Managing unplanned pregnancies in five countries: Perspectives on contraception and abortion decisions

Abstract

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries – the United States, Nigeria, Pakistan, Peru and Mexico – to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.

Keywords:

• pregnancy
• unplanned
• contraception
• induced abortion
• contraceptive behaviour
• couples

Acknowledgements

This is a revision of a paper presented at the seminar on ‘Interrelationships between contraception, unintended pregnancy and induced abortion’, Addis Ababa, Ethiopia, 1–3 December 2008. The seminar was organised by the IUSSP Scientific Panel on Abortion and Ipas-Ethiopia. Research assistance from Davida Becker, YeMon Myint, and Marissa Pine Yeakey is gratefully acknowledged. The comments of two reviewers are also much appreciated. The multi-country collaborative study was supported in part by the Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health.

Notes

1. Developing countries that permit abortion under the broadest criteria (without restriction as to reason) are: Cambodia, China, Cuba, Democratic People's Republic of Korea, Guyana, Mongolia, Nepal, Singapore, Tunisia, Turkey, South Africa and Vietnam. A few other countries permit abortion on socio-economic grounds: Barbados, Belize, St Vincent and Grenadines, Fiji, India and Zambia.

2. For China, 23 per 1000 women is the rate published by the government; the true rate is almost certainly higher.

3. FGD and IDI indicate comments come from focus group discussions and in-depth interviews, respectively. M (male) or F (female) indicates the participant's sex.