UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Expressed needs of women having abortions McKay, Reta Lynn 1974

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1974_A5_7 M32_9.pdf [ 4.23MB ]
Metadata
JSON: 831-1.0093006.json
JSON-LD: 831-1.0093006-ld.json
RDF/XML (Pretty): 831-1.0093006-rdf.xml
RDF/JSON: 831-1.0093006-rdf.json
Turtle: 831-1.0093006-turtle.txt
N-Triples: 831-1.0093006-rdf-ntriples.txt
Original Record: 831-1.0093006-source.json
Full Text
831-1.0093006-fulltext.txt
Citation
831-1.0093006.ris

Full Text

EXPRESSED NEEDS OP WOMEN HAVING ABORTIONS  by BETA LYNN MCKAY B.A., U n i v e r s i t y o f T o r o n t o ,  1971  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n the School of Nursing We a c c e p t t h i s t h e s i s a s c o n f o r m i n g t o t h e required standard  THE UNIVERSITY OF BRITISH COLUMBIA April,  197^  In p r e s e n t i n g t h i s  thesis  in p a r t i a l  f u l f i l m e n t of  the r e q u i r e m e n t s  an advanced degree at the U n i v e r s i t y of B r i t i s h C o l u m b i a , the L i b r a r y  s h a l l make i t  freely  available for  I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e  I agree  r e f e r e n c e and copying of  this  of t h i s t h e s i s f o r written  It  i s understood that c o p y i n g o r  thesis  The U n i v e r s i t y o f B r i t i s h Columbia Vancouver 8, Canada  or  publication  f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my  permission.  that  study.  f o r s c h o l a r l y purposes may be g r a n t e d by the Head o f my Department by h i s r e p r e s e n t a t i v e s .  for  EXPRESSED NEEDS OP WOMEN HAVING ABORTIONS The  purpose o f t h i s study was t o e x p l o r e t h e  a b o r t i o n experience  f r o m t h e woman's p o i n t o f v i e w t o d i s -  c o v e r any unmet needs. A l l t h e women were h a v i n g  abortions  w i t h i n t w e l v e weeks o f t h e i r l a s t m e n s t r u a l p e r i o d . The  study  included interviews with nineteen  a t three stages: before  women  t h e o p e r a t i o n , two weeks f o l l o w i n g ,  and f o u r months f o l l o w i n g t h e o p e r a t i o n . A b a s i c a l l y unstructured,  open-ended i n t e r v i e w method was u s e d , a l l o w i n g  f o r e x p l o r a t i o n o f areas important t o the study were made by (1)  t o t h e women. R e f e r r a l s  a l a y women's h e a l t h  and a b o r t i o n r e f e r r a l group, and (2)  a g y n e c o l o g i s t . The  f i n d i n g s were d e s c r i b e d u s i n g f r e q u e n c i e s a r i s i n g from the data. The  education  of categories  1  r e s u l t s o f t h i s study  h a v i n g a b o r t i o n s do e x p e r i e n c e  s u g g e s t t h a t some women  unmet needs. The most common  needs i d e n t i f i e d were: 1.  t h e need f o r t h o r o u g h d i s c u s s i o n o f b i r t h c o n t r o l  options coupled w i t h d i s c u s s i o n o f s e x u a l i t y ; 2.  t h e need f o r r e a d i l y a v a i l a b l e i n f o r m a t i o n about  I a l l aspects of a b o r t i o n ; 3.  t h e need f o r a b o r t i o n c o u n s e l l i n g , i n c l u d i n g  discussion of a l t e r n a t i v e s to abortion; 4. t h e need f o r e m o t i o n a l i z a t i o n and,  possibly,  support d u r i n g  hospital-  afterwards;  5 . t h e need t o e x p l o r e t h e meaning o f t h i s event ii  w i t h i n t h e c o n t e x t o f t h e woman's l i f e ,  i n terms of h e r  e x p e c t a t i o n s o f h e r s e l f and h e r r e l a t i o n s h i p s w i t h o t h e r s . A t t h e time o f the t h i r d i n t e r v i e w , many o f t h e women d e s c r i b e d changes i n t h e i r s e x u a l r e l a t i o n s h i p s r e l a t e d t o i n c r e a s e d f e e l i n g s o f c o n t r o l and d e t e r m i n a t i o n . The cons i s t e n c y between  the developed  r e c o g n i t i o n o f s e x u a l i t y and  use of r e l i a b l e c o n t r a c e p t i o n was e v i d e n t i n t w e l v e o f t h e f i f t e e n women seen a t t h a t t i m e . T h i s i n t e r v i e w r e v e a l e d t h a t a l l o f t h e women f e l t they h a d made t h e b e s t d e c i s i o n a t the t i m e , b u t f o u r s a i d they c o u l d n o t go t h r o u g h  w i t h an  a b o r t i o n a g a i n . The event was p r o f o u n d l y d i s t u r b i n g t o t h e i r p h i l o s o p h i c a l b e l i e f s . T h i s a s p e c t o f t h e women's l i v e s i s n o t a need o f t h e same o r d e r a s t h e o t h e r s ; r a t h e r , i t i s an area t o be u n d e r s t o o d  and a p p r e c i a t e d , b u t n o t s u b j e c t t o  specific Intervention. T h i s s t u d y h a s i d e n t i f i e d , f r o m a s m a l l sample, c e r t a i n unmet needs e x p e r i e n c e d by a b o r t i o n p a t i e n t s . A r e a s which r e q u i r e f u r t h e r r e s e a r c h , i n v o l v i n g l a r g e r numbers, centre around the f o l l o w i n g q u e s t i o n s : 1.  What a r e t h e most e f f e c t i v e ways o f m e e t i n g t h e  i d e n t i f i e d needs o f women h a v i n g  abortions?  2. What a r e t h e l o n g e r range e f f e c t s on a woman's a b i l i t y t o cope w i t h t h e a b o r t i o n , and on h e r l i f e g e n e r a l l y , o f meeting these needs? iii  TABLE OP CONTENTS  Page L I S T OP TABLES . .  v i i  ACKNOWLEDGEMENT  viii  Chapter 1. INTRODUCTION TO THE STUDY  1  THE PROBLEM .  1  J u s t i f i c a t i o n o f t h e Problem  .......  D e f i n i t i o n s o f Terms Used CONCLUSION 2. REVIEW OF THE LITERATURE MEDICAL PERSPECTIVES  2 5  . . . . .  5  .............  6  . .  PSYCHOLOGICAL/PSYCHIATRIC PERSPECTIVES  .  ?.  . .  9  SOCIAL PERSPECTIVES  l4>  WOMEN»S NEEDS AND EXPERIENCES  18  NURSING PERSPECTIVES ON ABORTION  21  SUMMARY  23  3. METHODOLOGY DESIGN  25  ......  .........  25  PROCEDURE  27  SAMPLE  28  LIMITATIONS OF THE STUDY  31  CONCLUSION  3?iv  V  Chapter  Page  4. FINDINGS AND DISCUSSION  33  PROFILE OF POPULATION  34  CONTRACEPTIVE USiGE  40  DECISION-MAKING  44  PROCESS  THE SEARCH FOR HELP  47  IMPLICATIONS OF DECISION IN L I F E SITUATION  49  NEEDS FOR INFORMATION  52 52  Concerning  the Law  Concerning  the H o s p i t a l E x p e r i e n c e  Concerning  Post-operative  ...  Expectations Concerning  52  53  Future Contraception . . . . . .  Other Needs . . . . . .  54 54  FIRST FOLLOW-UP V I S I T  55  H o s p i t a l Experience  55  P h y s i c a l Response  57  Contraception  .  57  R e l a t i o n s h i p w i t h Sexual P a r t n e r  ....  58  F e e l i n g s Related to the A b o r t i o n  . . . .  59  SECOND FOLLOW-UP V I S I T  6l  F e e l i n g s i n Response t o E v e n t S e x u a l i t y and R e l a t e d Needs  SUMMARY  .  63 6 4  Contraception Other Areas of Expressed  6l  Need . . . . . .  65 66  vi Chapter  Page  5. CONCLUSION  68  SUMMARY  68  IMPLICATIONS  72  RECOMMENDATIONS  74  RECOMMENDATIONS FOR FUTURE RESEARCH  ...  75  BIBLIOGRAPHY  77  APPENDIXES  82  A. THE FACE SHEET B. BROCHURE  0  82 •  84  C. SECTION 251, CRIMINAL CODE OF CANADA (SUBSECTIONS 1 TO 4—MARTIN'S CODE, 1 9 7 3 ) * •  86  L I S T OF TABLES TABLE  Page  I . M a r i t a l S t a t u s o f Women Having A b o r t i o n s  . .  34  I I . Age D i s t r i b u t i o n o f Women 34  Having A b o r t i o n s I I I . Occupation  o f Women H a v i n g A b o r t i o n s  . . . .  IV. R e l a t i o n s h i p Between Women Having A b o r t i o n s and P u t a t i v e F a t h e r s . . . . . . V. L i v i n g Arrangements o f Women Having A b o r t i o n s V I . L e n g t h o f Time S i n c e L a s t M e n s t r u a l P e r i o d o f Women H a v i n g A b o r t i o n s V I I . H o s p i t a l i z a t i o n P a t t e r n o f Women Having A b o r t i o n s . .  . . . .  X. C o n t r a c e p t i v e C h o i c e Two Weeks F o l l o w i n g Abortion X I . C o n t r a c e p t i v e P r a c t i c e s F o u r Months Following Abortion . . . . . . .  vii  36 37 38 38  V I I I . Timing o f I n t e r v i e w s i n R e l a t i o n to Abortion . . . . . . . . IX. Method o f B i r t h C o n t r o l P r i o r t o E x p e r i e n c i n g an Unwanted Pregnancy  35  39 40 58 65  vlii ACKNOWLEDGEMENTS Many p e o p l e have a s s i s t e d me I n c o m p l e t i n g  this  study. I w i s h t o thank t h e women whose t h o u g h t f u l p a r t i c i p a t i o n made t h e study p o s s i b l e . My t h a n k s a l s o a r e due because o f t h e e n c o u r a g i n g a s s i s t a n c e and c o o p e r a t i o n o f the Vancouver Women's H e a l t h C o l l e c t i v e , Dr G. K o r n , and Darlene L a r s o n . I am i n d e b t e d t o my committee members, M r s . H e l e n E l f e r t and Dr. George Povey, f o r t h e i r warm s u p p o r t and clear insights. My thanks a l s o go t o f r i e n d s who r e a d and commented on the t e x t . Others who have been c l o s e t o me d u r i n g t h i s p r o c e s s have been my c l a s s m a t e s : I  thank them f o r t h e i r  encouragement and sense o f humour. F i n a l l y , I thank my s p e c i a l f r i e n d and husband, I a n McKay, f o r h i s c o n t i n u i n g support and c o n s c i e n t i o u s t y p i n g o f t h e t e x t .  Chapter 1 INTRODUCTION TO THE STUDY U n t i l r e c e n t l y , women i n Canada who were f a c e d  with  an unwanted pregnancy had few a v a i l a b l e o p t i o n s . However, s i n c e t h e l i b e r a l i z a t i o n o f S e c t i o n 2 5 1 o f t h e C r i m i n a l Code o f Canada i n 1969» many women now have a g r e a t e r range o f choice.* There a r e s t i l l r e g i o n a l d i s p a r i t i e s i n t h e ease w i t h w h i c h women may o b t a i n a b o r t i o n s , s i n c e t h e r e s p o n s i b i l i t y f o r i n t e r p r e t a t i o n o f t h e changed l a w r e s t s s o l e l y w i t h each h o s p i t a l b o a r d , which may o r may n o t choose t o e s t a b l i s h a "Therapeutic  A b o r t i o n Committee."  However, a b o r t i o n a s a way o f d e a l i n g w i t h an unwanted pregnancy i s a n i n c r e a s i n g s o c i a l  event.  THE PROBLEM The p r o b l e m w i t h w h i c h t h e p r e s e n t  study i s concerned  i s t h i s : Do women e x p e r i e n c i n g a b o r t i o n s have unmet needs? T h i s p r o b l e m w i l l be e x p l o r e d once b e f o r e t h e o p e r a t i o n and a t two I n t e r v a l s f o l l o w i n g , i n o r d e r t o d e t e r mine a p p r o p r i a t e n u r s i n g i n t e r v e n t i o n s a t t h e d i f f e r e n t t i m e s and i n t h e d i f f e r e n t s e t t i n g s — h o s p i t a l , community,  See A p p e n d i x f o r t e x t o f S e c t i o n 1  251.  2 and s c h o o l — i n which n u r s e s a r e i n r e l a t i o n s h i p w i t h women experiencing  abortion.  J u s t i f i c a t i o n o f t h e Problem In the l a s t f o u r years, w i t h the l i b e r a l p r e t a t i o n of the l a w concerning  inter-  a b o r t i o n , t h e r e has been  an i n c r e a s e i n the number o f t h e r a p e u t i c a b o r t i o n s p e r f o r m e d . A study c a r r i e d o u t by t h e Vancouver G e n e r a l H o s p i t a l s t a t e s : The number o f t h e r a p e u t i c a b o r t i o n s p e r f o r m e d a t the Vancouver G e n e r a l H o s p i t a l i n 1969 double t h e average number f o r t h e p r e v i o u s f o u r y e a r s . I n 1969» 79 a b o r t i o n s were r e c o r d e d . One y e a r l a t e r , w i t h r e v i s i o n o f t h e Canadian C r i m i n a l Code, t h e number had r i s e n t o 1465. w  a  s  These f i g u r e s c o r r e s p o n d t o those d e s c r i b e d by P e l r l n e I n h e r book d i s c u s s i n g t h e a b o r t i o n s i t u a t i o n i n Canada: There i s no doubt t h a t i n c e r t a i n p a r t s o f Canada, more women a r e r e c e i v i n g h o s p i t a l a b o r t i o n s under t h e new l a w t h a n were p r e v i o u s l y . T a k i n g t h e example o f one h o s p i t a l board with a l i b e r a l p o l i c y , a b o r t i o n s performed by t h e Toronto G e n e r a l H o s p i t a l I n c r e a s e d n e a r l y t e n f o l d i n t h e t w e l v e months a f t e r t h e l a w took e f f e c t , f r o m s i x t y - s i x I n t h e p r e v i o u s t w e l v e months t o 628.