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Abortion as a “solution”: reformulation of abortion stigma in the context of service introduction
ABSTRACTS / Contraception 86 (2012) 290–325 consequences of disclosure of their abortion work or avoided disclosure at least some of the time. The majority (89%) reported feeling unappreciated by society. Almost half reported being victims of verbal or physical violence. Simultaneously, workers felt they were making a positive contribution to society (92%) and took great pride in their work (98%). Exploratory factor analysis resulted in a three-factor solution that explained 92% of the variance: devaluation, stigma management and discrimination. Conclusions: Our novel scale captures the experiences of, responses to, and outcomes of pervasive abortion stigma. Workers feel devalued and face decisions related to disclosure, they feel discrimination broadly in public discourse, and more intimately in their patient care. High levels of pride may help insulate workers from negative effects of stigma.
P24 PREDICTORS OF PYSCHOLOGICAL WELL-BEING IN THE IMMEDIATE POST-ABORTION PERIOD Quinley K University of Pennsylvania School of Medicine, Philadelphia, PA, USA Ratcliffe S, Schreiber C Objectives: The vast majority of women undergoing abortion do well psychologically over the long term. Few data, however, describe how women fare in the immediate post-abortion period, when interventions may be most effective. We sought to evaluate predictors of the need for additional postprocedural psychological care. Methods: Pre-procedural needs assessment questionnaires and post-procedural nursing assessments were collected via retrospective chart review for patients presenting to the Hospital of the University of Pennsylvania. We included all patients undergoing first- or second-trimester surgical abortion during the study period. Self-reported responses to psychological well-being questions before and after abortion, plus anticipated post-procedural psychological coping, were scored. Univariate analyses were performed using Student's t test. Spearman coefficients determined correlation between pre- and post-procedural psychological scores. Results: Sixty-two of 148 patients had complete questionnaires. Preprocedural psychological scores were positively associated with postprocedural psychological scores (r=0.259, p=.044). Compared with women with unplanned pregnancies, women with planned pregnancies predicted 80% worse psychological states following their procedure (p=.036) and overestimated their degree of poor post-procedural psychological coping (p=.027). Actual post-procedure psychological scores did not vary significantly between women with planned and unplanned pregnancies (p=.313). Conclusions: Women with planned pregnancies have more pessimistic views of how they may fare psychologically following abortion and tend to over predict poor psychological coping, compared with women with unplanned pregnancies. However, the two groups fare equally well psychologically within 1–3 days post-procedure. It is a woman's pre-procedural psychological state, rather than whether her pregnancy was planned, that predicts psychological coping post-procedure. These findings highlight opportunities for potential practice changes in postabortion patient counseling.
P25 ABORTION AS A “SOLUTION”: REFORMULATION OF ABORTION STIGMA IN THE CONTEXT OF SERVICE INTRODUCTION Hodoglugil NS Venture Strategies Innovations, Berkeley, CA, USA Gessessew A, Tsegay Y, Asier S, Holston M, Weinrib R, Prata N Objectives: Stigma attached to abortion varies cross-culturally in its roots and in how it plays out in the community. A pilot project was introduced in Tigray,
303
Ethiopia, where 4354 women sought services, to expand safe abortion care services. This qualitative research explores perceptions of abortion stigma and how it influences women's decision making in rural Ethiopia. Methods: Ten focus group discussions were conducted with 96 women in the pilot project sites, to explore attitudes toward abortion, conditions under which a woman may seek abortion and preferences for service provision. Indepth interviews were conducted with health extension workers (37), providers in facilities (6) and key informants in the community (23). Results: Abortion stigma was mainly attributed to the fact of getting pregnant inappropriately in the first place (young women who were not supposed to be sexually active; result of rape, etc.). Participants recounted stories of women who had used plants, laundry detergent or other unsafe methods to induce abortions, and gave examples of women who had died while attempting to abort. Committing suicide to save one's honor was mentioned frequently as an option. There was a strong perception that safe abortion would be the solution for many such women to avoid the stigma of an “inappropriate pregnancy,” which seemed to be worse than the stigma of getting an abortion. Men had different views on the need for preventing an unwanted pregnancy and on abortion. Conclusions: In this context, abortion is perceived as a solution, especially if it can be provided safely and privately.
P26 WOMEN'S PERCEPTIONS OF VIEWING ULTRASOUND BEFORE ABORTION: COMPARING FIRST AND SECOND TRIMESTER Wiebe E University of BC, Vancouver, BC, Canada Trouton K Objectives: The purpose of this study was to gain a better understanding of women's choices, perceptions and experiences of viewing an ultrasound before having first- or second-trimester abortions. Methods: A questionnaire was offered to women prior to their ultrasound asking if they wished to view it. For women who chose to view the ultrasound, a second questionnaire asked them about their experience. Women in the first trimester (up to 12.0 weeks by ultrasound) were compared to those in the second trimester. Results: A total of 234 women completed the first questionnaires — 172 first-trimester and 62 second-trimester. Fifty percent (86) of the firsttrimester patients and 47% (29) of the second-trimester patients wanted to see the images (NS). More second-trimester than first-trimester patients were unsure how they would feel about it (p=.01). There were 77 first-trimester and 27 second-trimester patients who completed the second questionnaire. When asked if viewing the ultrasound made having the abortion harder emotionally, 21% (16) of the first-trimester patients and 44% (12) of the second-trimester patients said “yes” (p=.01). Conclusions: About half of the women in this study wanted to see the ultrasound before the abortion. Second-trimester patients were more likely to be unsure about what to expect and were more likely to find it made the abortion harder emotionally. It is important that we prepare our secondtrimester patients carefully for the experience of viewing the ultrasound.
