Advertisement

Exploring Canadian Women's Multiple Abortion Experiences: Implications for Reducing Stigma and Improving Patient-Centered Care

      Abstract

      Background

      Roughly one-third of all abortions in Canada are subsequent abortions. However, few published reports showcase women's voices or explore women's experiences on this topic. Our study aimed to understand better the ways that women who have had multiple abortions talk about and view those experiences.

      Methods

      Between 2012 and 2016, we conducted in-depth interviews with 41 Canadian women who had a total of 87 abortions in the 5 years preceding the interviews. We audio-recorded and transcribed all English- and French-language interviews and analyzed our data for content and themes using a multiphased iterative approach and inductive and deductive techniques.

      Results

      Women described their abortion experiences as unique life events, even in cases when the overarching circumstances surrounding the pregnancies were similar. Participants recalled multiple factors that influenced their decisions to terminate, including their relationship status; level of support from family and friends; financial situation; health status; previous reproductive health, pregnancy, and abortion experiences; and desire to parent. In general, a previous abortion demystified the abortion process but did not play a significant role in decision making. Women described intensified feelings of shame and both internalized and externalized stigma surrounding their decision to have more than one abortion. However, the overwhelming majority were confident in their decisions.

      Conclusions

      The often-used phase “repeat abortion” fails to capture women's experiences and the complex decision making surrounding each pregnancy. Efforts to reframe the narrative of multiple abortions, including among health care providers, could help reduce the amplified stigma associated with having more than one lifetime abortion.
      To read this article in full you will need to make a payment
      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Alemayehu M.
        • Yebyo H.
        • Medhanyie A.A.
        • Bayray A.
        • Fantahun M.
        • Goba G.K.
        Determinants of repeated abortion among women of reproductive age attending health facilities in Northern Ethiopia: A case-control study.
        European Journal of Contraception and Reproductive Health Care. 2017; 22: 38-44
        • Ames C.M.
        • Norman W.V.
        Preventing repeat abortion in Canada: Is the immediate insertion of intrauterine devices postabortion a cost-effective option associated with fewer repeat abortions?.
        Contraception. 2012; 85: 51-55
        • Birks M.
        • Chapman Y.
        • Francis K.
        Memoing in qualitative research: Probing data and processes.
        Journal of Research in Nursing. 2008; 13: 68-75
        • Brandi K.
        • Woodhams E.
        • White K.O.
        • Mehta P.K.
        An exploration of perceived contraceptive coercion at the time of abortion.
        Contraception. 2018; 97: 329-334
        • Canadian Institute for Health Information (CIHI)
        Induced abortions reported in Canada in 2015.
        2015 (Available:) (Accessed: April 1, 2018)
        • Cannold L.
        Understanding and responding to anti-choice women-centred strategies.
        Reproductive Health Matters. 2002; 10: 171-179
        • Cano J.
        • Foster A.M.
        “They made me go through like weeks of appointments and everything”: Documenting women’s experiences seeking abortion care in Yukon Territory, Canada.
        Contraception. 2016; 94: 489-495
        • Cockrill K.
        • Nack A.
        “I’m not that type of person”: Managing the stigma of having an abortion.
        Deviant Behavior. 2013; 34: 973-990
        • Epstein R.M.
        • Fiscella K.
        • Lesser C.S.
        • Stange K.C.
        Why the nation needs a policy push on patient-centered health care.
        Health Affairs. 2010; 29: 1489-1495
        • Fisher W.A.
        • Singh S.S.
        • Shuper P.A.
        • Carey M.
        • Otchet F.
        • MacLean-Brine D.
        • Gunter J.
        Characteristics of women undergoing repeat induced abortion.