-' These s t a t i s t i c s a r e i n d i c a t i v e o f t h e i n c r e a s i n g Incidence  o f a b o r t i o n i n o u r s o c i e t y . The r e s e a r c h e r has  chosen t o l o o k a t t h e e x p r e s s e d needs o f women h a v i n g a n a b o r t i o n f o r s e v e r a l reasons.  F i r s t , previous  research,has  ''"A Study t o I d e n t i f y Problems E x p e r i e n c e d by P a t i e n t s h a v i n g T n e r a p e u t i c A b o r t i o n s on t h e One-Day S u r g i c a l S l a t e , " P r o j e c t D i r e c t o r , Mary L. Richmond-MacBean. N a t i o n a l H e a l t h G r a n t ( P r o j e c t Number 6 1 0 - 2 1 - 2 5 ) , June 1972, Vancouver. new  ^ E l e a n o r W. P e l r l n e , A b o r t i o n i n Canada, p r e s s , 1971), p. 36".  (Toronto:  f o c u s e d p r i m a r i l y on p h y s i c a l needs and on p s y c h o l o g i c a l o r p s y c h i a t r i c e f f e c t s o f a b o r t i o n , r a t h e r t h a n on consequent " p r o b l e m s - i n - l i v i n g " o r e x p r e s s e d needs. W h i l e t h e p r e v i o u s l y mentioned a r e a s a r e i m p o r t a n t  and need c o n s i d -  e r a t i o n , a d i f f e r e n t approach t o t h i s event may w e l l y i e l d i n f o r m a t i o n more s u i t a b l e t o t h e m a j o r i t y o f women who do not experience  medical  o r p s y c h i a t r i c need.  Such an approach has n o t been w i d e s p r e a d i n t h e l i t e r a t u r e , which v e r y o f t e n has d e a l t p r i m a r i l y w i t h t h e m o r a l and l e g a l i m p l i c a t i o n s . The need f o r r e s e a r c h  into  the p u b l i c h e a l t h o r " p r o b l e m s - l n - l i v i n g " c o n c e r n s o f those e x p e r i e n c i n g a b o r t i o n h a s been s t a t e d by D a v i d : s u c h should  research  Include  e f f o r t s t o i d e n t i f y women a t h i g h r i s k f o r unintended pregnancy o r r e p e a t e d a b o r t i o n s e e k i n g , o r those i n need o f s p e c i a l c o u n s e l l i n g b e f o r e o r a f t e r abortion.^" The p r e s e n t  study,  t h e n , p r o p o s e s t o add t o n u r s i n g knowledge  by e x p l o r i n g t h e needs o f women i n d i f f e r e n t a r e a s o f t h e i r l i v e s a s t h e y undergo an a b o r t i o n . Secondly, another reason f o r the s i g n i f i c a n c e of the problem i s t h a t a t p r e s e n t  t h e r e i s no s y s t e m a t i z e d  way o f  s e e i n g women a f t e r a b o r t i o n i n Vancouver, a p a r t f r o m t h e recommendation f o r a six-week c h e c k - u p — a recommendation  Henry P. D a v i d , " A b o r t i o n : P u b l i c H e a l t h Concerns and Needed P s y c h o s o c i a l R e s e a r c h , " A m e r i c a n J o u r n a l o f P u b l i c H e a l t h , 6 l : 3 (March, 1 9 7 D , 3 l J I  4  which I s s p o r a d i c a l l y g i v e n and n o t a l w a y s heeded. C o n c e r n i n g f o l l o w - u p , a comprehensive study e v a l u a t i n g t h e o u t r e a c h f a m i l y p l a n n i n g s e r v i c e s i n Vancouver s t a t e d : While the m a j o r i t y of t h e r a p e u t i c a b o r t i o n s a r e arranged t h r o u g h c o n s u l t a t i o n w i t h p r i v a t e p h y s i c i a n s , i t cannot be assumed t h a t c o n t r a c e p t i o n i s f u l l y d i s cussed a t t h i s t i m e . N o r can t h e g e n e r a l p r a c t i t i o n e r be e x p e c t e d t o p r o v i d e t h e k i n d o f f o l l o w - u p s e r v i c e n e c e s s a r y , e s p e c i a l l y where t h e r e l a t i o n s h i p w i t h t h e p a t i e n t s may b e g i n and end w i t h t h e t h e r a p e u t i c a b o r t i o n . Thus, a s y s t e m a t i c body o f n u r s i n g knowledge  regarding  r e a c t i o n s t o t h i s u n e x p e c t e d l i f e event has n o t been comp i l e d . The a r e a s e x p l o r e d i n t h e p r e s e n t  s t u d y may p r o v i d e  I n s i g h t s f o r more r e f i n e d r e s e a r c h t o a i d i n t h e g a t h e r i n g o f t h i s n u r s i n g knowledge. T h i r d l y , since the primary  f u n c t i o n of n u r s i n g i s  t o n u r t u r e , t h a t i s , " t o f o s t e r , p r o t e c t , s u s t a i n , and teach,  n u r s e s s h o u l d u n d e r s t a n d when and how t o c a r r y o u t  these f u n c t i o n s . There i s g e n e r a l knowledge a v a i l a b l e t o a s s i s t n u r s e s who a r e w i t h women h a v i n g a b o r t i o n s ; b u t more needs t o be known about t h e s p e c i f i c a l t e r a t i o n s w h i c h may o c c u r i n t h e l i v e s o f t h e s e women. W i t h such improved knowl e d g e , n u r s i n g I n t e r v e n t i o n c a n o c c u r i n a s e n s i t i v e and a p p r o p r i a t e manner.  ^ B a b i e s by C h o i c e n o t by Chance (Volume 2 ) , O u t r e a c h S e r v i c e s , S o c i a l P o l i c y and R e s e a r c h Department, U n i t e d Community S e r v i c e s o f G r e a t e r Vancouver A r e a , (June, 1973)> P. 17.  "Model f o r N u r s i n g , U n i v e r s i t y o f B r i t i s h C o l u m b i a School o f N u r s i n g , 1973 (mimeographed).  D e f i n i t i o n s of Terms UsedA b o r t i o n i n t h i s paper r e f e r s t o the l e g a l  induced  t e r m i n a t i o n o f a pregnancy w i t h i n a t w e l v e week i n t e r v a l f o l l o w i n g the l a s t n o r m a l m e n s t r u a l Expressed  period.  need i s d e f i n e d as a p e r c e i v e d l a c k , o r  a d e f i c i t w i t h i n the p e r s o n ' s e x p e r i e n c e m u n i c a t e d t o the  w h i c h was  com-  researcher.  N u r s i n g i s d e f i n e d as the n u r t u r i n g o f man d u r i n g c r i t i c a l p e r i o d s i n h i s l i f e so t h a t he may d e v e l o p and u t i l i z e a range of c o p i n g b e h a v i o u r s which p e r m i t him t o s a t i s f y h i s b a s i c human needs and t h e r e b y move toward o p t i m a l health.? N u r s i n g i n t e r v e n t i o n i s "a p l a n o f a c t i o n d e s i g n e d to a l t e r , r e v e r s e , o r s u s t a i n a c o u r s e of development. CONCLUSION The purpose o f t h i s p a p e r , t h e n , i s t o e x p l o r e , f r o m the woman's p o i n t o f v i e w , the a b o r t i o n e x p e r i e n c e .  Expressed  needs w i l l be examined, b e f o r e the o p e r a t i o n and a t  two  i n t e r v a l s f o l l o w i n g . The p o s s i b i l i t y o f n u r s i n g i n t e r v e n t i o n assisting  i n m e e t i n g those needs w i l l be  considered.  ?Model f o r N u r s i n g , U n i v e r s i t y o f B r i t i s h C o l u m b i a . ^E. Maloney, I n t e r p e r s o n a l R e l a t i o n s , (Dubuque: C. Brown Co., 1966), p. 62.  Chapter 2 REVIEW OF THE  LITERATURE  L i t e r a t u r e on the s u b j e c t of a b o r t i o n d e a l s a t l e n g t h w i t h the m e d i c a l , l e g a l , p s y c h o l o g i c a l and  moral  a s p e c t s o f the s i t u a t i o n . A r e v i e w o f t h i s l i t e r a t u r e shows t h a t the p o i n t of v i e w most o f t e n used f o r s u c h w r i t i n g s was  t h a t o f the p r o f e s s i o n a l — w h e t h e r  general  practitioner,  clergyman, p s y c h i a t r i s t , g y n e c o l o g i s t , lawyer, o f f i c e r of h e a l t h o r  medical  sociologist.  Many d i v e r s e o p i n i o n s a r e o f f e r e d r e g a r d i n g the m o r a l  p i m p l i c a t i o n s of a b o r t i o n .  I t i s n o t the purpose o f  this  p a p e r t o engage i n the m o r a l debate, but r a t h e r t o l e a r n more about what a c t u a l l y i s e x p e r i e n c e d  by the woman h a v i n g  an  a b o r t i o n . I n r e v i e w i n g t h e l i t e r a t u r e , t h e i n v e s t i g a t o r was s e a r c h i n g f o r i n f o r m a t i o n r e l a t i n g t o t h e needs and e x p r e s s e d  by the women who  experienced  had a b o r t i o n s . There was  d e a r t h o f such m a t e r i a l . T h i s review, then, w i l l l o o k at r e p r e s e n t a t i v e  a North  S e e f o r example a r t i c l e s i n R o b e r t E. H a l l , ( e d . ) , A b o r t i o n i n a Changing W o r l d ( I and I I ) , (New Y o r k : C o l u m b i a U n i v e r s i t y P r e s s , 1970), and D a v i d T. S m i t h , ( e d . ) , A b o r t i o n and the Law, ( C l e v e l a n d * The P r e s s o f Western R e s e r v e U n i v e r s i t y , 1967). x  F o r two d i f f e r e n t i n t e r p r e t a t i o n s of the m o r a l i m p l i c a t i o n s of a b o r t i o n , see D a n i e l C a l l a h a n , A b o r t i o n ; Law, Choice and M o r a l i t y , (London: M a c M i l l a n Co., 1 9 7 0 ) , a n d R u s s e l l Shaw, A b o r t i o n on T r i a l , ( O h i o ; P f l a u m P r e s s , 1 9 6 8 . ) 2  6  7 American a r t i c l e s w r i t t e n f r o m the m e d i c a l , p s y c h o l o g i c a l / p s y c h i a t r i c , and s o c i a l p e r s p e c t i v e s . These w i l l be examined to  determine t h e i r u s e f u l n e s s i n c o n t r i b u t i n g t o "knowledge  about women's needs. MEDICAL PERSPECTIVES R e p o r t i n g on a study of the f i r s t 500  cases  of  a b o r t i o n p e r f o r m e d a t the Vancouver G e n e r a l H o s p i t a l ( t h a t i s from 1965  t o J u l y , 1 9 7 0 ) , Claman w r i t e s t h a t "the b i g g e s t  s i n g l e f a c t o r l e a d i n g to c o m p l i c a t i o n s when pregnancy i s t e r m i n a t e d by c u r e t t a g e i s the d u r a t i o n o f g e s t a t i o n . " 3 T h i s f i n d i n g was  c o r r o b o r a t e d l a t e r i n an A m e r i c a n s t u d y ,  the  most comprehensive s t u d y of m e d i c a l c o m p l i c a t i o n s of a b o r t i o n c a r r i e d out i n the U n i t e d S t a t e s . T h i s s t u d y , r e p o r t e d i n 1972  by T i e t z e and L e w i t t , i n c l u d e d 72,988 women h a v i n g  a b o r t i o n s w i t h i n a one y e a r i n t e r v a l . ^ Among the m a j o r f i n d i n g s were t h a t t h r e e out o f f o u r a b o r t i o n s were p e r f o r m e d i n the f i r s t t r i m e s t e r o f pregnancy; t h a t most a b o r t i o n s i n this first  t r i m e s t e r were p e r f o r m e d by vacuum a s p i r a t i o n ;  that e a r l y medical c o m p l i c a t i o n s ( i n c l u d i n g minor d u r i n g the f i r s t t r i m e s t e r were on the o r d e r o f one  and  complaints) in  3A. D a v i d Claman e t . a l . , "Impact on H o s p i t a l P r a c t i c e o f L i b e r a l i z i n g A b o r t i o n s and Female S t e r i l i z a t i o n s , " Canadian M e d i c a l A s s o c i a t i o n J o u r n a l , 105 ( J u l y 10, 1 9 7 1 ) , 39. ^ C h r i s t o p h e r T i e t z e and Sarah L e w i t t , " J o i n t Program f o r the Study o f A b o r t i o n ( J P S A ) : E a r l y M e d i c a l C o m p l i c a t i o n s o f L e g a l A b o r t i o n , " S t u d i e s i n F a m i l y P l a n n i n g , 3:6 (June, 1972). . —  8 twenty a b o r t i o n s , whereas major c o m p l i c a t i o n s were one i n two hundred a b o r t i o n s . The r e p o r t s t a t e s t h a t "the r i s k t o h e a l t h a s s o c i a t e d w i t h a b o r t i o n s was t h r e e t o f o u r t i m e s a s h i g h I n t h e second t r i m e s t e r o f pregnancy a s i n t h e f i r s t t r i m e s t e r . "-5 ( T l e t z e r e f e r s t o the f i r s t t r i m e s t e r as the f i r s t  twelve  weeks  s i n c e t h e l a s t m e n s t r u a l p e r i o d . ) The study f o u n d t h a t t h e c o m p l i c a t i o n r a t e s were l o w e s t  " f o r a b o r t i o n s by s u c t i o n ,  f o l l o w e d I n a s c e n d i n g o r d e r by c l a s s i c a l D&C, s a l i n e ,  hyster-  otomy, and h y s t e r e c t o m y . T h e b e s t time f o r m i n i m i z i n g c o m p l i c a t i o n s was seven t o e i g h t weeks a f t e r t h e l a s t m e n s t r u a l p e r i o d . From t h i s time on, t h e c o m p l i c a t i o n  rate  i n c r e a s e d s t e a d i l y t o f i f t e e n weeks o r more. The r e s u l t s o f t h i s study i n d i c a t e t h a t an e a r l y a b o r t i o n i n a h e a l t h y woman p e r f o r m e d by a s k i l l e d  prac-  t i t i o n e r i s a r e l a t i v e l y s a f e p r o c e d u r e accompanied by m i n i mal r i s k . The study was a l s o a b l e t o i d e n t i f y p o t e n t i a l h i g h - r i s k p a t i e n t s from the medical  perspective.  