participants' knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. The invitations were sent to all fifth-year pharmacy students at Chulalongkorn University. RESULTS Among all invitations sent, 104/150 (69.3%) participants responded to the survey. Only a third of the participants (31.7%) had good knowledge scores. Based on five questions regarding the gestational age limit for legal abortion, most participants (52.7%) answered questions incorrectly. Although more than half of the participants (52.5%) disagreed with two pro-choice statements, an overwhelming majority (87.5%) agreed that abortion was a woman's right. Safe abortion services were mostly agreed upon with serious fetal defects (91.9%), non-HIV maternal health conditions (82.2%), and sexual assaults (77.4%). A positive attitude toward abortion affects the intention to perform an abortion under socioeconomic conditions. CONCLUSION Most participants lacked knowledge on the amended abortion law, especially on the gestational limits of abortion. Participants with favorable attitudes toward abortion tended to be more liberal regarding safe abortion services.
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Affiliation(s)
- Ratthapong Rongkapich
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Rada Poolkumlung
- Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Natchanika Sinthuchai
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA USA
| | - Phobsan Limsirorat
- Faculty of Pharmaceutical Science, Chulalongkorn University, 254 Phaya Thai Rd, Wang Mai District, Pathum Wan, Bangkok, 10330 Thailand
| | - Nattaporn Chiemchaisri
- Department of pharmacy, King Chulalongkorn memorial hospital, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330 Thailand
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23
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Bell LA, Tyler CP, Russell MR, Szoko N, Harrison EI, Kazmerski TM, Syed T, Kirkpatrick L. Preferences and Experiences Regarding Pregnancy Options Counseling in Adolescence and Young Adulthood: A Qualitative Study. J Adolesc Health 2023; 73:164-171. [PMID: 37032209 PMCID: PMC10330200 DOI: 10.1016/j.jadohealth.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Perspectives of adolescents and young adults (AYAs) experiencing pregnancy options counseling (POC) are absent from the literature. This study explores AYA experiences and preferences related to POC to inform best practice guidelines. METHODS We conducted semistructured phone interviews in 2020-2021 among US-based individuals, 18-35 years old, who experienced a pregnancy less than 20 years of age. We performed qualitative descriptive analysis of positive and negative attributes of AYA's experiences with POC. RESULTS Fifty participants reported 59 pregnancies (16 parenting, 19 abortions, 18 adoptions, three miscarriages) between the ages of 13 and 19 years. Positive attributes of POC experienced included: (1) provider communication that was compassionate, respectful, supportive, and attentive to nonverbal cues; (2) provider neutrality; (3) discussion of all pregnancy options; (4) asking about feelings, choice, life plans, and additional supports; (5) provision of informational materials; and (6) warm handoffs/follow-up facilitation. Negative attributes of POC experienced included: (1) judgmental, impersonal, or absent communication; (2) lack of counseling on all options and/or coercive/directive counseling; (3) insufficient time and supportive resources; and (4) confidentiality concerns. We identified no differences in these perspectives across pregnancy outcomes reported. Participants generally desired counseling about all options, with rare exceptions of ambivalence. DISCUSSION Individuals who experienced an adolescent pregnancy described similar positive and negative attributes of POC regardless of preferred pregnancy outcome. Their perspectives highlight how crucial interpersonal communication skills are for effective POC for AYA. POC training across health care specialties should emphasize confidential, compassionate, and nonjudgmental care for AYA patients.
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Affiliation(s)
- Lauren A Bell
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Crystal P Tyler
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, Chicago, Illinois
| | - Margaret R Russell
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas Szoko
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth I Harrison
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Traci M Kazmerski
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tahniat Syed
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura Kirkpatrick
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
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24
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Teoh SJY, Low PK, Ramsay JE. In Search of Safe Spaces: An Exploratory Study of the Anticipated Help-Seeking Needs and Preferences of Protestant Christian Women in Singapore with Respect to a Hypothetical Abortion Scenario. J Relig Health 2023; 62:819-838. [PMID: 36811725 PMCID: PMC10042958 DOI: 10.1007/s10943-023-01766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Research suggests that religious beliefs may contribute to abortion stigma, resulting in increased secrecy, reduced social support and help-seeking as well as poor coping and negative emotional consequences such as shame and guilt. This study sought to explore the anticipated help-seeking preferences and difficulties of Protestant Christian women in Singapore with regard to a hypothetical abortion scenario. Semi-structured interviews were conducted with 11 self-identified Christian women recruited through purposive and snowball sampling. The sample was largely Singaporean and all participants were ethnically Chinese females of a similar age range (late twenties to mid-thirties). All willing participants were recruited regardless of denomination. All participants anticipated experiences of felt, enacted and internalized stigma. These were affected by their perceptions of God (e.g., how they see abortion), their personal definitions of "life" and their perceptions of their religio-social environment (e.g., perceived social safety and fears). These concerns contributed to participants choosing both faith-based and secular formal support sources with caveats, despite a primary preference for faith-based informal support and secondary preference for faith-based formal support. All participants anticipated negative post-abortion emotional outcomes, coping difficulties and short-term decision dissatisfaction. However, participants who reported more accepting views of abortion also anticipated an increase in decision satisfaction and well-being in the longer term.
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Affiliation(s)
- S J Y Teoh
- School of Social and Health Sciences, James Cook University, Singapore, Singapore
| | - P K Low
- School of Social and Health Sciences, James Cook University, Singapore, Singapore
| | - J E Ramsay
- School of Social and Health Sciences, James Cook University, Singapore, Singapore.
