Women’s decision-making related to induced abortion – a cross sectional study during a period of Covid-19 pandemic, in Sweden

Abstract

Objectives

To investigate women’s decision-making on induced abortion.

Materials and methods

A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]).

Results

About half (n = 322;52%) scored 1–4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5–7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner’s hesitance (OR = 3.18, CI:1.76–5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28–3.87), having discussed the decision with someone (OR = 2.42, CI:1.67–3.50), age ≥30 (OR = 2.22, CI:1.03–4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20–3.59), and the desire to have children in the future (OR = 1.96, CI:1.18–3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5–7 (n = 140;47.9%) compared to those who scored 1–4 (n = 122;37.9), p = .029.

Conclusion

Women’s decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines.

FOR SOCIAL MEDIA

For many women, deciding to have an induced abortion is a complex process, even in settings with easy access to legal and safe abortion. This disproves arguments that abortion availability results in casual abortion decision-taking.

摘要

目的：调查妇女对人工流产的决策情况。材料与方法：对瑞典623名寻求堕胎的妇女进行多中心横断面调查（2021）。采用7分Likert量表测量流产困难程度, 并进行单因素和多因素分析（优势比[OR], 95%置信区间[CI])。结果：约有一半(N=322；52%）的评分为1-4分, 表明与评分为5-7分的(N=292；48%）相比, 这一决定被认为更容易做出。流产的原因有：经济条件差（166；27%）；恋爱过早（154；25.1%）；想先工作（147；23.9%）；想先学习（132；21.5%）；对恋爱关系不确定（104；16.9%）；年龄太小（104；16.9%）。认为决定很难的预测因素：伴侣的犹豫（OR=3.18,CI:1.76-5.73)、出生在北欧国家以外（OR=2.23,CI:1.28-3.87)、与某人讨论过决定（OR=2.42,CI:1.67-3.50)、30岁（OR=2.22,CI:1.03-4.76)、COVID-19流行病（OR=2.08,CI:1.20-3.59)和未来生孩子的愿望（OR=1.96,CI:1.18-3.28)。 在确认怀孕后, 得分5-7的人（140；47.9%）比得分1-4的人（122；37.9）更普遍, 精神幸福感差, P=0.029。结论：妇女对堕胎的决策是复杂的；在危机时刻, 决策程序可能更加困难。这些宝贵的知识可用于改进和促进超越医疗常规的令人满意的咨询。

Keywords:

• Covid-19
• decision-making
• induced abortion
• reasoning
• reproductive health

Acknowledgements

We thank all the women who participated in this study who shared their valuable views, and all midwives, physicians and secretaries who enabled the data collection. Special thanks go to Ninni Berg, Magdalena Hoveklint, Ann-Sofi Kullman-Östlund, Marianne Lindholm, Annika Lindqvist, Ulrika Nilsson, Ulrica Stråhlman, Cecilia Svedung and Kaj Wedenberg.

*We acknowledge that people with uteruses choose to identify with genders other than ‘woman’. For brevity’s sake in this paper, ‘women’ and ‘she’ are used as broad terms to refer to those who have uteruses and who may need to induce an abortion.

Author contributions

All authors contributed to the design of the study, data collection and drafting of the paper. Statistical analysis was performed by MM. All authors have read and approved the final manuscript.

Disclosure statement

KG-D has received consulting fees and/or payment or honoraria from Bayer, MSD, Gedeon Richter, Mithra, Exeltis, MedinCell, Cirqle, Natural Cycles, Exelgyn, Campus Pharma and HRA-Pharma. KG-D has been involved in advisory boards of Gedeon Richter and Bayer. KG-D is a member of the FIGO council, a former member of STAG, and current Director of a collaborating centre, WHO HRP/SRH, Geneva. KG-D is emeritus member of the ICCR, Population council, past president of the European Society for Contraception and Reproductive Health, and FIAPAC, and is an honorary Fellow of FSRH/RCOG (UK) honorary professor at HKU. IS-P has served occasionally on advisory boards or acted as an invited speaker at scientific meetings for Asarina Pharma, Bayer Health Care, Gedeon Richter, Peptonics, Shire/Takeda and Sandoz. No conflicts of interest are reported by any other authors.

Additional information

Funding

The study was supported by the Family Planning Fund under Grant number, Uppsala and The Faculty of Medicine, Lund University.