As t h e number o f a b o r t i o n s i n c r e a s e s , h o s p i t a l f a c i l i t i e s a t t e m p t t o accommodate t h e change. T i e t z e  looked  i a t a comparison o f c o m p l i c a t i o n r a t e s between h o s p i t a l i z e d p a t i e n t s and o u t p a t i e n t s , and f o u n d t h a t c o m p l i c a t i o n r a t e s f o r a b o r t i o n s by s u c t i o n , exc l u d i n g women w i t h p r e - e x i s t i n g c o m p l i c a t i o n s , . . . were  -^Tietze, p. 9 8 . ^ T l e t z e , p. 9 8 .  9 l o w e r f o r c l i n i c s t h a n f o r h o s p i t a l s and l o w e r f o r h o s p i t a l out-patients than f o r h o s p i t a l i n - p a t i e n t s . These d i f f e r e n t i a l s were due i n p a r t t o v a r i a t i o n s i n p e r i o d s o f g e s t a t i o n and i n t y p e o f s e r v i c e ( p r i v a t e v e r s u s n o n - p r i v a t e ) . Other f a c t o r s t h a t p r o b a b l y c o n t r i b u t e d t o t h e d i f f e r e n t i a l s were: (a) more r i g o r o u s s e l e c t i o n of p a t i e n t s ; (b) g r e a t e r e x p e r i e n c e o f p h y s i c i a n s ; and ( c ) l e s s complete r e c o r d i n g o f c o m p l i cations. 7 T h i s f i n d i n g s u p p o r t s a study a t t h e Vancouver G e n e r a l H o s p i t a l i n 1972 which p r o p o s e d t o i d e n t i f y problems e x p e r i e n c e d by p a t i e n t s h a v i n g a b o r t i o n s on a one-day s u r g i c a l basis. This report stated that "early discharge  d i d not create  any major problems t h a t t h e p a t i e n t h e r s e l f c o u l d n o t h a n d l e a t home."^ T h i s s t a t e m e n t was b a s e d on f o l l o w - u p v i s i t s made w i t h i n Zk h o u r s o f t h e a b o r t i o n . The v a l u e o f t h e r e s e a r c h m e n t i o n e d here i n a d d i n g t o an u n d e r s t a n d i n g o f women's needs r e l a t i n g t o a b o r t i o n I s o b v i o u s : t h e i n c i d e n c e o f p h y s i c a l need r e l a t i n g t o complications  i s l o w , p a r t i c u l a r l y i n women i n t h e e a r l y  g e s t a t i o n p e r i o d who have been s c r e e n e d t o d e t e r m i n e h i g h risk potential. PSYCHOLOGICAL/PSYCHIATRIC PERSPECTIVES O t h e r s t u d i e s have f o c u s e d more on t h e p s y c h o l o g i c a l and p s y c h i a t r i c r e a c t i o n s o f women h a v i n g a b o r t i o n s .  7  I n 1971»  T I e t z e , p. 9 8 .  8"A Study t o I d e n t i f y Problems E x p e r i e n c e d by P a t i e n t s h a v i n g T h e r a p e u t i c A b o r t i o n s on t h e One-Day S u r g i c a l S l a t e , " p. 28.  10 Brody e t . a l . a t t e m p t e d t o l o o k f o r p o s s i b l e p s y c h o l o g i c a l d i s t u r b a n c e s i n women a p p l y i n g f o r a b o r t i o n s , by a s k i n g whether t h e r a p e u t i c a b o r t i o n s had any e f f e c t on measurable psychological disturbance  ( i f demonstrated),  and whether  r e f u s i n g a b o r t i o n caused p s y c h o l o g i c a l i l l - e f f e c t s . The study, u s e d a c o n t r o l group o f women i n t h e same stage o f pregnancy f o r comparison.9 Using e l a b o r a t e t e s t s (Minnesota M u l t i p h a s i c Persona l i t y I n v e n t o r y ; Pregnancy R e s e a r c h Q u e s t i o n n a i r e ;  Minnesota-  B r l g g s S o c i a l H i s t o r y ; Mooney Problem C h e c k l i s t ; C o r n e l l M e d i c a l Index; F o r e r Sentence C o m p l e t i o n Differential),  t h e study suggested  and Semantic  the f o l l o w i n g character-  i s t i c s o f women who a p p l i e d f o r a b o r t i o n : These i n c l u d e a h i g h degree o f d e p r e s s i o n , c o n s i d e r a b l e concern w i t h b o d i l y p r e o c c u p a t i o n s , d i f f i c u l t i e s i n o b e y i n g r u l e s and r e g u l a t i o n s , t r o u b l e i n c o n t r o l l i n g impulses t o an extent t h a t leads t o s e r i o u s s o c i a l d i f f i c u l t i e s , a tendency t o be t o u c h y a n d c r i t i c a l o f o t h e r s , b e i n g an easy p r e y t o a n x i e t y and i r r a t i o n a l f e a r s , a marked tendency t o w i t h d r a w and u n e a s i n e s s I n social situations. 1 0  T h i s s t u d y , however, begs t h e q u e s t i o n : t o what e x t e n t c a n a survey o f p s y c h i a t r i c c h a r a c t e r i s t i c s be v a l i d , when based on t e s t s a d m i n i s t e r e d t o a woman who i s u p s e t i n the p a r t i c u l a r c i r c u m s t a n c e s ,  b u t who a l s o knows t h a t she  must p l e a d a case b e f o r e a committee, c o n v i n c i n g them t h a t  ^Harry Brody, Stewart M e i k l e , and R i c h a r d G e r r i t s e , "Therapeutic A b o r t i o n : A P r o s p e c t i v e Study. 1," American J o u r n a l o f O b s t e t r i c s and G y n e c o l o g y, 1 0 9 : 3 ( F e b r u a r y 1, 1 9 7 1 ) , 347-353. 1 0  B r o d y , p. 3 5 2 .  h e r good h e a l t h depends on h a v i n g an a b o r t i o n ? t h e m s e l v e s s t a t e t h a t "the a p p l i c a n t s may  The  authors  have a t t e m p t e d  t o fake a p s y c h o l o g i c a l d i s t u r b a n c e  i n o r d e r t o maximize  t h e i r chances of b e i n g a c c e p t e d , "  a l t h o u g h they  1 1  t h a t t h i s was not done s y s t e m a t i c a l l y ; r a t h e r , an may  believed individual  have e x a g g e r a t e d an e x i s t i n g symptom i n p r e s e n t i n g  c a s e . Brody e t . a l . c o n c l u d e t h a t a b o r t i o n does seem t o psychologically  her be  therapeutics  W i t h i n 6 weeks of t h e p r o c e d u r e , our p a t i e n t s showed a marked improvement i n t h e i r r e p o r t e d psychol o g i c a l s t a t u s , and t h i s improvement c o n t i n u e d up t o one y e a r a f t e r i n t e r v e n t i o n . 1 2  Studies which I n t e r p r e t data i n r e l a t i o n to whole c o n t e x t of the e x p e r i e n c e seem t o p r o v i d e  the  more u s e f u l  u n d e r s t a n d i n g of the woman's s i t u a t i o n . An example o f such a s t u d y , one  t h a t does l o o k a t the t o t a l s i t u a t i o n f o r the  e x p l a n a t i o n of b e h a v i o u r , i s t h a t done by Marder i n 1970 C a l i f o r n i a . For Instance,  Marder s t a t e s t h a t " h o s t i l i t y  resentment toward the p a t i e n t by s t a f f and n u r s i n g have been r e s p o n s i b l e f o r some of the e m o t i o n a l e x p e r i e n c e d by p a t i e n t s . 3 m 1  questionable  in and  personnel  disturbance  Such a s t a t e m e n t makes i t seem  f o r Brody e t . a l . t o c o n s i d e r  psychological  c h a r a c t e r i s t i c s o f women a p p l y i n g f o r a b o r t i o n i n I s o l a t i o n  B r o d y , p.  352.  B r o d y , p.  352.  i:L  1 2  3 L e o n Marder, " P s y c h i a t r i c E x p e r i e n c e w i t h a L i b e r a l i z e d A b o r t i o n Law," A m e r i c a n J o u r n a l o f P s y c h i a t r y , 126*9 (March, 1 9 7 0 ) , 70. 1  12 from t h e o t h e r s i t u a t i o n a l dynamics. I n Doth t h e s e s t u d i e s , an a t t e m p t was made t o f o l l o w up women who had "been r e f u s e d a b o r t i o n s . N o t s u r p r i s i n g l y , much d i f f i c u l t y was e n c o u n t e r e d i n f i n d i n g these women. As Marder s a y s , "Attempts t o e v a l u a t e  the e f f e c t s of r e j e c t i o n  f o r t h e r a p e u t i c a b o r t i o n have been d i f f i c u l t because o f t h e h o s t i l i t y d e v e l o p e d by many o f t h e a p p l i c a n t s . " - ^ Brody e t . a l .  c o n c l u d e d t h a t " t h e r e seems t o be  l i t t l e t h e r a p e u t i c v a l u e i n f o r c i n g a woman t o c a r r y an unwanted pregnancy t o t e r m , " ^ ^ b u t t h a t a b o r t i o n does seem t o have t h e r a p e u t i c p s y c h o l o g i c a l e f f e c t s . Marder f o u n d t h a t a n x i e t y and d e p r e s s i o n  which develop under the s t r e s s o f  unwanted pregnancy a r e a m e l i o r a t e d  a f t e r a b o r t i o n . ^ He a l s o  f o u n d t h a t s e r i o u s e m o t i o n a l problems o f g u i l t o r remorse d i d not o c c u r i n t h e p o s t - a b o r t a l p e r i o d . I n f a c t ,  "patients  g e n e r a l l y have d e s c r i b e d marked r e l i e f o f symptoms and r e p o r t improvement i n t h e i r r e l a t i o n s h i p s w i t h o t h e r s , a l o n g  with  an improved l i v i n g s i t u a t i o n , f o l l o w i n g t h e ' t h e r a p e u t i c ' abortion."17 Marder's d a t a , a s much as can be d e t e r m i n e d , seem t o have been g a t h e r e d t h r o u g h p s y c h i a t r i c i n t e r v i e w s ; a s mentioned, Brody e t . a l . used an e x t e n s i v e  1  l 5  l 6  harder,  p. 6 8 .  B r o d y , p. 3 5 2 . M a r d e r , p. 7 0 .  ^ M a r d e r , p. 7 0 .  s e r i e s of person-  a l l t y t e s t s . I n 1968,  W h i t t l n g t o n used the " s e l f - r e p o r t "  method t o t r y t o e v a l u a t e  therapeutic abortion.  Thirty-one  women responded t o h i s q u e s t i o n n a i r e . The d a t a suggest t h a t r e s p o n d e n t women who have r e c e i v e d a t h e r a p e u t i c a b o r t i o n f e e l t h e i r m e n t a l h e a l t h and s t a t e of h a p p i n e s s have been b e n e f i t t e d by t h e p r o c e d u r e and would make t h e d e c i s i o n again.1° These p r e v i o u s t h r e e s t u d i e s a l l d e a l t w i t h s i t u a t i o n s where t h e woman was a c c e p t e d f o r a b o r t i o n on p s y c h i a t r i c grounds; t h a t i s t o say, she was r e s p o n s i b l e f o r p e t i t i o n i n g h e r case b e f o r e a committee. O s o f s k y e t . a l . . ( 1 9 ? 1 )  describe  a d i f f e r e n t s i t u a t i o n i n S y r a c u s e , New Y o r k , where a l l requests f o r a b o r t i o n are granted  f o r p r e g n a n c i e s o f under  twelve weeks.19 The program a t t h e i n s t i t u t i o n includes education, The  involved  c o n t r a c e p t i o n and a b o r t i o n s e r v i c e s .  comprehensiveness o f t h i s program s t a n d s i n marked con-  t r a s t to other  facilities.  Shortly a f t e r the a b o r t i o n , the p a t i e n t i s i n t e r viewed i n o r d e r b o t h t o p r o v i d e h e r w i t h s u p p o r t , and to d e t e r m i n e h e r r e a c t i o n s t o t h e p r o c e d u r e . A d d i t i o n a l information i s gathered concerning h e r perception of options other than l e g a l i z e d a b o r t i o n , and h e r a t t i t u d e s and f u t u r e p l a n s r e l a t e d t o c o n t r a c e p t i o n , m a r r i a g e , c h i l d r e n , and l i f e s t y l e . 2 0  H.G. W h i t t l n g t o n , " E v a l u a t i o n o f T h e r a p e u t i c A b o r t i o n a s a n Element o f P r e v e n t i v e P s y c h i a t r y , " A m e r i c a n J o u r n a l of P s y c h i a t r y . 126:9 (March, 1 9 7 0 ) , 6 1 . xo  ! 9 j o y D. O s o f s k y e t . a l . , " P s y c h o l o g i c E f f e c t s o f L e g a l A b o r t i o n , " C l i n i c a l O b s t e t r i c s and G y n e c o l o g y : L e g a l A b o r t i o n s i n New Y o r k S t a t e : M e d i c a l , L e g a l , N u r s i n g , S o c i a l A s p e c t s ( J u l y 1-December 31% 1 9 7 0 ) . e d . George S c h a e f e r , (March, 1 9 7 1 ) , (New Y o r k : H a r p e r & Row M e d i c a l Department, 1 9 7 D , 215-234. O s o f s k y , p. 2 2 3 .  