        Canadian Medical Association Journal. 2005; 172: 637-641
        • Foster A.M.
        • LaRoche K.J.
        • El-Haddad J.
        • DeGroot L.
        • El-Mowafi M.
        “If I ever did have a daughter, I wouldn’t raise her in New Brunswick”: Exploring women’s experiences obtaining abortion care before and after policy reform.
        Contraception. 2017; 95: 477-484
        • Foucault M.
        The history of sexuality, Volume 1: An introduction.
        Pantheon Books, New York1978
        • Furedi A.
        Issues for service providers: A response to points raised.
        Journal of Medical Ethics. 2001; 27: ii28-ii32
        • Goodman S.
        • Hendlish S.K.
        • Reeves M.F.
        • Foster-Rosales A.
        Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion.
        Contraception. 2008; 78: 143-148
        • Grimes D.A.
        • Stuart G.
        Abortion Jabberwocky: The need for better terminology.
        Contraception. 2010; 81: 93-96
        • Hall S.
        The work of representation.
        in: Hall S. Representation: Cultural representations and signifying practices. Sage, London1997
        • Heikinheimo O.
        • Gissler M.
        • Suhonen S.
        Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion.
        Contraception. 2008; 78: 149-154
        • Hoggart L.
        • Newton V.L.
        • Bury L.
        ‘Repeat abortion’, a phrase to be avoided? qualitative insights into labelling and stigma.
        Journal of Family Planning & Reproductive Health Care. 2017; 43: 26-30
        • Justad-Berg R.T.
        • Eskild A.
        • Strøm-Roum E.M.
        Characteristics of women with repeat termination of pregnancy: A study of all requests for pregnancy termination in Norway during 2007-2011.
        Acta Obstetricia et Gynecologica Scandinavica. 2015; 94: 1175-1180
        • Keenan K.
        • Grundy E.
        • Kenward M.G.
        • Leon D.A.
        Women’s risk of repeat abortions is strongly associated with alcohol consumption: A longitudinal analysis of a Russian national panel study, 1994-2009.
        PLoS One. 2014; 9: e90356
        • Kilander H.
        • Alehagan S.
        • Svedlund L.
        • Westlund K.
        • Thor J.
        • Brynhildsen J.
        Likelihood of repeat abortion in a Swedish cohort according to the choice of post-abortion contraception: A longitudinal study.
        Acta Obstetricia et Gynecologica Scandinavica. 2016; 95: 565-571
        • Kumar A.
        • Hessini L.
        • Mitchell E.M.H.
        Conceptualising abortion stigma.
        Culture, Health & Sexuality. 2009; 11: 625-639
        • Leeners B.
        • Bieli S.
        • Huang D.
        • Tschudin S.
        Why prevention of repeat abortion is so challenging: Psychosocial characteristics of women at risk.
        European Journal of Contraception and Reproductive Health Care. 2017; 22: 38-44
        • Levinson W.
        • Lesser C.S.
        • Epstein R.M.
        Developing physician communication skills for patient-centered care.
        Health Affairs. 2010; 29: 1310-1318
        • McCaffrey D.
        • Keys J.
        Competitive framing processes in the abortion debate: Polarization-vilification, frame saving, and frame debunking.
        Sociological Quarterly. 2000; 41: 41-61
        • McCall S.J.
        • Flett G.
        • Okpo E.
        • Bhattacharya S.
        Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: Analysis of routinely collected health care data.
        Journal of Family Planning and Reproductive Health Care. 2016; 42: 133-142
        • McNicholas C.
        • Peipert J.F.
        Initiation of long-acting reversible contraceptive methods (IUDs and implant) at pregnancy termination reduces repeat abortion.
        Journal of Evidence-Based Medicine. 2013; 18: e29
        • Mentula M.J.
        • Niinimäki M.
        • Suhonen S.
        • Hemminki E.
        • Gissler M.
        • Heikinheimo O.
        Young age and termination of pregnancy during the second trimester are risk factors for repeat second-trimester abortion.
        American Journal of Obstetrics and Gynecology. 2010; 203: 107.e1-107.e7
        • Millar W.J.
        • Wadhera S.
