Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence

Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.

Looking Back, Looking Forward: Examining the Processing of Abortion Experiences Using Public Abortion Narratives

Limited research has utilized public abortion narratives to understand how individuals process through their abortion experiences. To address this gap in the literature, this study used thematic analysis to consider the public abortion stories of 39 participants from the Tennessee Stories Project, focusing on how individuals process through these experiences and the context of the abortion experience in a person’s life course. Participants were primarily those who were abortion patients; however, abortion providers and supporters including partners or spouses, family members, and friends of those who received abortion care were also represented. Data analysis indicated that abortion seekers engage in introspection, involving political and religious/spiritual considerations; report specific feelings about their abortion experience, including having no regrets and feeling gratitude; process emotions related to the abortion experience by normalizing emotional responses and using mementos; and position their abortion in the context of their life, both in terms of their family and career opportunities and personal development. These findings provide valuable insight into how individuals process through the abortion experience, before, during, and after the abortion procedure, and suggest possible directions for service providers, advocates, and policy makers in order to better support abortion patients, providers, and family members.

Repeat induced abortion and associated factors among reproductive age women who seek abortion services in Debre Berhan Town Health Institutions, Central Ethiopia, 2019

Objective: To assess the magnitude and associated factors of repeat induced abortion among women aged from 15-49 who seek abortion care services in the health institutions of Debre Berhan town, Central Ethiopia, 2019Results: This study shows that the prevalence of repeat induced abortion among 355 respondents was to be 20.3 %. Those who reported as they had more than one partner in the last 12 preceding months, (AOR= 7.3, 95%CI: 3.21, 16.46), Age of the first sexual intercourse less than 18 years (AOR= 6, 95% CI: 2.54, 13.95) and Perceiving abortion procedure as it was not painful (AOR= 7.7, 95% CI: 2.9, 20.6) were variables positively associated with the repeatedly induced abortion among women who sought abortion services.

The Lincoln Offensive

To dramatize deplorable health conditions and the race and class origins of pre-existing conditions, the Young Lords took-over Lincoln Hospital in July 1970. The occupation forced the construction of a modern medical building and creation of one of the Western world’s first acupuncture drug treatment centers. Cited as the first of its kind in American medicine, the group incited a public clinical hearing where a lay audience cross-examined doctors after the death of a Puerto Rican woman, the result of an abortion procedure conducted by an unsupervised medical resident. The Lords organized with non-medical hospital staff in the Health Revolutionary Unity Movement (HRUM) and white radical doctors in the Pediatric Collective under the banner, Think Lincoln. Together they drafted the earliest known Patient Bill of Rights. In the wake of late 60s draconian cuts in social spending, they and others staved off the advent of neoliberal social policies in the late 1970s. Historians interpret sixties revolutionary nationalism as a rejection of coalitions with white Americans. These alliances suggest otherwise. But the Lords challenged power dynamics in cross-racial and cross-class alliances, rejecting uninterrogated racial prejudices and liberal tendencies of middle-class white radicals and the potential for their disproportionate influence in coalitions.

Termination of pregnancy

When an unintended pregnancy occurs secondary to contraceptive failure, the availability of safe means of pregnancy termination is important to minimize morbidities and mortalities associated with the abortion procedure. Where allowed within the legal constraints, access to safe abortion should be facilitated without prejudice and stigmatization. The healthcare providers should offer proper pre-abortion counselling and assessment, and choice of the abortion method should be made based on the gestational age and local expertise. Both medical and surgical methods are available for the effective termination of first- and second-trimester pregnancies. Most recommended regimens for medical abortion involve the use of misoprostol with or without mifepristone, whereas surgical abortions generally employ suction evacuation of the uterus. Providers of abortion service should be familiarized with the evidence-based guidelines and protocols published by various authorities on the abortion procedures and postabortion care, as well as means to prevent complications.

‘There’s the Man who Shifts the Babies’: Abortion in the Scottish High Court 1900–30

Based on a detailed analysis of every prosecution heard in the Scottish High Court in the period 1900−30 involving a charge of abortion or attempted abortion, Chapter 5 provides a comprehensive survey of the practice. It examines the age, marital status, class, occupation, and motivation of the women seeking an abortion. Abortion is revealed not as a single event but part of an elaborate process of social networking and medical intervention. An initial phase of self-treatment is explored followed by a review of the variety of ways in which women gained access to abortionists. Thereafter, the study provides a breakdown of the social and occupational status of the abortionists indicted before the High Court. A further section summarises the abortion procedure including a review of the drugs and instruments employed and the medical outcomes. The chapter then describes how the police were alerted to an offence, the legal framework and particular constraints operating under Scottish criminal law, and the process of assembling a prosecution case with particular reference to the role of forensic medicine. Finally, variations in convictions and sentencing are examined and conclusions drawn as to the implications of this study for the historiography of abortion..

Disgust, stigma, and the politics of abortion

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