14 Longer term follow-up  was "being p l a n n e d a t t h e time o f  writing. The  r e s u l t s o f t h i s s t u d y , w h i c h i n v o l v e d 250 women,  showed t h a t few women have f e l t s t r o n g g u i l t , u n h a p p i n e s s , o r s e l f - a n g e r ; r e l a t i v e l y few have "been o b j e c t i v e l y d i s t r e s s e d . A l t h o u g h many have p h y s i c a l l y f e a r e d t h e p r o c e d u r e and a l t h o u g h a c o n s i d e r a b l e number would have l i k e d to bear the c h i l d i f p o s s i b l e , given the e x i s t e n t s o c i a l and/or economic c i r c u m s t a n c e s , t h e predominant moods have been r e l i e f and h a p p i n e s s . 2 1 T h i s study a l s o f o u n d t h a t t h e e x p e r i e n c e o f t h e a b o r t i o n i n c r e a s e d the d e s i r e f o r e f f e c t i v e c o n t r a c e p t i o n . s t r e s s t h a t more s e x e d u c a t i o n  and c o n t r a c e p t i v e  The a u t h o r s availability  a r e needed because t h e women i n t h e s t u d y d i d n o t p r e f e r o r d e s i r e a b o r t i o n a s a means o f c o n t r a c e p t i o n . SOCIAL PERSPECTIVES Some w r i t e r s have been c o n c e r n e d w i t h t h e p s y c h o s o c i a l and s o c i a l e f f e c t s o f a b o r t i o n , on t h e s o c i e t y i n g e n e r a l and on t h e woman I n t h a t s o c i e t y i n p a r t i c u l a r . D a v i d (1971) s t r e s s e s t h e need f o r more adequate p r e p a r a t i o n f o r m e d i c a l and h e a l t h w o r k e r s i n terms o f d e a l i n g w i t h human s e x u a l i t y . Such p e o p l e , i n t h e p a s t , have been p o o r l y p r e p a r e d t o d e a l w i t h t h e c h a n g i n g s o c i a l  reality  o f l e g a l i z e d a b o r t i o n and need " e d u c a t i o n a l programs d e s i g n e d  2 1  0sofsky,  p. 231.  15 t o enhance awareness and s k i l l f o r d e a l i n g a d e q u a t e l y and appropriately with abortion r e q u e s t s . "  2 2  He a l s o " b e l i e v e s  t h a t more knowledge i s r e q u i r e d about " t h e d i f f e r e n c e s I n b e l i e f s , a t t i t u d e s , v a l u e s , and m o t i v a t i o n s i n f l u e n c i n g human b e h a v i o r "  i n t h e a r e a o f f a m i l y p l a n n i n g and a b o r -  t i o n . - ^ D a v i d t h u s adds t o an u n d e r s t a n d i n g 2  of the s o c i a l  i m p l i c a t i o n s o f a b o r t i o n by s t r e s s i n g r e l a t e d needs i n terms of h e a l t h p r o f e s s i o n re-education  and i n d i v i d u a l  motivation.  S c h w a r t z (1972) d i s c u s s e s t h e s o c i a l e f f e c t s o f l e g a l a b o r t i o n u s i n g such sweeping g e n e r a l i z a t i o n s t h a t no new i n s i g h t s a r e gained; sented concerning  i n f a c t , erroneous i n f o r m a t i o n i s pre-  the p o s i t i v e s o c i a l e f f e c t s of l e g a l  a b o r t i o n . S p e c i f i c a l l y , Schwartz s t a t e s t h a t l e g a l i s t h e b e s t s i n g l e method f o r d e c r e a s i n g  abortion  t h e b i r t h r a t e and  c o n s e q u e n t l y p r e s e r v i n g t h e environment f r o m f u r t h e r d e t e r i o r a t i o n , f o r decreasing improving  the incidence of poverty,  and f o r  the q u a l i t y of c h i l d care, " l e a d i n g t o decrease i n  the p o t e n t i a l incidence of c r i m i n a l i t y , psychosis,  drug  a d d i c t i o n , a l c o h o l i s m , and o t h e r s e v e r e d i s o r d e r s o f behavior." ^ 2  C l e a r l y , t h i s i s too s i m p l i s t i c an approach  t o complex s o c i e t a l c o n c e r n s .  22Davld, " A b o r t i o n s P u b l i c H e a l t h Concerns and Needed P s y c h o s o c i a l R e s e a r c h , " p. 5 1 ^ . 2  3Davld,  p.  513.  R i c h a r d A. S c h w a r t z , "The S o c i a l E f f e c t s o f L e g a l A b o r t i o n , " A m e r i c a n J o u r n a l o f P u b l i c H e a l t h , 62:10 (October, 1972), 1335. . 2 i f  16 More u s e f u l i n s i g h t s a r e p r o v i d e d by Schwenger (1973) who  s t u d i e d a b o r t i o n i n Canada and r a i s e s some impor-  t a n t q u e s t i o n s r e g a r d i n g the s o c i a l i n e q u a l i t i e s of  our  present  i n the  system, s p e c i f i c a l l y as they a r e m a n i f e s t e d  s i t u a t i o n s of p r e g n a n t women.25 Women's needs a r e  met  d i f f e r e n t l y i n d i f f e r e n t p a r t s of the c o u n t r y . There i s , f o r example, a g e o g r a p h i c a l  d i f f e r e n c e : i t i s over t h i r t y  times  e a s i e r t o o b t a i n an a b o r t i o n i n B r i t i s h C o l u m b i a t h a n i n Newfoundland. Women i n r u r a l a r e a s have a more d i f f i c u l t time o b t a i n i n g a b o r t i o n s t h a n do c i t y women, because of l a c k o f h o s p i t a l f a c i l i t i e s o r l a c k of s u f f i c i e n t p h y s i c i a n s t o form Therapeutic  A b o r t i o n Committees. A n o t h e r i n e q u a l i t y  i s the f a c t t h a t i t i s s t i l l more d i f f i c u l t f o r p o o r women t o get a b o r t i o n s , i f t r a v e l t o a n o t h e r c i t y i s r e q u i r e d . Y e t a n o t h e r s o u r c e o f i n e q u a l i t y l i e s i n the f a c t t h a t i n d i v i d u a l committees may  d e c i d e whether t o a c c e p t a b r o a d  d e f i n i t i o n of h e a l t h ( i n c l u d i n g the p a t i e n t ' s p h y s i c a l , m e n t a l , and s o c i a l c o n c e r n s ) ,  or a narrow  one.  Those, t h e n , a r e some o f t h e ways i n w h i c h i n d i v i d u a l women w i t h i n our s o c i e t y a r e a f f e c t e d by a b o r t i o n and  abortion  l a w s . Schwenger a l s o d e s c r i b e s some o f the o v e r a l l p u b l i c h e a l t h e f f e c t s , one  o f w h i c h i s t h a t "the drop i n the  o f n e o n a t a l m o r t a l i t y and p e r i n a t a l m o r t a l i t y o v e r the  rates past  5 c o p e W. Schwenger, " A b o r t i o n i n Canada as a P u b l i c H e a l t h P r o b l e m and as a Community H e a l t h Measure," C a n a d i a n J o u r n a l o f P u b l i c H e a l t h , 64:3 (May-June, 1 9 7 3 ) , 223-229. 2  17 f i v e y e a r s shows t h e g r e a t e s t r e d u c t i o n f r o m 1970-1971, presumably f r o m t h e i n c i d e n c e o f l e g a l a b o r t i o n . " ^ W h i l e 2  r e c o g n i z i n g the c o n t r i b u t i o n t h a t i n c r e a s e d a v a i l a b i l i t y o f a b o r t i o n has made t o p u b l i c h e a l t h , Schwenger s t r e s s e s t h a t "more a c c e p t a b l e  a l t e r n a t i v e methods o f b i r t h c o n t r o l such  as c o n t r a c e p t i o n and s t e r i l i z a t i o n must be made more r e a d i l y a v a i l a b l e . 7 He emphasizes t h e need f o r c o u n s e l l i n g as an h 2  I n t e g r a l p a r t o f a b o r t i o n s e r v i c e s t h a t s h o u l d be " f r e e l y entered  i n t o , s u p p o r t i v e , n o n - j u d g m e n t a l , and e d u c a t i o n a l . " ^ 2  The  preceding  d i s c u s s i o n has shown t h a t , g e n e r a l l y ,  women e x p e r i e n c i n g a b o r t i o n s do n o t have g r e a t need i n t h e i r p h y s i c a l o r p s y c h o l o g i c a l r e s p o n s e s t o t h e e v e n t . The a r e a s of need seem t o f o c u s on t h e woman's p s y c h o s o c i a l  situation.  Does she have a c c e s s t o a b o r t i o n f o r an unwanted pregnancy? What c o n t r a c e p t i v e a d v i c e , i f any,  had she been g i v e n ? A r e  t h e r e adequate c o u n s e l l i n g f a c i l i t i e s a v a i l a b l e t o h e r ? The  r e s t of t h i s l i t e r a t u r e review w i l l look a t  i n f o r m a t i o n r e g a r d i n g women's needs w i t h an emphasis on t h e woman h e r s e l f a s t h e p r i m a r y e v a l u a t o r o f h e r e x p e r i e n c e .  2  ^Schwenger, p. 227.  ^ S c h w e n g e r , p. 228. 28  S c h w e n g e r , p. 229.  18 WOMEN'S NEEDS AND EXPERIENCES A r e p o r t o f an e x p e r i m e n t i n a " m u l t i d i s c i p l i n e d a p p r o a c h " t o t h e care o f women h a v i n g a b o r t i o n s i n an Ontario  c l i n i c s t a t e s t h a t t h e most common needs o f t h e  women were f o r : (1) a comprehensive assessment o f p s y c h o s o c i a l problems; (2) concerned h e a l t h team members who c a n h e l p a p a t i e n t s o r t o u t h e r f e e l i n g s and s e l e c t a s a t i s f a c t o r y s o l u t i o n t o h e r problem; (3) o n g o i n g e m o t i o n a l support; (4) a v a i l a b i l i t y o f i n d i v i d u a l and f a m i l y t r e a t m e n t r e s o u r c e s e i t h e r w i t h i n t h e team o r a c c e s s i b l e t o i t ; (5) f o l l o w - u p a s s e s s m e n t s , c o n t r a c e p t i v e c o u n s e l l i n g , and f o l l o w - t h r o u g h by a c a r i n g i n d i v i d u a l who may w e l l be I n t h e p a t i e n t ' s own community.29 . S m i t h (1973) r e p o r t s a study  i nMissouri involving  154 women, where t h e a i m was t o l o o k a t o t h e r a s p e c t s o f the woman's l i f e i n r e l a t i o n t o t h e a b o r t i o n . She s t a t e s : I n o r d e r t o more f u l l y u n d e r s t a n d t h e e f f e c t s o f a b o r t i o n and t h e immediate and l o n g e r range a d j u s t m e n t p a t t e r n s , i t was d e c i d e d t o a s k women who had o b t a i n e d a b o r t i o n s t o e v a l u a t e t h e i r e x p e r i e n c e and i t s e f f e c t upon them. T h e i r s u b j e c t i v e r e a c t i o n s t o a b o r t i o n , t h e i r current functioning, r e l a t i o n s h i p s with the sexual p a r t n e r , c o n t r a c e p t i v e usage, and subsequent unwanted p r e g n a n c i e s were e x p l o r e d . 3 0 The  group, which was t y p i c a l l y w h i t e ,  single, Protestant  c o l l e g e students, p r i m a r i l y f e l t t h a t t h e a b o r t i o n had had a p o s i t i v e e f f e c t on t h e i r l i v e s . A d v e r s e p s y c h o l o g i c a l symp-  29joan M. Rogers and D a v i d W. Adams, " T h e r a p e u t i c A b o r t i o n : A M u l t i d i s c i p l i n e d Approach t o P a t i e n t Care f r o m a S o c i a l Work P e r s p e c t i v e , " C a n a d i a n J o u r n a l o f P u b l i c H e a l t h , 64:3 (May-June, 1 9 7 3 ) , 257. 3°Elizabeth M. S m i t h , "A F o l l o w - u p S t u d y o f Women Who Request A b o r t i o n , " A m e r i c a n J o u r n a l o f O r t h o p s y c h i a t r y , 43:4 ( J u l y , 1 9 7 3 ) , 5 7 6 .  19 toms were e x p e r i e n c e d "by o n l y a s m a l l number o f women and were u s u a l l y s e l f - l i m i t i n g . Most o f t h e women remained s e x u a l l y a c t i v e a f t e r t h e e x p e r i e n c e , and t h e m a j o r i t y o f t h e s e were u s i n g r e l i a b l e c o n t r a c e p t i o n a t t h e time o f f o l l o w - u p . Of t h e women i n t h i s s t u d y , a l m o s t h a l f (44p e r c e n t ) h a d s e p a r a t e d from t h e s e x u a l p a r t n e r a f t e r t h e a b o r t i o n , and 13 p e r c e n t had m a r r i e d t h e p a r t n e r . The a u t h o r o f t h e s t u d y c o n c l u d e s t h a t t h e r e i s a need f o r f u r t h e r s y s t e m a t i c s t u d i e s o f a b o r t i o n and development o f methods o f p r e d i c t i n g women who a r e a t r i s k f o r p o s t - a b o r t i o n r e a c t i o n and subsequent unwanted p r e g n a n c i e s . 31 Monsour and S t e w a r t twenty  (1973) conducted a s t u d y o f  c o l l e g e women t o a s s e s s "the consequences o f a b o r t i o n  as seen i n changes i n s e l f - p e r c e p t i o n , a l t e r a t i o n s i n s e x u a l f e e l i n g s and b e h a v i o r , and m o d i f i c a t i o n s o f a t t i t u d e s  toward  c h l l d b e a r i n g and c h i l d r e n . " 3 2 The average time i n t e r v a l  until  f o l l o w - u p was seven and o n e - h a l f months. A l l o f t h e s u b j e c t s were s i n g l e . The a u t h o r s i n d i c a t e t h a t c o l l e g e y e a r s a r e a p e r i o d o f p s y c h o s o c i a l development, and so, f o r t h e s e women, " t h e t r a n s i e n c e o f t h e s e r e l a t i o n s h i p s and d i s i n t e r e s t i n t h e i r c o n t i n u a n c e were i m p o r t a n t f a c t o r s i n c h o o s i n g abortion."33  3 1  S m l t h , p. 5 8 5 .  