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25
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Zhang Q, Qin C, Xie J, Li X, Zeng L, Wang Y, Wang Y, Peng H. Effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:435-443. [PMID: 37164927 PMCID: PMC10930079 DOI: 10.11817/j.issn.1672-7347.2023.220327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To explore the effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. METHODS Based on literature review, a self-made general demographic information questionnaire, the Edinburgh Postnatal Depression Scale, the Individual Level Abortion Stigma Scale, the Acceptance and Action Questionnaire-II, the Cognitive Fusion Questionnaire-Fusion, the Responses to Stress Questionnaire and the Perceived Social Support Scale were used to investigate pregnant women with fetal anomaly before abortion in tertiary general hospitals and specialist maternity hospitals in Changsha, to develop a hypothesis model of the factors influencing depressive symptoms before terminating the pregnancy. The hypothesis model was verified by applying structural equation modelling analysis. RESULTS The structural equation model showed that the stigma directly or indirectly influenced depressive symptoms before terminating the pregnancy via psychological flexibility, social support and avoidance coping. The total effect value was 0.55 (P<0.05), the direct effect value was 0.22 (P<0.05), and the indirect effect value was 0.33 (P<0.05). Psychological flexibility and social support had protective mediating effects, while avoidance coping had harmful mediating effects. CONCLUSIONS Abortion stigma has large positive effect on the depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. Among direct and indirect effect, the indirect effect is major. Effective measures to reduce the stigma, increase psychological flexibility, improve social support and coping style will have an important influence on the prevention and reduction of depressive symptoms before terminating the pregnancy.
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Affiliation(s)
- Qiuxiang Zhang
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Chunxiang Qin
- Xiangya Nursing School, Central South University, Changsha 410013
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Jiaying Xie
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Xi Li
- Jishou University School of Medicine, Jishou Hunan 416000
| | - Lihong Zeng
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Ying Wang
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Yaohan Wang
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Huiting Peng
- Xiangya Nursing School, Central South University, Changsha 410013.
- Department of Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha 410008, China.
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Sebola BR. What it does and does not do: Effects of ultrasound viewing on women's intention to terminate a pregnancy. Afr J Reprod Health 2023; 27:71-76. [PMID: 37584974 DOI: 10.29063/ajrh2023/v27i3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Ultrasound imaging is a renowned prenatal technology used globally to assess foetal growth, viability and abnormalities. In South Africa, ultrasound viewing has not been made mandatory for women who want to terminate their pregnancies. The purpose of this study was to provide a deeper understanding of the effects of ultrasound viewing on women's intention to terminate their pregnancies. Fifteen women in their first trimester were recruited for the study from a community health centre mandated for abortion. Van Manen's hermeneutic phenomenological analysis method was adopted for the study. Three major themes emerged from the data analysis: motivation beyond ultrasound viewing, the emotional burden of the experience, and viewing the ultrasound image as punishment. The study concluded that even though most participants reported the ultrasound viewing negatively affected their person, their reason for termination was so strong that they would not change their minds. However, the ultrasound viewing helped three participants to earnestly reflect on their situations, weigh the pros and cons, and subsequently decide to continue their pregnancy.
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Affiliation(s)
- Botshelo R Sebola
- Department of Health Studies, University of South Africa, PO Box 392, Pretoria, South Africa
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Nguyen M, Cartwright AF, Upadhyay UD. Fear of procedure and pain in individuals considering abortion: A qualitative study. Patient Educ Couns 2023; 108:107611. [PMID: 36603469 PMCID: PMC10152982 DOI: 10.1016/j.pec.2022.107611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To explore concerns about procedural abortion and abortion-related pain in a cohort searching for abortion online. METHODS The Google Ads Abortion Access Study was a national longitudinal cohort study that recruited people searching for abortion online. Participants completed a baseline demographic survey and a follow-up survey four weeks later evaluating barriers and facilitators to abortion. This qualitative study utilized thematic analysis to produce a descriptive narrative based on overarching themes about procedural abortion and abortion-related pain. RESULTS There were 57 separate mentions from 45 participants regarding procedural abortion or abortion-related pain. We identified two main themes: 1) concerns about the procedure (with subthemes, fear of procedural abortion, comparison to medication abortion, lack of sedation) and 2) abortion-related pain (with subthemes fear of abortion-related pain, experiences of pain, fear of complications and cost-barriers to pain control). CONCLUSIONS This study highlights the need for improved anticipatory guidance and accessible resources to assuage potential fears and misconceptions regarding abortion. PRACTICE IMPLIACTIONS Abortion resources, particularly online, should provide accurate and unbiased information about abortion methods and pain to help patients feel more prepared. Providers should be aware of potential concerns surrounding procedural abortion and pain when counseling patients presenting for care.
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Affiliation(s)
- May Nguyen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Alice F Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA; Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, CA, USA.
