On fertility, responsibility and relationships : a study of young people's experiences of abortion in early pregnancy, and of the midwives’ experiences of caring in this context

The aim of this thesis is to achieve a deeper understanding of experiences of abortion in early pregnancy through illuminating the meaning both of the experiences of young people who seek to undergo an abortion, and of the midwives’ experiences of caring in this context. The aims of the four sub-studies were to illuminate the meaning of: – Young women’s experiences of being pregnant and of having decided on an abortion in early pregnancy (Sub-study I), – Young women’s experiences of having undergone an early abortion (Sub-study II), – Young men’s experiences of their girlfriends’ abortions in early pregnancy (Sub-study III), – Midwives’ experiences of tending young people who were seeking and undergoing abortion in early pregnancy (Sub-study IV).

The theoretical perspective of the dissertation is grounded in phenomenological hermeneutics and a life world perspective. The ten young women in sub-studies I–II were recruited from two youth clinics and two gynaecology outpatient clinics. In sub-study I the young women were interviewed 4–20 days prior to their abortions in pregnancy week 6–10. In sub-study II, the young women were interviewed 2–6 weeks after the abortion about their experiences of either the medical or surgical abortion in pregnancy week 6–12. In sub-study III the young men were recruited from two gynaecology outpatient clinics except for one young man who signalled his interest to participate in the study on his own initiative. They were interviewed 2–12 weeks after their girlfriends’ abortions. The young man who participated on his own initiative was interviewed three years after his girlfriend’s abortion. All participants were Swedish speaking and were below twenty years of age. The midwives’ who were interviewed in sub-study III had more than three years experience of working with young people who sought and underwent abortions.

The interpreted whole of the participants’ experiences is expressed as “taking responsibility for fertility and relationships”, and is illuminated as a moral act that arises between people who share the experience of an abortion in early pregnancy. This is in line with Walker’s theoretical analysis of moral acts which has been useful in gaining a deeper understanding of the results from this thesis. The moral issue of whether it is right or wrong to have an abortion only emerges to a minor extent in the participants’ experiences of abortion. Instead, it is what people do for, or to, each other or are expected to do for each other that is of greater importance and which constitutes the moral act for the participants in the study. The social interaction surrounding an abortion involves the foetus itself, the young woman, the partner, parents, friends and caregivers such as mid- wives, social workers and gynaecologists.

In sub-study I the experiences are expressed as, “I am happy about my fertility but I choose not to give life now”. In sub-study II the experiences are expressed in a capacity to take responsibility for personal choices by considering personal welfare and of others’ well-being in a life cycle perspective. In sub-study III the experiences are expressed as a wish to compensate the girlfriend for her suffering and to share the responsibility with her for having interrupted a life-giving process. In sub-study IV the experiences are expressed as a conflict of values arising in the meeting between mid- wives and young people. For the midwives, it was difficult to accept that young people could decide on abortion instead of accepting shortcoming with using contraceptives because it affected their appearance negatively in relation to ideals of beauty or because of the pleasures of unprotected inter- course. Feelings of frustration arose when young people refused to inform their parents about the abortion, lacked parents’ support in an abortion situation, or refuse to use contraceptives.

The result of the dissertation can be used to elucidate young men’s and women’s experiences of abortion in early pregnancy and midwives’ experiences of tending young people in this context. This knowledge can be used in educating in young people in sexuality and relationships. In addition, the result can be used in order to develop and redirect work in preventing abortion with the objective of helping young women and young men take equal responsibility for their sexuality and reproductive choices.

List of scientific papers

I. Halldén BM, Christensson K, Olsson P. (2005). Meanings of being pregnant and having decided on abortion: young Swedish womens experiences. Health Care Women Int. 26(9):788-806.
https://pubmed.ncbi.nlm.nih.gov/16214794

II. Halldén BM, Christensson K, Olsson P. (2009). Early abortion as narrated by young Swedish women. Scand J Caring Sci. 23(2):243-50.
https://pubmed.ncbi.nlm.nih.gov/19170958

III. Halldén BM, Christensson, K. (2010). Swedish Young mens lived experiences of a girlfriend s early induced abortion. [Submitted]

IV. Halldén BM, Lundgren I, Christensson, K. (2010). Ten Swedish midwives lived experiences of the care of teenagers early induced abortions. [Submitted]