3 % a r e m J . Monsour and B a r b a r a S t e w a r t , " A b o r t i o n and S e x u a l B e h a v i o r i n C o l l e g e Women," A m e r i c a n J o u r n a l o f O r t h o p s y c h i a t r y . 4 3 : 5 ( O c t o b e r , 1 9 7 3 ) , 80c~ 33Monsour, p. 808.  20 Most women I n t h e s t u d y f e l t t h a t the p e r i o d o f pregnancy was more s t r e s s f u l i n p e r s o n a l terms t h a n t h e a b o r t i o n i t s e l f . However, f o r one woman, t h e a b o r t i o n was most s t r e s s f u l , s i n c e she f e l t a c c u s e d i n t h e eyes o f t h e n u r s e s and d o c t o r s who made d e r o g a t o r y remarks about h e r a l l e g e d s e x u a l p r o m i s c u i t y and c h o i c e o f a b o r t i o n . 3 ^ Regarding  t h e use o r non-use o f c o n t r a c e p t i o n , t h e  a u t h o r s d e s c r i b e what was a common p a t t e r n w i t h t h e s e young women: a " c o n s p i r a c y o f s i l e n c e " d e v e l o p s  i n f a m i l i e s when  human s e x u a l i t y i s a f o r b i d d e n s u b j e c t . The d a u g h t e r s l e a r n e d "to  become ' p a r t n e r s * i n m a i n t a i n i n g a f a m i l y atmosphere o f  s e c r e c y about s e x u a l  behavior.  In c o l l e g e , a s r e l a t i o n s h i p s w i t h men become I n c r e a s i n g l y i m p o r t a n t t o them, t h e s e women a p p e a r t o c o n t i n u e t o keep t h e " s e c r e t " o f t h e i r s e x u a l b e h a v i o r f r o m themselves. They behave.towards t h e n s e l v e s a s t h e i r p a r e n t s behaved towards them. They p r e s e r v e t h e "cons p i r a c y o f s i l e n c e , " o f n o t "knowing" about t h e i r own sexual behavior.3° The a u t h o r s conclude  t h a t g r e a t e r openness about s e x u a l i t y ,  l e a d i n g t o p e r s o n a l and e m o t i o n a l knowledge and awareness, i s more I m p o r t a n t "than most o f t h e e d u c a t i o n a l and i n f o r m a t i o n a l programs now b e i n g u s e d i n h i g h s c h o o l s and colleges."37 The  study f o u n d t h e m a j o r r e a c t i o n t o t h e a b o r t i o n  i t s e l f was r e l i e f . No untoward e f f e c t s were  observed  34Monsour, p. 809.  35Monsour, p. 812.  36Monsour, p. 812.  37Monsour, p. 813.  21 on p e r s o n a l a t t i t u d e s t o motherhood, c h l l d b e a r i n g , o r  their  b o d i e s . "The m a j o r e f f e c t on t h e i r s e x u a l a t t i t u d e s and b e h a v i o r was  to i n c r e a s e t h e i r sense o f f u t u r e c a u t i o n  acceptance of p e r s o n a l r e s p o n s i b i l i t y f o r t h e i r  and  own  behavior."38 NURSING PERSPECTIVES ON ABORTION L i t t l e has been w r i t t e n by n u r s e s  Involved with  women h a v i n g a b o r t i o n s when compared t o the s t u d i e s and r e p o r t s done by p h y s i c i a n s and s o c i a l w o r k e r s . appearing on one  Articles  i n the n u r s i n g l i t e r a t u r e a r e o f t e n a defence  s i d e o r t h e o t h e r o f "the a b o r t i o n i s s u e " i n m o r a l  terms.39 R e c e n t l y , n u r s e s have begun t o d e s c r i b e  their  e x p e r i e n c e s w i t h women i n d i f f e r e n t a b o r t i o n f a c i l i t i e s . Danon (1973) d e s c r i b e s h e r work w i t h t h r e e p h y s i c i a n s i n c r e a t i n g an a b o r t i o n s e r v i c e i n J e r s e y C i t y . I n t h i s s i t u a t i o n , the n u r s e was p l a c e d i n the r o l e o f c o u n s e l l o r , and "when h i r i n g , we  nurse-  sought a n u r s e who  could  respond warmly and e a s i l y t o the p a t i e n t on a woman-towoman b a s i s . " ^  3 Monsour, p. 8  813.  3 W f o r example, P a u l E h r l i c h and J o h n P. H o l d r e n , " A b o r t i o n and M o r a l i t y , " C a n a d i a n N u r s e , 68:6 (June, 1 9 7 2 ) , 37; and R.E. G r o v e s . " I s A b o r t i o n M u r d e r ? " N u r s i n g Times, 68:20 (May 18, 1 9 7 2 ) , 6 2 4 - 6 2 5 . ^°Ardis H y l a n d Danon, " O r g a n i z i n g an A b o r t i o n S e r v i c e , " N u r s i n g O u t l o o k , 21:7 ( J u l y , 1 9 7 3 ) , 5^2.  22 Some f i n d i n g s o f t h i s c l i n i c e x p e r i e n c e  were t h a t  women h a v i n g a b o r t i o n s undergo t h e u s u a l a n x i e t y f e l t  before  a s u r g i c a l p r o c e d u r e and t h a t women o f t e n f e e l q u i t e  "alone"  when h a v i n g an a b o r t i o n . I t was n o t i c e d t h a t e m o t i o n a l "far  exceeding  support  a n y t h i n g we c o u l d p r o v i d e " was g i v e n by t h e  women t o each o t h e r i n t h e w a i t i n g room.^-*The group method was f o u n d u s e f u l a t t h i s  clinic  f o r p r e p a r i n g t h e women and a l l a y i n g some f e a r s p r e o p e r a t i v e l y as w e l l a s f o r conducting  i n f o r m a l , open e d u c a t i o n a l  sessions  b e f o r e t h e women l e f t t h e c l i n i c . A n o t h e r program w h i c h emphasizes t h e r o l e o f n u r s e c o u n s e l l o r i s f o u n d i n B e l l e v u e H o s p i t a l , New Y o r k C i t y . A t t h i s c l i n i c , the goal I s " t o create a comfortable  atmos-  phere where t h e p a t i e n t s f e e l f r e e t o i n t e r a c t w i t h each o t h e r a n d w i t h t h e n u r s e i n an open exchange o f i d e a s . " * * Contraceptive  2  teaching i s s t r e s s e d , as i s d i s c u s s i o n o f  s e x u a l i t y . The a u t h o r s o f t h i s r e p o r t  conclude:  The c o m b i n a t i o n o f m e d i c a l knowledge, s o c i a l awaren e s s , and f e m i n i n e u n d e r s t a n d i n g a l l o w s t h e p r o f e s s i o n a l n u r s e t o be t h e n a t u r a l p e r s o n t o whom t h e a b o r t i o n p a t i e n t w i l l r e l a t e . We s t r o n g l y f e e l t h a t t h e n u r s e has a unique c o n t r i b u t i o n t o make I n t h e t o t a l c a r e o f these women.43  ^ D a n o n , p. 4 6 3 . 42chri s t a K e l l e r a n d Pamela C o p e l a n d , " C o u n s e l l i n g the A b o r t i o n P a t i e n t i s More Than T a l k , " A m e r i c a n J o u r n a l of N u r s i n g . 72:1 ( J a n u a r y , 1 9 7 2 ) , 104. ^ K e l l e r , p. 1 0 6 .  23 1  The  SUMMARY  l i t e r a t u r e reviewed  i n t h i s c h a p t e r has shown  t h a t f o r t h e most p a r t women e x p e r i e n c i n g e a r l y a b o r t i o n s do n o t d e v e l o p s e r i o u s m e d i c a l  c o m p l i c a t i o n s ^ t h a t t h e y do  n o t s u f f e r f r o m p s y c h i a t r i c c o n d i t i o n s o f extreme g u i l t o r severe d e p r e s s i o n ; t h a t they do, however, a p p r e c i a t e emotional  s u p p o r t and t h e o p p o r t u n i t y t o e x p l o r e  f e e l i n g s ; t h a t they e x p e r i e n c e  their  the usual anxiety before  sur-  g i c a l p r o c e d u r e , which i s r e d u c e d by e x p l a n a t i o n o f what w i l l o c c u r ; and t h a t they a r e i n t e r e s t e d i n l e a r n i n g how t o t a k e more r e s p o n s i b l e care o f t h e i r  bodies.  The g r e a t e r p a r t o f r e s e a r c h done o n women's needs a f t e r an a b o r t i o n has had a p a t h o l o g i c a l f o c u s : t h e r e has been a s e a r c h f o r t h e u n u s u a l .  Only r e c e n t l y have s t u d i e s  begun t o d e s c r i b e what t h i s e x p e r i e n c e  has meant t o t h e  woman's o n g o i n g l i f e , and whether i t has h a d a s i g n i f i c a n t e f f e c t on h e r f a m i l y r e l a t i o n s h i p s , h e r f e e l i n g s about h e r s e l f , h e r m o t i v a t i o n f o r e f f e c t i v e c o n t r a c e p t i o n , and h e r i d e a s about c h i l d r e a r i n g and m o t h e r i n g . The  r e s e a r c h e r was i n t e r e s t e d i n e x p l o r i n g these  i d e a s f u r t h e r , t o add t o n u r s i n g knowledge on t h e c a r e o f women u n d e r g o i n g a b o r t i o n . N u r s i n g  i s i n an i d e a l p o s i t i o n  t o be i n r e l a t i o n s h i p w i t h women who may have needs r e g a r d i n g t h e i r a b o r t i o n , because n u r s i n g a l l o w s f o r many d i f f e r e n t f o c u s e s . The home, h o s p i t a l , and w i d e r community a r e a l l  p l a c e s where n u r s i n g knowledge about women h a v i n g a b o r t i o n can be u t i l i z e d . By s t u d y i n g how d i f f e r e n t unsettling  women adapt t o t h i s  l i f e e v e n t , n u r s i n g can b e t t e r u n d e r s t a n d t h e  dynamic i n f l u e n c e s which o p e r a t e  i nthis situation.  t h i s knowledge, n u r s i n g i n t e r v e n t i o n c a n be p l a n n e d , a p p r o p r i a t e , and o p e r a t i v e i n t h e p r e v e n t i v e  stages.  With  Chapter 3 METHODOLOGY The  r e s e a r c h p r o j e c t was p l a n n e d t o i n t e r v i e w _ women,  s c h e d u l e d f o r an a b o r t i o n , about t h e i r e x p r e s s e d needs by u t i l i z i n g an open-ended i n t e r v i e w f o r m a t . The t a r g e t p o p u l a t i o n I n c l u d e d anyone who a p p l i e d f o r an a b o r t i o n a t e i t h e r o f t h e two r e f e r r a l s o u r c e s d u r i n g t h e p e r i o d u n d e r study. The  study was c a r r i e d o u t i n a l a r g e C a n a d i a n  city  between A p r i l , 1 9 7 3 , and A p r i l , 1974. The m a j o r i t y o f women h a d t h e i r a b o r t i o n s on an o u t p a t i e n t b a s i s ( t w e l v e o u t of t w e n t y ) . The r e m a i n d e r were a d m i t t e d  overnight, not  because o f any d i f f e r e n c e i n l e n g t h o f g e s t a t i o n , b u t because o f crowded o p e r a t i n g - r o o m s c h e d u l e s on t h e o u t p a t i e n t department s l a t e . The women ranged i n age f r o m f o u r t e e n t o t h i r t y - s e v e n y e a r s , w i t h t h e g r e a t e r number ( t w e l v e ) n i n e t e e n and t w e n t y - e i g h t  between  years. DESIGN  The  s c a r c i t y o f n u r s i n g r e s e a r c h on t h e s u b j e c t o f  women's needs a f t e r an a b o r t i o n meant t h a t t h e i n v e s t i g a t o r was n o t a b l e t o use an e x i s t i n g r e s e a r c h t o o l f o r t h i s e x p l o r a t i o n . S t u d i e s by o t h e r h e a l t h p r o f e s s i o n a l s u t i l i z e d t o o l s which were n o t s u i t e d t o t h i s p a r t i c u l a r t a s k . What d i d seem  25  26 s u i t a b l e f o r t h i s study was an e x p l o r a t o r y s t y l e o f r e s e a r c h , w i t h t h e r a t h e r b r o a d purpose o f g a t h e r i n g p r e l i m i n a r y  data,  and t r y i n g t o d e r i v e i n s i g h t s and p o s s i b l y i d e n t i f y hypot h e s e s amenable t o more f o r m a l  study.  The l o g i c a l s t r a t e g y o f e x p l o r a t o r y s t u d i e s c o n s i s t s of p r o v i d i n g a framework which may f a c i l i t a t e t h e p r o c e s s of a s k i n g p e r t i n e n t q u e s t i o n s i n t h e i n v e s t i g a t i o n o f a phenomenon. The p r o c e s s o f d i s c o v e r y . i s n o t a r t i c u l a t e d s u f f i c i e n t l y so t h a t a r e s e a r c h e r c a n f o l l o w a p r e s c r i b e d set o f r u l e s ; i n d e e d such a c r e a t i v e p r o c e s s does n o t n e c e s s a r i l y f o l l o w orderly r u l e s of l o g i c . 