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Mueller J, Kirstein M, VandeVusse A, Lindberg LD. Improving abortion underreporting in the USA: a cognitive interview study. Cult Health Sex 2023; 25:126-141. [PMID: 36007884 PMCID: PMC9812882 DOI: 10.1080/13691058.2022.2113434] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/11/2022] [Indexed: 05/31/2023]
Abstract
Abortion is a difficult-to-measure behaviour with extensive underreporting in surveys, which compromises the ability to study and monitor it. We aimed to improve understanding of how women interpret and respond to survey items asking if they have had an abortion. We developed new questions hypothesised to improve abortion reporting, using approaches that aim to clarify which experiences to report; reduce the stigma and sensitivity of abortion; reduce the sense of intrusiveness of asking about abortion; and increase respondent motivation to report. We conducted cognitive interviews with cisgender women aged 18-49 in two US states (N = 64) to assess these new approaches and questions for improving abortion reporting. Our findings suggest that including abortion as part of a list of other sexual and reproductive health services, asking a yes/no question about lifetime experience of abortion instead of asking about number of abortions, and developing an improved introduction to abortion questions may help to elicit more accurate survey reports. Opportunities exist to improve survey measurement of abortion. Reducing the underreporting of abortion in surveys has the potential to improve sexual and reproductive health research that relies on pregnancy histories.
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Li X, Peng H, Zeng L, Owusua T, Wang Y, Wang Y, Qin C. Stigma and its influencing factors among women with termination of pregnancy for fetal anomaly: A cross-sectional study. Midwifery 2023; 116:103553. [PMID: 36410260 DOI: 10.1016/j.midw.2022.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the level of stigma and identify its influencing factors among women with termination of pregnancy for fetal anomaly(TOPFA) in China. DESIGN This was a cross-sectional study design. SETTING AND PARTICIPANTS A total of 469 women with TOPFA were recruited from a tertiary care hospital in China using a convenience sampling method. MEASUREMENT AND FINDINGS Women with TOPFA participating in the study completed the Demographic Characteristics Questionnaire, Individual Level Abortion Stigma Scale(ILASS), Acceptance and Action Questionnaire- II scale(AQQ- II), Cognitive Fusion Questionnaire scale (CFQ), Multidimensional Perceived Social Support Scale(MPSS), Responses to Stress Questionnaire (RSQ). Women with TOPFA reported moderate levels of stigma(1.49±0.60). Multiple linear regression showed that correlates influencing their stigma included gestational age (β =0.103, P < 0.05), psychological flexibility (β =-0.319, P < 0.01), social support(β =-0.190, P < 0.01), and disengagement coping(β =0.148, P < 0.05). KEY CONCLUSION AND IMPLICATION FOR PRACTICE Gestational age and disengagement coping are positive predictors of stigma, but psychological flexibility and social support are negative predictors of stigma. Further attention should focus on developing targeted intervention strategies to improve protective and reduce harmful factors to confront the stigma-related challenges faced by women with TOPFA.
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Affiliation(s)
- Xi Li
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; Jishou University School of Medical, Jishou, China.
| | - Huiting Peng
- Xiangya School of Nursing, Central South University, Changsha, China; Department of Gynaecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Lihong Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Ying Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yaohan Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China.
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Wang N, Creedy DK, Zhang M, Lu H, Elder E, Allen J, Guo L, Xiao Q, Gamble J. Designing a Needs-Oriented Psychological Intervention for Chinese Women Undergoing an Abortion. Int J Environ Res Public Health 2022; 20:782. [PMID: 36613103 PMCID: PMC9819149 DOI: 10.3390/ijerph20010782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Accessing good quality abortion care is a fundamental human right and contributes to achieving Sustainable Development Goals. However, well-designed abortion care that meets women's needs is limited. This study aims to systematically develop an intervention to promote the psychological well-being of Chinese women undergoing an abortion. A five-step iterative approach informed by intervention mapping was undertaken to determine the intervention design. Step 1 used in-depth interviews with 14 Chinese women undergoing an abortion to assess real-life stressors and support needs. We identified eight stressors and found women's support needs varied with the time trajectory of the abortion. Step 2 used a focus group discussion with care providers to select modifiable stressors that impact negative psychological outcomes. In Step 3 and Step 4, we determined and integrated the exact strategies to eliminate or mitigate possible modifiable stressors by incorporating information from in-depth interviews and the Transactional Model of Stress and Coping. The integrated strategies were instructional support, informational support, and timely communication. In Step 5, we composed the detailed intervention design according to the best available evidence and, to confirm content validity, consulted 10 women who had undergone abortion in the previous 2-6 weeks. The intervention was titled STress-And-coping suppoRT (START), which included four interacting components: (1) a face-to-face consultation at the first appointment; (2) a printed booklet with information on abortion, self-care, and managing emotions and intimate relationships; (3) a WeChat-based online public profile page offering the same information as the booklet; (4) a telephone hotline. This study paves the way for a new approach to addressing the psychological needs of women experiencing abortion in China. The rigorous process provides an example of developing tailored health promotion interventions.
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Affiliation(s)
- Na Wang
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Gold Coast, QLD 4215, Australia
| | - Debra K. Creedy
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
| | - Mingna Zhang
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Hong Lu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Elizabeth Elder
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Gold Coast, QLD 4215, Australia
| | - Jyai Allen
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
| | - Li Guo
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Jenny Gamble
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
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Ogbu-Nwobodo L, Shim RS, Vinson SY, Fitelson EM, Biggs MA, McLemore MR, Thomas M, Godzich M, Mangurian C. Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations. N Engl J Med 2022; 387:1613-1617. [PMID: 36300980 DOI: 10.1056/nejmms2211124] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucy Ogbu-Nwobodo
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Ruth S Shim
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Sarah Y Vinson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Elizabeth M Fitelson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - M Antonia Biggs
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Monica R McLemore
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Marilyn Thomas
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Micaela Godzich
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Christina Mangurian
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
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Coleman-Minahan K, Alspaugh A. Abortion Knowledge Among Advanced Practice Clinicians in Colorado. Womens Health Issues 2022; 32:461-469. [PMID: 35738986 PMCID: PMC9532373 DOI: 10.1016/j.whi.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians. METHODS We conducted a stratified random survey of advanced practice clinicians, oversampling women's health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores. RESULTS A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, "I don't know" was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, "I don't know" was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women's health. Providing options counseling was positively associated with abortion knowledge (law, β = 0.44; 95% confidence interval [CI], 0.10-0.78; care, β = 0.52; 95% CI, 0.08-0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β = -0.03; 95% CI, -0.65 to 0.59), but lower abortion care knowledge (β = -1.85; 95% CI, -2.34 to -1.36). CONCLUSIONS Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.
