Psychosocial factors related to the choice of legal abortion

Abstract

Psychosocial factors related to the choice of legal abortion were studied in women faced with a legal abortion during the late 1980s at a time when the number of abortions increased by 13 %. Women in group A (201 subjects), 20-29 years of age (simple random sample), who were seeking an abortion or repeat abortion were asked about their spontaneous personal motives for abortion. More than half responded that the relationship with their partner had been of short duration or was a bad relationship. Other dominant motives were characteristics of the women and their partners, mainly immaturity, work/studies and an unsuitable life situation for having a child. Less common motives were financial situation, housing and health factors. When women having an abortion (A1=137) or repeat abortion (A2=64) were compared with women continuing the pregnancy (B=203), it was found that 40% in group A1, 51% in group A2 and 29% in group B reported side effects from their contraceptives. The side effects were significantly more frequent in groups A1 and A2, and these women had stopped using their current contraceptive method more often than in group B. The most predominant reasons for having stopped using the most recently used contraceptive were concern for side effects and termination of the relationship. One third of the women stated that they had used contraceptives at the time of conception. Women who had had a previous abortion/abortions (A2=64) had experienced more psychological problems during their lifetime than women having a first abortion (A1=137), than women continuing the pregnancy without ever having had an abortion (B1=142), and than those continuing the pregnancy who had previously had an abortion(s) (B2=58). They had had more contact with social services than women having a first abortion, and than women continuing the pregnancy with no previous abortion(s). In a qualitative study of 20 women undergoing repeat abortion in the age group 20-29 years, the women were asked to express their thoughts and feelings concerning their situation and their choices. The following categories were found: psychosocial background factors, reactions to previous abortion(s), reflections about fertility, sexuality, psychological factors, social factors, contraceptive use, the present pregnancy, motives for the planned abortion, feelings about the planned abortion, and the risk-taking process. During decision making about the pregnancy in women having an abortion(A1) and repeat abortion (A2) and women continuing the pregnancy (B), ambivalent feelings emerged among one third of the women in the A-groups and 25% in the B-group. More than half the women in A1 and A2 decided to have an abortion upon first knowledge about the pregnancy, and after a few weeks of thought most of them had decided to have the abortion. More than half the women stated that it was comparatively or very difficult to make a decision, and it was significantly harder for women who had had contacts with social services. Most of the women in the A-groups did not feel influenced by someone else when deciding about the abortion. However, 10% in the A1-group and 6% in the A2-group were influenced to a great or comparatively great extent. In a one-year study of 162 women 20-30 years of age who received abortion counselling from medical social workers it was found from the social workers¥ records that one fourth of the women decided to continue the pregnancy. Half of the women who wanted counselling were ambivalent concerning what to do about the pregnancy and one third needed support although they were not explicitly ambivalent. The remaining group met with a medical social worker primarily because this was required by law. The relationship to the partner and emotional factors related to the pregnancy were the most predominant subjects in the counselling sessions. The most common arguments pro abortion among the ambivalent women were a conflicted relationship, rejection of single parenthood and influence from significant others in favour of abortion, while the argument against abortion was that the women wanted a child and thought it was hard to choose an abortion