1 The  r e s e a r c h p r o j e c t , t h e n , made u s e o f an e x p l o r a t o r y ,  open-ended i n t e r v i e w d e s i g n  t o d e t e r m i n e t h e e x p r e s s e d needs  o f women h a v i n g a b o r t i o n s . T h i s d e s i g n was chosen f o r i t s f l e x i b i l i t y i n allowing e x p l o r a t i o n without r e s t r i c t i o n of a r e a s m e a n i n g f u l t o t h e women. The  same f o r m a t was u s e d on each o f t h r e e v i s i t s t o  each woman t o determine h e r needs r e l a t i n g t o t h e a b o r t i o n , as p e r c e i v e d a t t h r e e d i f f e r e n t t i m e s : b e f o r e  the operation,  two weeks f o l l o w i n g , a n d f o u r months f o l l o w i n g . The  i n i t i a l i n t e r v i e w was d e s i g n e d t o e x p l o r e  whether  t h e woman a n t i c i p a t e d any a r e a s o f need and what t h e y were. The  second i n t e r v i e w h a d t h e purpose o f l o o k i n g a t h e r  r e a c t i o n t o the operation, the h o s p i t a l experience, h e r r e l a t i o n s h i p w i t h h e r s e x u a l p a r t n e r , and h e r p l a n s contraception.  for  I n t h e f i n a l i n t e r v i e w , any changes i n f e e l i n g ,  T o n y A. T r i p o d i e t . a l . , S o c i a l Program E v a l u a t i o n , ( I t a s c a : Peacock P u b l i s h e r s , 1 9 7 1 ) , p. 4 5 . x  27 p e r c e p t i o n , o r need r e l a t i n g t o t h e a b o r t i o n were t o be discussed. The  r e v i e w o f t h e l i t e r a t u r e had s u g g e s t e d some o f  the a r e a s t o be e x p l o r e d : Information;  t h e need f o r c o n t r a c e p t i v e  t h e need t o speak o p e n l y about s e x u a l i t y ; t h e  need f o r e m o t i o n a l  support;  and t h e c o n c e r n about t h e o n g o i n g  r e l a t i o n s h i p w i t h t h e s e x u a l p a r t n e r . The i n v e s t i g a t o r added o t h e r a r e a s o f e x p l o r a t i o n concerned w i t h t e x p e c t a t i o n s I n r e l a t i o n to the a v a i l a b i l i t y of assistance; the l e g a l s i t u a t i o n ; the post-operative  experience;  and t h e woman's  f e e l i n g s about h e r s e l f . A l l o f t h e s e a r e a s were I n c l u d e d i n the I n t e r v i e w s where t h e y were a p p l i c a b l e . The  i n t e r v i e w was p r e - t e s t e d on f o u r women. A r e a s  f o r d i s c u s s i o n w h i c h were i n c l u d e d a f t e r t h e p r e - t e s t were: p r e v i o u s f e e l i n g s and t h o u g h t s r e g a r d i n g a b o r t i o n i n g e n e r a l ; method o f s e e k i n g h e l p ; c o n s i d e r a t i o n o f h a v i n g  t h e baby;  and t h e e f f e c t o f t h e d e c i s i o n t o have a n a b o r t i o n on t h e family  situation. PROCEDURE The  f o l l o w i n g s t e p s were t a k e n i n p l a n n i n g t h e s t u d y  a f t e r t h e i n i t i a l i d e a was f o r m u l a t e d . 1. V i s i t s were made t o d i f f e r e n t community  resource  p e o p l e t o a s s e s s whether t h i s was a v i a b l e r e s e a r c h t o p i c . 2.  The l i t e r a t u r e r e v i e w was begun.  3. P o t e n t i a l committee members were secured.  approached, and  28  4. A r e s e a r c h the committee  d e s i g n was drawn up and s u b m i t t e d t o  chairwoman.  5« F o l l o w i n g t h e committee's a p p r o v a l ,  an o u t l i n e  of the p r o p o s e d p r o j e c t was s u b m i t t e d t o t h e U n i v e r s i t y o f B r i t i s h Columbia H e a l t h Sciences Screening  Committee f o r  R e s e a r c h I n v o l v i n g Human S u b j e c t s . .6.  When a p p r o v a l  t h e two community  was g r a n t e d by t h e l a t t e r  Committee,  s e r v i c e s were approached: (a) d i s c u s s i o n  was c a r r i e d on w i t h a g y n e c o l o g i s t  and h i s n u r s e - r e c e p t i o n i s t ,  s t a t i n g t h e purpose o f t h e s t u d y and r e q u e s t i n g  t h e i r par-  t i c i p a t i o n ; they were w i l l i n g t o a s s i s t t h e r e s e a r c h e r , (b) D i s c u s s i o n was h e l d w i t h a women's h e a l t h e d u c a t i o n and r e f e r r a l group, s t a t i n g t h e purpose o f t h e s t u d y and t h e n a t u r e o f t h e i r p o s s i b l e a s s i s t a n c e . The group a g r e e d t o cooperate w i t h the p l a n . 7. Data c o l l e c t i o n began i n May, 1973, and was completed i n March, 1974. SAMPLE The sample was o b t a i n e d  by u s i n g a l l a v a i l a b l e  s u b j e c t s a s t h e y were r e f e r r e d f r o m t h e two s o u r c e s : t h e community-organized women's h e a l t h e d u c a t i o n a l and r e f e r r a l group and t h e p r i v a t e g y n e c o l o g i s t ' s  o f f i c e . These two  s o u r c e s were chosen w i t h t h e i n t e n t i o n o f o b t a i n i n g a s r e p r e s e n t a t i v e a sample a s p o s s i b l e . The r e s e a r c h e r  origin-  a l l y t h o u g h t t h a t t h e women's r e f e r r a l g r o u p , which does comprehensive f e m a l e h e a l t h t e a c h i n g and a b o r t i o n  referral,  2 9  would I n t r o d u c e h e r t o a younger p o p u l a t i o n , l e s s e s t a b l i s h e d i n permanent r e l a t i o n s h i p s , and t h a t t h e g y n e c o l o g i s t , who saw women r e f e r r e d by many g e n e r a l p r a c t i t i o n e r s , would p o s s i b l y be r e f e r r i n g women who were o l d e r and i n e s t a b l i s h e d family  situations. Both s o u r c e s were t o approach e v e r y woman who came  r e q u e s t i n g an a b o r t i o n , a s k i n g whether she would p a r t i c i p a t e i n t h e s t u d y . AIT those who i n d i c a t e d and m a i n t a i n e d an i n t e r e s t were i n c l u d e d i n t h e s t u d y . A l i m i t o f twenty women was d e c i d e d upon f o r two reasons: f i r s t ,  t h e time l i m i t o f t h e r e s e a r c h e r was a m a j o r  c o n s i d e r a t i o n ; and second, a group o f t h i s s i z e was c o n s i d e r e d ample f o r an e x p l o r a t o r y s t u d y . I t was r e c o g n i z e d t h a t s t a t i s t i c a l t e s t s would n o t a p p l y t o such a s m a l l group b u t that descriptive  i n f o r m a t i o n would r e s u l t . C o n t e n t a n a l y s i s  would be t h e p r i m a r y method o f e x a m i n i n g t h e d a t a . The  o n l y c r i t e r i o n f o r t h e study s u b j e c t s was t h a t  t h e a b o r t i o n was t o be p e r f o r m e d by e i t h e r t h e d i l a t i o n a n d c u r e t t a g e o r t h e vacuum a s p i r a t i o n method. B o t h r e f e r r a l s o u r c e s were aware o f t h i s c r i t e r i o n , a l t h o u g h one woman, a t f o u r t e e n weeks' g e s t a t i o n , and s c h e d u l e d f o r a s a l i n e i n d u c t i o n , was r e f e r r e d t o t h e r e s e a r c h e r . T h i s woman moved and was s u b s e q u e n t l y  l o s t t o f o l l o w - u p . T h e r e f o r e , i t was  d e c i d e d t o have a t o t a l a c t u a l sample o f n i n e t e e n women. The  sample was o b t a i n e d d u r i n g two d i f f e r e n t  time  i n t e r v a l s because o f t h e r e s e a r c h e r ' s p r i o r commitments. The f i r s t p a r t o f t h e sample ( n i n e women) was I n t e r v i e w e d f o r t h e  30 f i r s t and second t i m e s i n May and J u n e , 1973• The f o u r month f o l l o w - u p i n t e r v i e w s were done i n O c t o b e r , 1973. The remaining  t e n women were c o n t a c t e d i n O c t o b e r and November,  1973, and t h e i r f o l l o w - u p i n t e r v i e w s were i n March, 197^. As mentioned e a r l i e r , t h e women were c o n t a c t e d through  initially"  t h e s e r v i c e w h i c h t h e y had approached.  B o t h s e r v i c e s were g i v e n a s h o r t b r o c h u r e  to give t o the  i n t e r e s t e d women, s t a t i n g who the r e s e a r c h e r was, what she was d o i n g , and how t h e woman c o u l d h e l p . The two s e r v i c e s k e p t a l i s t o f women who had i n d i c a t e d i n t e r e s t ; t h e researcher c o l l e c t e d t h i s l i s t  t w i c e weekly by t e l e p h o n e .  The r e s e a r c h e r then c o n t a c t e d t h e woman by t e l e p h o n e , i d e n t i f i e d h e r s e l f , and made arrangements t o meet. The i n t e r views were h e l d i n a p l a c e chosen by t h e woman: h e r home, the r e s e a r c h e r ' s home, o r n e u t r a l t e r r i t o r y  ( f o r example, a  restaurant o r a u n i v e r s i t y lounge). Each i n t e r v i e w l a s t e d approximately  one hour. The i n t e r v i e w e r took n o t e s  the i n t e r v i e w , which were e l a b o r a t e d upon  during  immediately  f o l l o w i n g the i n t e r v i e w . Of t h e o r i g i n a l l i s t o f i n t e r e s t e d women which t h e r e s e a r c h e r o b t a i n e d f r o m t h e two s e r v i c e s ,  twenty-nine  c o n t a c t s were made b e f o r e n i n e t e e n women a g r e e d t o c o n t i n u e w i t h t h e study.: Some o f t h e s t a t e d r e a s o n s f o r n o t t a k i n g p a r t were: " S i n c e I went t o t h e d o c t o r , I have had my p e r i o d . " ?I  thought I had t o agree t o t h e i n t e r v i e w i n o r d e r  31 to get the a b o r t i o n . " " I j u s t want t o g e t i t o v e r w i t h and f o r g e t about It." "I'm  so u p s e t — m y p a r e n t s want me t o have t h e a b o r t i o n  and I don't want t o go t h r o u g h w i t h i t . I don't want t o t a l k t o anyone." (Aged l 6 y e a r s . ) The  researcher attempted t o d i s c u s s the l a t t e r three  r e a s o n s w i t h t h e women and a l l b u t two c o n t i n u e d tininterested.  t o be  A n o t h e r e i g h t women were u n r e a c h a b l e a t t h e  g i v e n a d d r e s s o r phone number. LIMITATIONS OF THE STUDY A m a j o r l i m i t a t i o n o f t h i s study was t h a t t h e sampling  was non-random, w i t h t h e r e s u l t  t h a t t h e sample  i s perhaps n o t r e p r e s e n t a t i v e o f t h e p o p u l a t i o n . Time p e r m i t t e d o n l y n i n e t e e n women t o be i n t e r v i e w e d , which i s a l i m i t a t i o n i n terms o f g a t h e r i n g a l a r g e body of data. The  r e l a t i v e l y u n s t r u c t u r e d i n t e r v i e w method meant  t h a t t h e women's r e c a l l a b i l i t y was depended upon t o e l u c i d a t e a r e a s o f need. However, I f t h i s was a l i m i t a t i o n i n i t i a l l y , i t seemed t o be compensated f o r by t h e two follow-up v i s i t s which allowed f o r mentioning p r e v i o u s l y omitted  areas.  32 CONCLUSION T h i s e x p l o r a t o r y s t u d y u t i l i z e d an u n s t r u c t u r e d , open-ended i n t e r v i e w on each o f t h r e e v i s i t s t o n i n e t e e n women t o g a t h e r i n f o r m a t i o n about t h e needs women  experienced  r e l a t e d t o h a v i n g an a b o r t i o n . The women were r e f e r r e d t o t h e p r o j e c t by (1) a l a y women's e d u c a t i o n a l and a b o r t i o n r e f e r r a l group, and (2) a g y n e c o l o g i s t . C a t e g o r i e s a r i s i n g f r o m t h e d a t a w i l l be u s e d t o describe the findings.  Chapter 4 FINDINGS AND DISCUSSION The women i n t h i s study were v i s i t e d t h r e e t i m e s so t h a t t h e i r needs r e l a t e d t o h a v i n g an a b o r t i o n c o u l d be e x p l o r e d . As t h e r e s e a r c h e r t a l k e d w i t h t h e s e women o f d i f f e r i n g age, i n t e r e s t , and a s p i r a t i o n , t h e s i g n i f i c a n c e of  t h i s e x p e r i e n c e t o t h e s e women became c l e a r e r : o f t e n , i n  the r e s o l u t i o n o f t h i s p r o b l e m a t i c e v e n t , m a j o r changes o c c u r r e d i n the l i f e e x p e r i e n c e o f t h e woman and t h e p e o p l e c l o s e s t to her. Consequently,  t h e needs e x p r e s s e d by t h e  women d i d n o t a l w a y s seem d i r e c t l y r e l a t e d t o t h e a b o r t i o n i t s e l f but rather t o t h e i r t o t a l  lives.  To d i s c u s s t h e i n f o r m a t i o n o b t a i n e d f r o m t h e i n t e r v i e w s , t h e r e s e a r c h e r has d e c i d e d t o p r e s e n t t h e m a t e r i a l which w i l l g i v e an o v e r a l l p r o f i l e o f t h e women i n t h e s t u d y and t h e n d e s c r i b e the e x p e r i e n c e t h e s e women r e l a t e d , b e g i n n i n g w i t h t h e i r s e x u a l a c t i v i t y and c o n t r a c e p t i v e p r a c t i c e s , and f o l l o w i n g t h r o u g h t o pregnancy and t h e d e c i s i o n to did  have an a b o r t i o n . What needs d i d t h e women have and what t h e y do about them? A f t e r t h e a b o r t i o n , what were t h e  s t a t e d a r e a s of need? D i d t h e s e change o v e r a f o u r month p e r i o d ? D i d new a r e a s emerge? What d i d t h e women d e s c r i b e as t h e i r ways o f d e a l i n g w i t h these?  