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Affiliation(s)
- Kate Coleman-Minahan
- University of Colorado College of Nursing, Aurora, Colorado; University of Colorado Population Center, Boulder, Colorado.
| | - Amy Alspaugh
- University of Tennessee College of Nursing, Knoxville, Tennessee; ACTIONS Program, University of California, San Francisco, San Francisco, California
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Tlhabela DD, Peu MD, Mataboge SM, Rasweswe MM, Seretlo RJ, Mooa RS. Community health nurses' experiences regarding provision of termination of pregnancy services in Johannesburg metro subdistricts clinics. Afr J Reprod Health 2022; 26:112-122. [PMID: 37585037 DOI: 10.29063/ajrh2022/v26i8.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Experiences of community health nurses contribute to access of termination of pregnancy (TOP) to be affected. The aim of this study was to explore and describe the experiences of community health nurses who provide termination of pregnancy in Johannesburg Metro sub districts clinics. This study was conducted in a natural setting namely the clinics where the community health nurses worked. The clinic was the natural setting for the community health nurses because it was where they provide termination of pregnancy services on a daily basis. The researcher conducted the study in 5 sub districts clinics in Johannesburg Metro. A qualitative, explorative and descriptive method was used in this study. The population comprised of community health nurses who were selected purposively. Data were collected amongst 11 participants using individual face to face interviews in a natural setting. Data were analyzed using the Tesch method of data analysis. Two themes emerged; attributes of termination of pregnancy providers as the first theme with sub-theme possess emotional stability, courage, self-worth, and selflessness. The second theme that emerged was a requirement for termination of pregnancy services with staff, equipment for termination of pregnancy, management support, training, and development needs were sub-themes of the second theme. Termination of pregnancy providers experienced stigma and discrimination by their colleagues and community. Though the community health nurses loved their job, lack of support from the supervisors contributed to them feeling neglected and this in turn caused them, to experience stress. The experiences of community health nurses who provided termination of pregnancy in Johannesburg Metro subdistricts clinics were explored and described. It was noted that the community health nurses were overwhelmed with work, doing everything on their own which resulted in them experiencing stress and burnout. Lack of equipment and consumables increased their stress levels because they had to improvise in order to keep the service going.
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Sudhinaraset M, Landrian A, Cotter SY, Golub G, Opot J, Seefeld CA, Phillips B, Ikiugu E. Improving stigma and psychosocial outcomes among post-abortion Kenyan women attending private clinics: A randomized controlled trial of a person-centered mobile phone-based intervention. PLoS One 2022; 17:e0270637. [PMID: 35749557 PMCID: PMC9232159 DOI: 10.1371/journal.pone.0270637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The objective of this study was to evaluate a person-centered abortion care mobile-based intervention on perceived social stigma, social support, mental health and post-abortion care experiences among Kenyan women who received abortion services at private clinics. Methods This randomized controlled study enrolled women who obtained an abortion from private clinics in Nairobi county, Kenya and randomized them into one of three study arms: 1) standard of care (follow-up by service provider call center); 2) post-abortion phone follow-up by a peer counselor (a woman who has had an abortion herself and is trained in person-centered abortion care); or 3) post-abortion phone follow-up by a nurse (a nurse who is trained in person-centered abortion care). All participants were followed-up at two- and four-weeks post-abortion to evaluate intervention effects on mental health, social support, and abortion-related stigma scores. A Kruskal-Wallis one-way ANOVA test was used to assess the effect of each intervention compared to the control group. In total, 371 women participated at baseline and were each randomized to the study arms. Results Using Kruskal-Wallis tests, the nurse arm improved mental health scores from baseline to week two; however this was only marginally significant (p = 0.059). The nurse arm also lowered stigma scores from baseline to week four, and this was marginally significant (p = 0.099). No other differences were found between the study arms. This person-centered mobile phone-based intervention may improve mental health and decrease perceived stigma among Kenyan women who received abortion services in private clinics. Conclusions Nurses trained in person-centered abortion care, in particular, may improve women’s experiences post-abortion and potentially reduce feelings of shame and stigma and improve mental health in this context.
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Affiliation(s)
- May Sudhinaraset
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Amanda Landrian
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Sun Yu Cotter
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | - James Opot
- Innovations for Poverty Action, Nairobi, Kenya
| | - C. Avery Seefeld
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Beth Phillips
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
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Abstract
INTRODUCTION When clinicians feel negative emotions toward patients, providinge patient-centered care can be difficult. This can occur in family planning scenarios, such as when a provider is uncomfortable with a patient choosing abortion. The Professionalism in Family Planning Care Workshop (PFPCW), framed around professionalism values, used guided reflection to foster self-awareness and empathy in order to teach future providers to provide patient-centered care. METHODS In the PFPCW, learners discussed challenging patient interactions and family planning scenarios to develop self-awareness and identify strategies for maintaining therapeutic relationships with patients when they experience negative feelings toward them. We implemented the workshop across the United States and Canada and collected pre- and postsurvey data to evaluate program outcomes at Kirkpatrick evaluation levels of participant reaction and effects on learners' attitudes. RESULTS A total of 403 participants participated in 27 workshops in which pre- and postworkshop surveys (70% and 46% response rates, respectively) were administered. Sixty-five percent of the participants were residents, and 36% had previously participated in a similar workshop. The majority (92%) rated the PFPCWs as worthwhile. Participants valued the discussion and self-reflection components. Afterward, 23% reported that their attitudes toward caring for people with unintended pregnancy changed to feeling more comfortable. Participants said they would employ self-reflection and empathy in future challenging interactions. DISCUSSION In this pilot implementation study, our workshop provided learners with strategies for patient-centered care in challenging family planning patient interactions. We are currently modifying the workshop and evaluation program based on feedback.