        • Henshaw S.K.
        Repeat abortions in Canada, 1975-1993.
        Family Planning Perspectives. 1997; 29: 20-24
        • Moore A.M.
        • Singh S.
        • Bankole A.
        Do women and men consider abortion as an alternative to contraception in the United States? An exploratory study.
        Global Public Health. 2011; 6: S25-S37
        • Ngo T.D.
        • Keogh S.H.
        • Nguyen T.H.
        • Le H.T.
        • Pham K.H.
        • Nguyen Y.B.
        Risk factors for repeat abortion and implications for addressing unintended pregnancy in Vietnam.
        International Journal of Gynecology and Obstetrics. 2014; 125: 241-246
        • Norman W.V.
        Induced abortion in Canada 1974-2005: Trends over the first generation with legal access.
        Contraception. 2012; 85: 185-191
        • Norris A.
        • Bessett D.
        • Steinberg J.R.
        • Kavanaugh M.L.
        • De Zordo S.
        • Becker D.
        Abortion stigma: A reconceptualization of constituents, causes, and consequences.
        Women’s Health Issues. 2011; 21: S49-S54
        • Pestvenidze E.
        • Berdzuli N.
        • Lomia N.
        • Gagua T.
        • Umikashvili L.
        • Stray-Pedersen B.
        Repeat induced abortions in Georgia, characteristics of women with multiple pregnancy terminations: Secondary analysis of the Reproductive Health Survey 2010.
        European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016; 205: 85-90
        • Picavet C.
        • Goenee M.
        • Wijsen C.
        Characteristics of women who have repeat abortions in the Netherlands.
        European Journal of Contraception and Reproductive Health Care. 2013; 18: 327-334
        • Pohjoranta E.
        • Mentula M.
        • Gissler M.
        • Suhonen S.
        • Heikinheimo O.
        Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion: First-year results of a randomized controlled trial.
        Human Reproduction. 2015; 30: 2539-2546
        • Prager S.W.
        • Steinauer J.E.
        • Foster D.G.
        • Darney P.D.
        • Drey E.A.
        Risk factors for repeat elective abortion.
        American Journal of Obstetrics and Gynecology. 2007; 197: 575.e1-575.e6
        • Pruitt S.L.
        • Mullen P.D.
        Contraception or abortion? Inaccurate descriptions of emergency contraception in newspaper articles, 1992-2002.
        Contraception. 2005; 71: 14-21
        • Rose S.B.
        • Lawton B.A.
        Impact of long-acting reversible contraception on return for repeat abortion.
        American Journal of Obstetrics and Gynecology. 2012; 206: e1-e6
        • Toprani A.
        • Cadwell B.L.
        • Li W.
        • Sackoff J.
        • Greene C.
        • Begier E.
        Repeat abortions in New York City, 2010.
        Journal of Urban Health. 2015; 92: 593-603
        • Vogel K.
        • LaRoche K.J.
        • El-Haddad J.
        • Chaumont A.
        • Foster A.M.
        Exploring Canadian women’s knowledge of and interest in mifepristone: Results from a national qualitative study with abortion patients.
        Contraception. 2016; 94: 137-142
        • Weitz T.A.
        • Foster A.
        • Ellertston C.
        • Grossman D.
        • Stewart F.H.
        “Medical” and “surgical” abortion: Rethinking the modifiers.
        Contraception. 2004; 69: 77-78
        • Weitz T.A.
        • Kimport K.
        A need to expand our thinking about “repeat” abortions.
        Contraception. 2012; 85: 408-412
        • Wynn L.L.
        • Foster A.M.
        • Trussell J.
        Would you say you had unprotected sex if …? Sexual health language in emails to a reproductive health website.
        Culture, Health & Sexuality. 2010; 12: 499-514

      Biography

      Kathryn J. LaRoche, PhD(c), MSc, is a PhD Student in Population Health at uOttawa. Her research centers on improving access to high-quality, nonjudgmental abortion care in Canada and abroad.

      Biography

      Angel M. Foster, DPhil, MD, AM, is the 2011–2016 Endowed Chair in Women's Health Research at uOttawa. She received her DPhil from the University of Oxford and her MD from Harvard Medical School. Her research focuses on emergency contraception, abortion, and health professions education.