P27 MISCONCEPTIONS ABOUT ABORTION RISKS IN PROCHOICE AND ANTICHOICE WOMEN HAVING ABORTIONS Wiebe E University of BC, Vancouver, BC, Canada Littman L
P24 PREDICTORS OF PYSCHOLOGICAL WELL-BEING IN THE IMMEDIATE POST-ABORTION PERIOD Quinley K University of Pennsylvania School of Medicine, Philadelphia, PA, USA Ratcliffe S, Schreiber C Objectives: The vast majority of women undergoing abortion do well psychologically over the long term. Few data, however, describe how women fare in the immediate post-abortion period, when interventions may be most effective. We sought to evaluate predictors of the need for additional postprocedural psychological care. Methods: Pre-procedural needs assessment questionnaires and post-procedural nursing assessments were collected via retrospective chart review for patients presenting to the Hospital of the University of Pennsylvania. We included all patients undergoing first- or second-trimester surgical abortion during the study period. Self-reported responses to psychological well-being questions before and after abortion, plus anticipated post-procedural psychological coping, were scored. Univariate analyses were performed using Student's t test. Spearman coefficients determined correlation between pre- and post-procedural psychological scores. Results: Sixty-two of 148 patients had complete questionnaires. Preprocedural psychological scores were positively associated with postprocedural psychological scores (r=0.259, p=.044). Compared with women with unplanned pregnancies, women with planned pregnancies predicted 80% worse psychological states following their procedure (p=.036) and overestimated their degree of poor post-procedural psychological coping (p=.027). Actual post-procedure psychological scores did not vary significantly between women with planned and unplanned pregnancies (p=.313). Conclusions: Women with planned pregnancies have more pessimistic views of how they may fare psychologically following abortion and tend to over predict poor psychological coping, compared with women with unplanned pregnancies. However, the two groups fare equally well psychologically within 1–3 days post-procedure. It is a woman's pre-procedural psychological state, rather than whether her pregnancy was planned, that predicts psychological coping post-procedure. These findings highlight opportunities for potential practice changes in postabortion patient counseling.
P25 ABORTION AS A “SOLUTION”: REFORMULATION OF ABORTION STIGMA IN THE CONTEXT OF SERVICE INTRODUCTION Hodoglugil NS Venture Strategies Innovations, Berkeley, CA, USA Gessessew A, Tsegay Y, Asier S, Holston M, Weinrib R, Prata N Objectives: Stigma attached to abortion varies cross-culturally in its roots and in how it plays out in the community. A pilot project was introduced in Tigray,
303
Ethiopia, where 4354 women sought services, to expand safe abortion care services. This qualitative research explores perceptions of abortion stigma and how it influences women's decision making in rural Ethiopia. Methods: Ten focus group discussions were conducted with 96 women in the pilot project sites, to explore attitudes toward abortion, conditions under which a woman may seek abortion and preferences for service provision. Indepth interviews were conducted with health extension workers (37), providers in facilities (6) and key informants in the community (23). Results: Abortion stigma was mainly attributed to the fact of getting pregnant inappropriately in the first place (young women who were not supposed to be sexually active; result of rape, etc.). Participants recounted stories of women who had used plants, laundry detergent or other unsafe methods to induce abortions, and gave examples of women who had died while attempting to abort. Committing suicide to save one's honor was mentioned frequently as an option. There was a strong perception that safe abortion would be the solution for many such women to avoid the stigma of an “inappropriate pregnancy,” which seemed to be worse than the stigma of getting an abortion. Men had different views on the need for preventing an unwanted pregnancy and on abortion. Conclusions: In this context, abortion is perceived as a solution, especially if it can be provided safely and privately.
P26 WOMEN'S PERCEPTIONS OF VIEWING ULTRASOUND BEFORE ABORTION: COMPARING FIRST AND SECOND TRIMESTER Wiebe E University of BC, Vancouver, BC, Canada Trouton K Objectives: The purpose of this study was to gain a better understanding of women's choices, perceptions and experiences of viewing an ultrasound before having first- or second-trimester abortions. Methods: A questionnaire was offered to women prior to their ultrasound asking if they wished to view it. For women who chose to view the ultrasound, a second questionnaire asked them about their experience. Women in the first trimester (up to 12.0 weeks by ultrasound) were compared to those in the second trimester. Results: A total of 234 women completed the first questionnaires — 172 first-trimester and 62 second-trimester. Fifty percent (86) of the firsttrimester patients and 47% (29) of the second-trimester patients wanted to see the images (NS). More second-trimester than first-trimester patients were unsure how they would feel about it (p=.01). There were 77 first-trimester and 27 second-trimester patients who completed the second questionnaire. When asked if viewing the ultrasound made having the abortion harder emotionally, 21% (16) of the first-trimester patients and 44% (12) of the second-trimester patients said “yes” (p=.01). Conclusions: About half of the women in this study wanted to see the ultrasound before the abortion. Second-trimester patients were more likely to be unsure about what to expect and were more likely to find it made the abortion harder emotionally. It is important that we prepare our secondtrimester patients carefully for the experience of viewing the ultrasound.
P27 MISCONCEPTIONS ABOUT ABORTION RISKS IN PROCHOICE AND ANTICHOICE WOMEN HAVING ABORTIONS Wiebe E University of BC, Vancouver, BC, Canada Littman L