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Affiliation(s)
- Jody Steinauer
- Distinguished Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine
| | - Aliza Adler
- Program and Academic Coordinator, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine
| | - Jema Turk
- Director, Ryan Program, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine
| | - Jessie Chien
- PhD Candidate, Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health
| | - Uta Landy
- Senior Advisor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine
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Kayi EA, Biney AAE, Dodoo ND, Ofori CAE, Dodoo FNA. Women's post-abortion contraceptive use: Are predictors the same for immediate and future uptake of contraception? Evidence from Ghana. PLoS One 2021; 16:e0261005. [PMID: 34932576 PMCID: PMC8691597 DOI: 10.1371/journal.pone.0261005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
This study seeks to identify the socio-demographic, reproductive, partner-related, and facility-level characteristics associated with women’s immediate and subsequent use of post-abortion contraception in Ghana. Secondary data from the 2017 Ghana Maternal Health Survey were utilized in this study. The weighted data comprised 1,880 women who had ever had an abortion within the five years preceding the survey. Binary logistic regression analyses were performed to examine the associations between the predictor and outcome variables. Health provider and women’s socio-demographic characteristics were significantly associated with women’s use of post-abortion contraception. Health provider’s counselling on family planning prior to or after abortion and place of residence were associated with both immediate and subsequent post-abortion uptake of contraception. Among subsequent post-abortion contraceptive users, older women (35–49), women in a union, and women who had used contraception prior to becoming pregnant were strong predictors. Partner-related and reproductive variables did not predict immediate and subsequent use of contraception following abortion. Individual and structural/institutional level characteristics are important in increasing women’s acceptance and use of contraception post abortion. Improving and intensifying family planning counselling services at the health facility is critical in increasing contraceptive prevalence among abortion seekers.
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Affiliation(s)
- Esinam Afi Kayi
- Department of Adult Education and Human Resource Studies, School of Continuing and Distance Education, University of Ghana, Legon, Ghana
- * E-mail:
| | | | - Naa Dodua Dodoo
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | | | - Francis Nii-Amoo Dodoo
- Department of Sociology, Pennsylvania State University, State College, Pennsylvania, United States of America
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Merga J, Wirtu D, Bekuma TT, Regasa MT. Unintended pregnancy and the factors among currently pregnant married youths in Western Oromia, Ethiopia: A mixed method. PLoS One 2021; 16:e0259262. [PMID: 34735534 PMCID: PMC8568197 DOI: 10.1371/journal.pone.0259262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Unintended pregnancy is a global concern affecting both developed and developing countries. Some young women who had unintended pregnancies obtain an abortion while others carry their pregnancies to term, incurring the risk of morbidity and mortality higher than those for adult women. Despite the availability of highly effective methods of contraception, different studies in Ethiopia revealed that there is a high level of unintended pregnancy. OBJECTIVE To assess the magnitude of unintended pregnancy and associated factors among currently pregnant married youths in Kiremu district. METHODS A community-based cross-sectional study was conducted among currently pregnant married 15-24 years women. Multi-stage stratified sampling technique was used to select 434 study units. Ten kebeles were randomly selected and samples were selected from each of ten kebeles by simple random sampling using kebeles household identification numbers as the sampling frame. Quantitative data was entered with SPSS version 20 and crude and adjusted odds ratio together with their 95%CI were computed and interpreted accordingly. A p-value<0.05 was considered to declare a result as statistically significant in this study. In-depth interviews and transcripts of the recorded discussions were coded and analyzed thematically. The results were finally presented in texts, tables, and graphs. RESULT Unintended pregnancies among currently pregnant married young women in the study area were 31.1%. Educational status (AOR = 3.195,95%CI = 1.757,5.811),being Gov't employee (AOR = 0.039, 95% CI = 0.002,0.988), ever heard contraceptives(AOR = 0.260, 95%CI = 0.077, 0.876), ever used contraceptives (AOR = 0.348,95%CI = 0.168,0.717),discussion about contraceptives with husband(AOR = 0.027,95%CI = 0.015, 0.050),fear of side effect of contraceptives (AOR = 5.819,95% CI = 1.438,23.422), autonomy on health (AOR = 0.122,95%CI = 0.035,0.431), age at first marriage (AOR = 3.195, 95%CI = 1.757,5.811), age first pregnancy(AOR = 23.660,95%CI = 12.573,44.522), being visited by health care providers (AOR = 0.202,95%CI = 0.073,0.566) and average birth interval (AOR = 3.472,95%CI = 1.392,8.61) were the factors associated with unintended pregnancy. CONCLUSION AND RECOMMENDATION Significant proportion of women had an unintended pregnancy in the study area. Therefore, emphasis should be given to married youths especially on women empowerment, encouraging partner discussions, and providing appropriate counseling on contraceptive side effects by giving due attention to those marred at younger ages (<18 years).