33  34 PROFILE OF POPULATION The m a j o r i t y o f women i n t h i s s t u d y were s i n g l e , between n i n e t e e n and t w e n t y - e i g h t y e a r s o f age, and employed a t a j o b o u t s i d e t h e home. (TABLES I , I I , I I I . ) TABLE I M a r i t a l S t a t u s o f Women . . Having Abortions  Status . .  . . .  Number 3  Married  10  Single  6  Common-law  19  Total  TABLE I I Age D i s t r i b u t i o n o f Women Having A b o r t i o n s  Age i n Y e a r s  Number  14-18  6  19-23  4  24-28  7  29-33  0  34-38  2 Total  19  35 TABLE I I I O c c u p a t i o n o f Women Having A b o r t i o n s  Type Employed  Number. 10  High School Student  2  U n i v e r s i t y o r Community C o l l e g e Student  2  A t Home  5 Total  19  Most o f t h e r e l a t i o n s h i p s w i t h t h e p u t a t i v e  fathers  were l o n g - t e r m ; i n f a c t , t h e m a j o r i t y o f t h e women were l i v i n g with t h e i r sexual partners.  (TABLES I V , V.)  TABLE IV R e l a t i o n s h i p Between Women H a v i n g A b o r t i o n s and P u t a t i v e Fathers.  Relationship  .  . ..  Number  Husband  3  Common-law Husband  6  Fiance  1  Boyfriend  7  Casual Friend  1  Unknown  . . Total  1 19  37 TABLE V L i v i n g Arrangements o f Women Having A b o r t i o n s  Type  . .  Number 11  W i t h Husband o r B o y f r i e n d With Parents  4  With G i r l f r i e n d  1  Single Parent with C h i l d  1  Alone  .. Total .  .  2 19  38 A l l o f t h e women were w i t h i n t h e f i r s t  trimester of  pregnancy ( f i r s t t r i m e s t e r i s d e f i n e d a s t h e t w e l v e  weeks  s i n c e the l a s t m e n s t r u a l p e r i o d ) ; the m a j o r i t y h a d t h e a b o r t i o n on an o u t p a t i e n t b a s i s d u r i n g t h e e v e n i n g .  (TABLES  VI, VII.) TABLE V I L e n g t h o f Time S i n c e L a s t M e n s t r u a l of Women H a v i n g A b o r t i o n s '  Weeks  Period  Number  6 or less  6  7-12  13 Total  19  TABLE V I I H o s p i t a l i z a t i o n P a t t e r n o f Women Having A b o r t i o n s  Type Outpatient  Number 11  Overnight  7  Unknown  1 Total  19  39  T h i s was t h e f i r s t pregnancy f o r e l e v e n  of the  women. Of t h e e i g h t who had been p r e g n a n t b e f o r e , t h r e e had g i v e n a c h i l d up f o r a d o p t i o n a t b i r t h , and f o u r were c u r r e n t l y mothers l o o k i n g a f t e r  t h e i r c h i l d r e n . F o u r women  i n t h i s s t u d y h a d had an a b o r t i o n p r e v i o u s l y , t h r e e o f w h i c h were done l e g a l l y and one i l l e g a l l y  (this latter i n  1969).  The p r i v a t e g y n e c o l o g i s t was t h e r e f e r r a l s o u r c e f o r e l e v e n women, and t h e women's h e a l t h e d u c a t i o n and a b o r t i o n r e f e r r a l group was r e s p o n s i b l e f o r e i g h t . The number o f women seen a t each i n t e r v i e w i s shown i n TABLE V I I I . TABLE V I I I Timing of Interviews i n R e l a t i o n t o Abortion  Interview Pre-operative  Number  Interview  Two Week P o s t - o p e r a t i v e  19  Interview  F o u r Month P o s t - o p e r a t i v e  Interview  18 15  Total One woman, whose a b o r t i o n was u n s u c c e s s f u l , was v i s i t e d f o u r t i m e s , b r i n g i n g t h e a c t u a l t o t a l t o 53 i n t e r views. x  CONTRACEPTIVE USAGE S i x t e e n o f t h e n i n e t e e n women were u s i n g some f o r m of b i r t h c o n t r o l when they became p r e g n a n t . (TABLE I X . ) A l l b u t t h r e e o f t h e s e s i x t e e n were u s i n g a method w h i c h , by i t s e l f ,  c o u l d be c l a s s i f i e d a s u n r e l i a b l e .  2  TABLE I X Method o f B i r t h C o n t r o l P r i o r t o E x p e r i e n c i n g Unwanted Pregnancy "' ' Type Intrauterine  Device  —• Number 3  Condoms Foam Rhythm  3  Withdrawal  2  None  3 Total  ^ " R e l i a b l e " methods I n t h i s s t u d y i n c l u d e t h e p i l l , IUD, diaphragm and j e l l y , and condom w i t h foam. " U n r e l i a b l e " methods i n c l u d e rhythm, w i t h d r a w a l , condom, o r foam. F o r a r e p o r t o f t h e I n c i d e n c e o f c o n t r a c e p t i v e f a i l u r e , see Norman B. Ryder, " C o n t r a c e p t i v e F a i l u r e i n t h e U n i t e d S t a t e s F a m i l y P l a n n i n g P e r s p e c t i v e s , 5 : 3 (Summer, 1 9 7 3 ) , 133-1^2.  4l L o o k i n g a t age i n r e l a t i o n t o c h o i c e o f b i r t h c o n t r o l method y i e l d s some i n t e r e s t i n g i n s i g h t s . F o r i n s t a n c e , o f the s i x youngest women (between the ages o f 14 and 1 8 ) , f o u r were u s i n g condoms ( a l t h o u g h n o t r e g u l a r l y ) and had begun t h e i r s e x u a l a c t i v i t y o n l y r e c e n t l y ( t h r e e w i t h i n two months and t h e f o u r t h f i v e months p r e v i o u s l y ) . T h i s c o m p r i s e d the t o t a l number who had chosen t o use condoms. (It  i s perhaps more a c c u r a t e t o say t h a t condoms were used  by, and p r o b a b l y  chosen by, t h e male. Thus, w h i l e condoms  were u s e d , i t i s n o t assumed t h a t these young women were in  fact taking responsibility f o r their  use.)  E x p l o r a t i o n o f t h e women's f e e l i n g s i n r e l a t i o n t o t h e i r sexual experience  showed t h a t s e v e r a l i n t h i s young  age group d i d n o t p a r t i c u l a r l y enjoy s e x u a l a c t i v i t y . Three mentioned t h a t they f e l t p r e s s u r e f r o m t h e i r b o y f r i e n d s to  p a r t i c i p a t e , p a r t i c u l a r l y i f t h e f r i e n d s h i p was t o  c o n t i n u e . Thus, f e e l i n g s o f i n s e c u r i t y i n t h e r e l a t i o n s h i p were e x p r e s s e d ,  a s w e l l a s some resentment t h a t t h e y were  "caught" (by p r e g n a n c y ) .  One woman s a i d t h a t she p r e f e r r e d  condoms because by t a k i n g t h e p i l l ,  she "would be a d m i t t i n g  what I am d o i n g " s e x u a l l y . The  o t h e r two i n t h i s age group were two o f t h e  t h r e e who were n o t , a t t h e time o f c o n c e p t i o n , u s i n g any b i r t h c o n t r o l ; however, b o t h o f these young women h a d a t one time been on t h e p i l l .  One h a d d i s c o n t i n u e d because she h a d  moved away from h e r b o y f r i e n d and had n o t a n t i c i p a t e d t h e need f o r c o n t i n u e d c o n t r a c e p t i o n . The o t h e r woman h a d g i v e n  4-2  b i r t h t o a c h i l d f i v e months p r e v i o u s l y , begun on the b i r t h control p i l l ,  developed uncomfortable  s i d e e f f e c t s , and had  been a d v i s e d by h e r p h y s i c i a n , t o "go o f f t h e p i l l and w a i t f o r your p e r i o d . Then come i n and see me  again.  M  These d a t a show t h a t t h e young women were n o t comp l e t e l y i g n o r a n t about t h e need f o r c o n t r a c e p t i o n , n o r were they u n f a m i l i a r w i t h a method w h i c h , p o t e n t i a l l y , i s r e l i a b l e . The a r e a t h a t seemed more d i f f i c u l t f o r them t o come t o terms w i t h surrounded all  t h e i r s e x u a l i t y . They d i d n o t  f e e l t h a t they had any c o n t r o l i n t h e i r s e x u a l e x p e r i e n c e .  They "gave i n , " because " I d i d n ' t want t o l o s e my boyf r i e n d . " The i n t e g r a t i o n o f t h e s p e c i f i c knowledge and p r a c t i c a l use o f b i r t h c o n t r o l w i t h t h e woman's s e x u a l i t y t o be an a r e a o f g r e a t need. T h i s s t a t e m e n t  seemed  seems t o a p p l y ,  I n g e n e r a l , t o many o f t h e women i n t h e s t u d y . O t h e r methods o f c o n t r a c e p t i o n were v a r i e d among t h e d i f f e r e n t age  groups.  What were some o f t h e m o t i v a t i o n s f o r o t h e r women's c h o i c e s o f b i r t h c o n t r o l ? One woman had been t r e a t e d f o r "hormonal p r o b l e m s " s e v e r a l y e a r s ago and had been t o l d by h e r p h y s i c i a n t h a t she was " p r o b a b l y i n f e r t i l e . "  That i n f o r -  mation, p l u s t h e r e g u l a r use o f foam, had s e r v e d h e r w e l l for  a two y e a r p e r i o d . Two o t h e r women had been u s i n g foam  by i t s e l f f o r s h o r t e r p e r i o d s o f t i m e , a s they had e x p e r i e n c e d s e r i o u s symptoms on t h e b i r t h c o n t r o l p i l l .  Two women  had managed w i t h the rhythm method f o r two y e a r s , and one u s e d w i t h d r a w a l w i t h s u c c e s s f o r t h e same l e n g t h o f t i m e .  43 A n o t h e r f o u r women had been on t h e p i l l  and h a d  e x p e r i e n c e d s i d e e f f e c t s r a n g i n g from p a i n f u l b r e a s t and a x i l l a r y lumps, c h r o n i c v a g i n a l i n f e c t i o n and d y s p a r u n i a , to  v i s u a l changes, d i z z i n e s s , and headaches. These women  were I n t h e p r o c e s s o f d e c i d i n g on an a l t e r n a t i v e c o n t r a c e p t i v e method, b u t e i t h e r were n o t f u l l y aware o f t h e a l t e r n a t i v e s o r were a f r a i d o r r e l u c t a n t t o t a k e t h e n e c e s s a r y s t e p s . They may have h a l f - h e a r t e d l y been u s i n g foam, w i t h d r a w a l , o r rhythm i n t h i s i n t e r v a l o f i n d e c i s i o n . The r e m a i n i n g t h r e e women had i n t r a u t e r i n e d e v i c e s in  p l a c e a t t h e time o f c o n c e p t i o n . One, a D a l k o n  shield,  had been i n s i t u f o r one y e a r . The o t h e r two, b o t h L i p p e s Loops, had been i n p l a c e f o r two and o n e - h a l f and s i x and one-half years r e s p e c t i v e l y . More women i n t h e o l d e r group have had some e x p e r i e n c e w i t h a r e l i a b l e method o f b i r t h c o n t r o l . However, t h e r e s t i l l remain a r e a s o f need c o n c e r n i n g a woman's c o n t r a c e p t i v e p r o t e c t i o n and h e r s e x u a l l i f e .  The d a t a c o n s i s t e n t l y  r e v e a l e d t h a t when a woman e x p e r i e n c e d some problem o r d i f f i c u l t y w i t h h e r b i r t h c o n t r o l method, she had l i t t l e or  no a c c e s s t o p a t i e n t and concerned  guidance  which  could  a s s i s t h e r I n s o r t i n g o u t h e r f e e l i n g s a n d p r e f e r e n c e s and In  making a d e c i s i o n . S e v e r a l women mentioned t h a t t h e y h a d n o t been  i n f o r m e d o f t h e p o s s i b i l i t y o f s i d e e f f e c t s from t h e p i l l . When symptoms d i d d e v e l o p , t h e s e women, n o t r e c o g n i z i n g t h e i r s i g n i f i c a n c e , f e l t r e l u c t a n t t o " b o t h e r " an " a l r e a d y busy  44 d o c t o r " w i t h a " s m a l l q u e s t i o n . " One  woman, who  d i d complain  t o h e r p h y s i c i a n about t r o u b l e s o m e s i d e e f f e c t s ,  was  told,  " Y o u ' l l have t o l e a r n to l i v e w i t h them." O t h e r women had been r e a s s u r e d by t h e i r o f the e f f e c t i v e n e s s o f foam u s e d a l o n e . Two mentioned t h a t t h e i r p h y s i c i a n s had  physicians  m a r r i e d women  i m p l i e d i t was  t h e y had a c h i l d , and would o n l y suggest foam f o r  time contracep-  tion. Some women, i n d i s c o v e r i n g t h e i r use o f an u n r e l i a b l e method, blamed t h e m s e l v e s , s a y i n g , " I s h o u l d have known b e t t e r , " o r " I f o n l y I had t r i e d t o f i n d a b e t t e r method," o r " I guess I d i d n ' t want t o admit to m y s e l f what I d o i n g and r e a l l y p l a n my  birth  was  control."  