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Affiliation(s)
- Jaleta Merga
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Desalegn Wirtu
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tariku Tesfaye Bekuma
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- * E-mail:
| | - Misganu Teshoma Regasa
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Jacques L, Carpenter E, Valley T, Alvarez B, Higgins J. Medication or surgical abortion? An exploratory study of patient decision making on a popular social media platform. Am J Obstet Gynecol 2021; 225:344-347. [PMID: 34022196 DOI: 10.1016/j.ajog.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Jacques
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, McConnell Hall, Fourth Floor, 1010 Mound St., Madison, WI 53715.
| | - Emma Carpenter
- Texas Policy Evaluation Project, University of Texas at Austin, Austin, TX
| | - Taryn Valley
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Anthropology, University of Wisconsin-Madison, Madison, WI
| | - Barbara Alvarez
- The Information School, University of Wisconsin-Madison, Madison, WI
| | - Jenny Higgins
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI
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Fleming V, Frith L, Ramsayer B. Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland. HEC Forum 2021; 33:189-213. [PMID: 31273516 PMCID: PMC8390396 DOI: 10.1007/s10730-019-09378-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK's Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4(1) of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: "Is Greater Glasgow and Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?" The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms "mid-level professionals" such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research.
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Affiliation(s)
- Valerie Fleming
- School of Nursing and Allied Health, Liverpool John Moores, University, 15-21 Webster St, Liverpool, L3 2ET, UK.
| | | | - Beate Ramsayer
- School of Nursing and Allied Health, Liverpool John Moores, University, 15-21 Webster St, Liverpool, L3 2ET, UK
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Munro S, Benipal S, Williams A, Wahl K, Trenaman L, Begun S. Access experiences and attitudes toward abortion among youth experiencing homelessness in the United States: A systematic review. PLoS One 2021; 16:e0252434. [PMID: 34197477 PMCID: PMC8248724 DOI: 10.1371/journal.pone.0252434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives We sought to review the literature on the access experiences and attitudes toward abortion among youth experiencing homelessness in the United States. Methods We conducted a systematic review of peer‐reviewed literature published from 2001 to 2019. We included qualitative studies involving US participants that focused on access experiences, views, or accounts of unintended pregnancy and/or abortion among youth experiencing homelessness. We excluded studies published before 2001 as that was the year mifepristone medication abortion was made available in the US and we aimed to investigate experiences of access to both medical and surgical abortion options. Results Our thematic analysis of the data resulted in five key themes that characterize the abortion attitudes and access experiences of youth experiencing homelessness: (1) engaging in survival sex and forced sex, (2) balancing relationships and autonomy, (3) availability does not equal access, (4) attempting self-induced abortions using harmful methods, and (5) feeling resilient despite traumatic unplanned pregnancy experiences. Conclusions Youth experiencing homelessness experience barriers to abortion access across the US, including in states with a supportive policy context and publicly funded abortion services. In the absence of accessible services, youth may consider harmful methods of self-induced abortion. Improved services should be designed to offer low-barrier abortion care with the qualities that youth identified as important to them, including privacy and autonomy.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- * E-mail:
| | - Savvy Benipal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aleyah Williams
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Kate Wahl
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver BC, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Adde KS, Darteh EKM, Kumi-Kyereme A. Experiences of women seeking post-abortion care services in a Regional Hospital in Ghana. PLoS One 2021; 16:e0248478. [PMID: 33878103 PMCID: PMC8057598 DOI: 10.1371/journal.pone.0248478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/27/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Abortions remain one of the highest contributors to maternal deaths in Ghana. In 2003, a policy on post-abortion care was introduced to help reduce abortion-related mortality and morbidity. However, depending on the method of pregnancy termination; women encounter varying experiences. This study examines the experiences of women seeking post-abortion care services in a Regional Hospital in Ghana. Materials and methods In-depth interview technique was used to collect data from 20 purposively selected post-abortion care clients at the Volta Regional Hospital. Data were analysed manually using a qualitative content analysis technique. Results The study found that medical abortion was the main method of pregnancy termination used by women who participated in the study to induce abortion. Spontaneous abortion, however, was attributed mainly to engaging in activities that required the use of excessive energy and travelling on bad roads by pregnant women. The study also revealed that, women do not seek early post-abortion care services due to stigma and poverty. Conclusions We found that severity of pain from complications, stigma and financial constraints were factors that influenced women’s decision to seek post-abortion care services. Our findings also suggest that women who experienced spontaneous abortion mainly received financial and emotional support from partners and other family members. To encourage women to seek early post-abortion care services, the Ministry of Health and the Ghana Health Service should take pragmatic steps to educate women on the dangers associated with delay in seeking post-abortion care services and the factors that expose women to spontaneous abortions.
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Affiliation(s)
- Kenneth Setorwu Adde
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Eugene Kofuor Maafo Darteh
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Akwasi Kumi-Kyereme
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
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Adiyaman D, Atakul BK, Kuyucu M, Sahingoz Yildirim AG, Pala HG. Termination of pregnancy following a Down Syndrome diagnosis: decision-making process and influential factors in a Muslim but secular country, Turkey. J Perinat Med 2021; 49:170-177. [PMID: 32920541 DOI: 10.1515/jpm-2020-0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/22/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to present the termination of pregnancy (TOP) rates and elucidate the decision-making process following a prenatal diagnosis of Trisomy 21 in Turkey. METHODS This retrospective single-center study was conducted with 146 pregnant women between January 2016 and December 2019 in a tertiary hospital. Data on maternal characteristics, sonographic findings, indications for chromosome analysis, and educational, religious, and economic factors that can influence the parental decision process were collected. RESULTS The TOP rate of Down syndrome (DS) in our center was 78.8%. We concluded that maternal age, earlier diagnosis, indication for chromosome analysis, and previous pregnancies had no effect on the TOP decision. On the other hand, not having a minor or a major sonographic sign, employed mothers, middle- and high-income families, and families having a secondary or higher education tended to terminate the pregnancy affected by DS at statistically higher rates. CONCLUSIONS There are many studies worldwide investigating the TOP preferences for DS. However, there is limited data about TOP rates and influential factors affecting the decision-making process in Muslim countries. This study contributes by clarifying the factors in the decision-making process and elucidating perspectives about TOP in a Muslim country with a unique status: Turkey.
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Affiliation(s)
- Duygu Adiyaman
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Bahar Konuralp Atakul
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Melda Kuyucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkim Gulsah Sahingoz Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Halil Gursoy Pala
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
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Moore B, Poss C, Coast E, Lattof SR, van der Meulen Rodgers Y. The economics of abortion and its links with stigma: A secondary analysis from a scoping review on the economics of abortion. PLoS One 2021; 16:e0246238. [PMID: 33600471 PMCID: PMC7891754 DOI: 10.1371/journal.pone.0246238] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although abortions are a common aspect of people's reproductive lives, the economic implications of abortion and the stigmas that surround abortion are poorly understood. This article provides an analysis of secondary data from a scoping review on the economic impact of abortion to understand the intersections between stigma and economics outcomes at the microeconomic (i.e., abortion seekers and their households), mesoeconomic (i.e., communities and health systems), and macroeconomic (i.e., societies and nation states) levels. METHODS AND FINDINGS We conducted a scoping review using the PRISMA extension for Scoping Reviews. Studies reporting on qualitative and/or quantitative data from any world region were considered. For inclusion, studies must have examined one of the following microeconomic, mesoeconomic, or macroeconomic outcomes: costs, benefits, impacts, and/or value of abortion-related care or abortion policies. Our searches yielded 19,653 items, of which 365 items were included in our final inventory. As a secondary outcome, every article in the final inventory was screened for abortion-related stigma, discrimination, and exclusion. One quarter (89/365) of the included studies contained information on stigma, though only 32 studies included stigma findings directly tied to economic outcomes. Studies most frequently reported stigma's links with costs (n = 24), followed by economic impact (n = 11) and economic benefit (n = 1). Abortion stigma can prevent women from obtaining correct information about abortion services and laws, which can lead to unnecessary increases in costs of care and sizeable delays in care. Women who are unable to confide in and rely on their social support network are less likely to have adequate financial resources to access abortion. CONCLUSIONS Abortion stigma has a clear impact on women seeking abortion or post-abortion care at each level. Programmatic interventions and policies should consider how stigma affects delays to care, access to accurate information, and available social and financial support, all of which have economic and health implications.
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Affiliation(s)
- Brittany Moore
- Ipas, Chapel Hill, North Carolina, United States of America
| | - Cheri Poss
- Ipas, Chapel Hill, North Carolina, United States of America
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Yana van der Meulen Rodgers
- Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Women’s and Gender Studies, Rutgers University, Piscataway, New Jersey, United States of America
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Low ST, Chen ZE, Cameron S. Women's experiences of self-referral to an abortion service: qualitative study. BMJ Sex Reprod Health 2021; 47:37-42. [PMID: 32269055 DOI: 10.1136/bmjsrh-2019-200568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Guidelines from the UK recommend that women should be able to self-refer to abortion services. In 2016, a self-referral system was introduced to the abortion service in Edinburgh, Scotland, as an option for women. Women could telephone a dedicated phone line during office hours and speak to an administrative assistant working in the abortion service who provided them the next available appointment to be seen in the service. This study aimed to evaluate a self-referral service to abortion by investigating its impact on women's experiences of the referral process. METHODOLOGY 21 semistructured interviews of women attending a specialist abortion service in Edinburgh, Scotland, were conducted. Interviews were transcribed verbatim and thematically analysed. The interviews focused on women's experience of the referral process. RESULTS Three main themes arose from the interviews, including reasons for choosing self-referral, experience of self-referral and challenges to using self-referral. Reasons for choosing self-referral were related to convenience, privacy and autonomy. Women found the experience of self-referral to be pleasant, non-judgemental and patient-centred, and self-referral prepared them for the appointment at the specialist abortion service. However, some women felt rushed, and self-referral made them anxious to attend the appointment. Challenges were difficulty with getting through on telephone lines, varying levels of support required for different individuals and awareness about the option of self-referral. CONCLUSION Women valued the option of self-referral. Women felt that the service should be expanded to increase availability,and promoted to women more widely within the community .
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Affiliation(s)
- Shin Thong Low
- The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Zhong Eric Chen
- Clinical Effectiveness Unit of the FSRH, Chalmers Centre, Edinburgh, UK
| | - Sharon Cameron
- Clinical Effectiveness Unit of the FSRH, Chalmers Centre, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Affiliation(s)
- Janet M Turan
- Janet M. Turan and Henna Budhwani are with the Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health
| | - Henna Budhwani
- Janet M. Turan and Henna Budhwani are with the Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health
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Abstract
COVID-19 has compromised and disrupted sexual and reproductive health (SRH) across multiple dimensions: individual-level access, health systems functioning, and at the policy and governance levels. Disruptions to supply chains, lockdown measures and travel restrictions, and overburdened health systems have particularly affected abortion access and service provision. The pandemic, rather than causing new issues, has heightened and exposed existing fractures and fissures within abortion access and provision. In this viewpoint, we draw on the concept of "structural violence" to make visible the contributing causes of these ruptures and their inequitable impact among different groups.
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Affiliation(s)
- Rishita Nandagiri
- ESRC Postdoctoral Fellow, Department of Methodology, London School of Economics and Political Science, London,
| | - Ernestina Coast
- Professor of health and international development, Department of International Development, London School of Economics and Political Science, London
| | - Joe Strong
- Doctoral candidate, Department of Social Policy, London School of Economics and Political Science, London
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Abstract
Adolescent girls comprise a considerable proportion of annual abortion deaths, worldwide, with 15% of all unsafe abortions taking place among girls under 20 years of age. Despite recent global attention to the health and welfare of adolescent girls, little is known about their abortion experience, particularly of those under the age of 15 years. This review examines existing peer-reviewed and grey literature on abortion-related experiences of adolescent girls, paying particular attention to girls ages 10-14. In December 2019, the authors conducted a comprehensive search of five major online resource databases, using a two-part keyword search strategy for articles from 2003 to 2019. Of the original 3,100+ articles, 1,228 were individually screened and 35 retained for inclusion in the analysis. Findings show that while adolescent girls may have knowledge of abortion in general, they lack specific knowledge of sources of care and delay care-seeking due to the fear of stigma, lack of resources and provider bias. Adolescent girls do not experience higher rates of physical complications compared to older cohorts, but they are at risk of psychosocial harm. For girls ages 10-14, abortion experience may be compounded by pregnancy due to sexual abuse or transactional sex, and they face even more barriers to care than older adolescents in terms of provider bias and lack of agency. Adolescents have unique needs and experiences around abortion, which should be accounted for in programming and advocacy. Adolescent girls need information about safe abortion at an early age and a responsive and stigma-free health system.
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Affiliation(s)
- Cecilia Espinoza
- Ipas Senior Advocacy Advisor, Ipas, Chapel Hill, North Carolina, USA
| | | | - Kathryn Andersen
- Chief Scientific and Technical Officer, Ipas, Chapel Hill, North Carolina, USA
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Purcell C, Maxwell K, Bloomer F, Rowlands S, Hoggart L. Toward normalising abortion: findings from a qualitative secondary analysis study. Cult Health Sex 2020; 22:1349-1364. [PMID: 31933421 PMCID: PMC7611965 DOI: 10.1080/13691058.2019.1679395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/08/2019] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Carrie Purcell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Karen Maxwell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Fiona Bloomer
- School of Applied Social and Policy Sciences, Ulster University, Newtownabbey, UK
| | - Sam Rowlands
- Centre of Postgraduate Medical Research and Education, Bournemouth University, Bournemouth, UK
| | - Lesley Hoggart
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
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Bass M. Caring for Patients' Reproductive Healthcare During the COVID-19 Pandemic. J Pastoral Care Counsel 2020; 74:265-268. [PMID: 33228495 PMCID: PMC7686922 DOI: 10.1177/1542305020962012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Abortion care requires supporting a patient through the decision to end a pregnancy, the process of having an abortion, and how to care for themselves after the decision is made. This process is nuanced in the best of times and has been exacerbated by the COVID-19 pandemic. This article provides a foundation for clergy and mental health providers on some of the issues that patients will experience accessing abortion care, specifically during the pandemic.
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Affiliation(s)
- Maya Bass
- Maya Bass, Assistant Professor, Department of
Family, Community, and Preventive Medicine, Drexel University College of Medicine, 219 N
Broad St, First Floor, Philadelphia PA 19107, USA
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50
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Abstract
Abortion providers' approaches to patient-centred pregnancy tissue viewing (PCV) - when a patient requests to see their products of conception - is understudied in abortion care. This mixed-method study aimed to identify: (1) if, when, and how PCV is facilitated at US independent abortion clinics; (2) how staff are trained to offer viewing; and (3) provider experiences facilitating PCV. We surveyed administrators from 22 independent abortion clinics affiliated with the Abortion Care Network about their PCV practices and then completed in-depth semi-structured interviews with 25 providers to better understand their experiences facilitating PCV. Results indicate that most of the clinics that provide PCV do so by patient request. A variety of providers facilitate viewing, including counsellors, educators, physicians, nurses, and medical assistants. Timing, viewing location, and staff training vary by facility. Benefits of and barriers to PCV emerged through three themes: (1) patient-centred care; (2) misinformation about fetal tissue; and (3) personal navigations as providers. Providers and administrators report PCV aligns with their patient-centred clinic missions and offers patients opportunities for choice, closure, and access to information. Yet, anti-abortion misinformation about fetal tissue impacts the ways providers must navigate complex conversations about PCV professionally and personally. Clinic resources and concern about adverse patient reactions to identifiable fetal parts present barriers to offering viewing. Understanding providers' experiences and approaches to PCV is an important first step to developing quality practices that can be shared across clinics. The findings of this study support the need for more research and training on PCV in abortion care.
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Affiliation(s)
- Lena R Hann
- Assistant Professor of Public Health, Augustana College, Rock Island, IL, USA. Correspondence:
| | - Andréa Becker
- Doctoral Student, CUNY Graduate Center, New York, NY, USA
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