DECISION-MAKING PROCESS Once a woman s u s p e c t e d t h a t she was  pregnant,  she  had t o make a d e c i s i o n r e g a r d i n g the outcome. There was wide range of r e a c t i o n s to t h i s s i t u a t i o n .  Two  women had  p r e v i o u s l y been s t r o n g l y opposed to a b o r t i o n and had i t as " k i l l i n g ; " one  a  regarded  o t h e r p e r s o n had been opposed t o a b o r t i o n  u n t i l two y e a r s p r e v i o u s l y when she came t o b e l i e v e t h a t " a l l c h i l d r e n s h o u l d be wanted." Comments i n f a v o u r o f a b o r t i o n were v a r i e d : seen too many ' f o r c e d ' m a r r i a g e s end u n h a p p i l y " ; b e a r t o have a c h i l d and g i v e i t up";  "I  couldn't  "Women s h o u l d be  t o choose whether o r not t h e y want to keep a c h i l d " ; b e l i e v e i n a b o r t i o n on demand."  "I've  "I  able  45 Within  these d i f f e r i n g p h i l o s o p h i c a l frameworks,  women worked out  s o l u t i o n s t o t h e i r s i t u a t i o n s . Those  had p r e v i o u s l y opposed a b o r t i o n when i t happens to you and  you  the  who  stated that " I t i s d i f f e r e n t are n o t a b l e to keep the  child  (because you l a c k f i n a n c i a l r e s o u r c e s and a r e n o t s e t t l e d down)." The was  obviously  d i f f i c u l t d e c i s i o n t o have an  abortion  i n f l u e n c e d by a number of f a c t o r s ; some were e x p r e s s e d  i n such comments ass  "I'm  not ready y e t " ;  " I don't have  economic r e s o u r c e s t o s u p p o r t a c h i l d " ;  "I'm  t h e d i r e c t i o n o f my  i n a stable  s h i p w i t h a man  own  life";  "I'm  not  uncertain  the about  relation-  at present."  F o r .some women, the p r e s e n c e of one  o r more of  these  f a c t o r s seemed t o d i c t a t e the d e c i s i o n . A n o t h e r group of women, who  were i n s t a b l e r e l a t i o n s h i p s w i t h men,  previously discussed  had  what they would do i n t h i s e v e n t u a l i t y ;  f o r them, the p r e s e n t d e c i s i o n was  a r e a f f i r m a t i o n of  an  e a r l i e r agreement. F o u r women, who  were mothers, d i s c u s s e d  the  anxiety  t h e y e x p e r i e n c e d i n making the d e c i s i o n . Three were s i n g l e women, one had  of whom d e s c r i b e d  gone t h r o u g h to p r o v i d e  a g e r s . She  was  f o r h e r two  c h i l d r e n , now  r e l u c t a n t to a l t e r her c u r r e n t l y  s i t u a t i o n , e c o n o m i c a l l y and a new  i n some d e t a i l the s t r u g g l e  cope w i t h a pregnancy. The  teen-  stable  s o c i a l l y , w i t h the a d d i t i o n of  f a m i l y member. A n o t h e r s i n g l e mother was  h e a l t h problems h e r s e l f and  she  simply  experiencing  d i d n o t f e e l she  could  t h i r d s i n g l e p a r e n t would have  46 l i k e d t o keep t h e pregnancy,  b u t e c o n o m i c a l l y i t was a l l she  c o u l d manage t o keep h e r s e l f and a s i x y e a r o l d d a u g h t e r g o i n g . I f she had had male s u p p o r t i n h e r l i v i n g  situation,  she s a i d , t h a t would have made a g r e a t d i f f e r e n c e . The f o u r t h mother had had t o x e m i a d u r i n g a v e r y d i f f i c u l t pregnancy  w i t h h e r daughter  (now two and o n e - h a l f  y e a r s o l d ) . T h i s woman and h e r husband had c o n s i d e r e d a d o p t i n g i n t h e f u t u r e and now found t h e m s e l v e s  i n an awk-  ward s i t u a t i o n . The d e c i s i o n t o have t h e a b o r t i o n was made on the b a s i s o f t h e mother's h e a l t h and t h e t i m i n g o f t h e pregnancy.  B e f o r e h a v i n g a n o t h e r c h i l d , she wanted t o r e j o i n  t h e w o r l d o f g a i n f u l employment, h a v i n g g i v e n up an e n j o y a b l e career before the f i r s t c h i l d ' s b i r t h . Some f o u n d t h e s i t u a t i o n p a r t i c u l a r l y  distressing  because t h e y c o u l d n o t a c c e p t t h a t they were p r e g n a n t . One woman f e l t t h a t she had t r a n s g r e s s e d an i m p o r t a n t m o r a l l a w and f e a r e d excommunication  from h e r c h u r c h i f she spoke  w i t h h e r p r i e s t . A n o t h e r wanted t h e a b o r t i o n i m m e d i a t e l y and did  n o t want t o t h i n k about I t a s she was s t i l l  unsettled  f r o m t h e b i r t h o f a d a u g h t e r f i v e months p r e v i o u s l y .  While  t h e d a u g h t e r was g i v e n up a t b i r t h f o r a d o p t i o n , and t h e mother had a c c e p t e d t h e s i t u a t i o n i n t e l l e c t u a l l y , she s t i l l woke up i n t h e m i d d l e o f t h e n i g h t h e a r i n g h e r c h i l d c r y . Y e t a n o t h e r woman, who had f o r m e r l y been opposed t o a b o r t i o n , s a i d she s t i l l f e l t l i k e a c h i l d h e r s e l f and c o u l d n o t cope w i t h a baby a t t h i s p o i n t i n h e r l i f e . The women who had s e r i o u s l y c o n s i d e r e d k e e p i n g t h e  47 pregnancy  were t h e same ones who s a i d t h e y e x p e r i e n c e d t h e  g r e a t e s t d i f f i c u l t y i n making t h e d e c i s i o n t o have t h e a b o r t i o n . The o t h e r s , who had n e v e r c o n s i d e r e d k e e p i n g t h e c h i l d , seemed t o have somewhat l e s s d i f f i c u l t y i n a r r i v i n g a t the d e c i s i o n . . F i v e women s t a t e d t h a t they had had h e l p ( f r o m a husband o r b o y f r i e n d ) i n r e a c h i n g t h e d e c i s i o n ; t h e r e m a i n i n g f o u r t e e n made t h e d e c i s i o n on t h e i r own, a l t h o u g h f r e q u e n t l y s u p p o r t e d i n t h e i r d e c i s i o n by a f r i e n d o r r e l a t i v e once i t was made. C l e a r l y , t h e n , many o f t h e women examined t h i s s i t u a t i o n from  s e v e r a l a n g l e s b e f o r e making a d e c i s i o n . THE  SEARCH FOR HELP  By f o l l o w i n g t h e c o u r s e o f a c t i o n o f t h e s e women a f t e r t h e y s u s p e c t e d t h e i r pregnancy,  I t i s possible to  determine o t h e r a r e a s o f need. Three o f t h e women i n t h i s s t u d y h a d an o n g o i n g , t r u s t i n g r e l a t i o n s h i p w i t h a d o c t o r i n t h i s c i t y , and went d i r e c t l y t o t h e i r r e s p e c t i v e p h y s i c i a n s t o seek h e l p . Three were new t o t h e c i t y and were n o t e s t a b l i s h e d w i t h a p h y s i c i a n . O t h e r s were a f r a i d t h e i r d o c t o r would t e l l t h e i r p a r e n t s o r would r e f u s e because o f h i s b e l i e f s . S t i l l o t h e r s , on t h e b a s i s o f p a s t e x p e r i e n c e s w i t h the medical p r o f e s s i o n , f e l t unable o r u n w i l l i n g to approach a p h y s i c i a n . Most women, t h e n , d i d n o t have a p l a c e t o t u r n t o a t t h i s Important p o i n t i n t h e i r l i v e s . Many women d e s c r i b e d t h e complete  d e s p e r a t i o n and f e a r t h e y  48 experienced  a s t h e y t r i e d t o d e a l w i t h t h e f a c t o f an  unwanted pregnancy, n o t knowing where t o go f o r a s s i s t a n c e . They mentioned t h a t t h e h e a l t h care system does n o t o p e n l y p r o v i d e p o i n t s o f e n t r y f o r women i n such a s i t u a t i o n . One  young woman h a d t r i e d a v i n e g a r douche i n an  a t t e m p t t o a b o r t . No o t h e r r e p o r t s o f a t t e m p t s a t s e l f i n d u c e d a b o r t i o n s were g i v e n . Some women had t h e support  o f a husband o r f r i e n d  t o a s s i s t them i n t h e i r s e a r c h f o r h e l p . A g e n c i e s w h i c h were approached f o r h e l p i n c l u d e d t h e F a m i l y P l a n n i n g A s s o c i a t i o n (where t h e woman was t o l d , "You're a l i t t l e l a t e f o r u s . " ) , the C r i s i s C e n t r e , a Community. I n f o r m a t i o n S e r v i c e , a women's h e a l t h r e f e r r a l s e r v i c e , f r e e c l i n i c s , a s w e l l a s underground newspapers and t h e Y e l l o w Pages. Someone new t o t h e c i t y had approached t h e B r i t i s h C o l u m b i a M e d i c a l A s s o c i a t i o n f o r h e l p ; she d e s c r i b e d t o the r e s e a r c h e r h e r f r u s t r a t i o n i n having f i v e telephone  c a l l s before  t o make a t l e a s t  she r e c e i v e d any i n d i c a t i o n  o f p o s s i b l e a s s i s t a n c e . Most p e o p l e made two o r t h r e e c o n t a c t s w i t h d i f f e r e n t s e r v i c e s b e f o r e they r e c e i v e d t h e necessary  information.  C l e a r l y , when women needed i n f o r m a t i o n r e g a r d i n g t h e a v a i l a b i l i t y o f a b o r t i o n , t h e r e was no e a s i l y a c c e s s i b l e , w e l l - p u b l i c i z e d way o f o b t a i n i n g i t .  Rather,  t h e network  which l i n k e d t h e p e r s o n w i t h t h e needed r e s o u r c e was made up o f f r i e n d s , sometimes u n f a m i l i a r newspapers, and unknown people.  F o r many, t h i s " u n d e r c o v e r " q u a l i t y o f t h e e x p e r i e n c e  r e i n f o r c e d t h e shame they a l r e a d y f e l t . They were f o r c e d t o approach r e s o u r c e s which p r e v i o u s l y would have been o u t o f the q u e s t i o n due t o d i f f e r e n c e i n l i f e  style (for instance,  the underground newspaper o r t h e f r e e c l i n i c ) . Some m e n t i o n e d a s t i g m a they f e l t s i m p l y because they needed t o c a l l t h e C r i s i s C e n t r e o r an I n f o r m a t i o n C e n t r e and s t a t e a p r o b l e m . Only one woman s t a t e d t h a t what she wanted was an i m p e r s o n a l , e f f i c i e n t s e r v i c e . Many o t h e r s s a i d i t was d i f f i c u l t f o r them t o t a l k w i t h a complete s t r a n g e r about something so i m p o r t a n t t o t h e m s e l v e s ,  although they d i d  a p p r e c i a t e t h e h e l p g i v e n by t h e d i f f e r e n t s e r v i c e s i n r e f e r r i n g them t o a g y n e c o l o g i s t . Once a woman was i n s i d e t h e network o f a b o r t i o n r e f e r r a l , she f e l t r e l i e v e d and r e a s s u r e d , b u t i t d i d t a k e an e f f o r t t o d i s c o v e r t h a t network. IMPLICATIONS OF DECISION IN L I F E SITUATION The  i m p l i c a t i o n s i n t h e woman's f a m i l y l i f e o f t h i s  d e c i s i o n were e x p l o r e d t o determine  i f any r e l a t e d needs  a r o s e . A l l o f t h e s e x u a l p a r t n e r s e x c e p t f o r t h r e e were aware o f t h e pregnancy. Of those t h r e e , one was n o t t o l d because he s t i l l h a r b o u r e d a n o t h e r woman p r e g n a n t ;  g u i l t f e e l i n g s o v e r h a v i n g made  t h a t woman had been u n a b l e t o  o b t a i n an a b o r t i o n and had e x p e r i e n c e d problems i n r a i s i n g t h e c h i l d on h e r own. The p r e s e n t l y p r e g n a n t woman d i d n o t want t o upset h e r f r i e n d f u r t h e r , so she c a r r i e d o u t h e r p l a n s on h e r own.  50 A n o t h e r woman was n o t sure which o f two men was t h e f a t h e r , so she s a i d n o t h i n g t o e i t h e r man. The t h i r d woman had ended h e r r e l a t i o n s h i p w i t h t h e p u t a t i v e f a t h e r and saw no purpose b e i n g s e r v e d by i n f o r m i n g him o f t h i s e v e n t . The remaining support  s i x t e e n women r e c e i v e d d i f f e r i n g degrees o f  f r o m t h e men i n v o l v e d . I t i s worth r e m a r k i n g how o f t e n t h e young women,  whose f a m i l i e s were f o r t h e most p a r t n e a r by, d i d n o t share the experience  o r t h e p l a n s w i t h t h e i r f a m i l i e s . The most  commonly g i v e n r e a s o n f o r n o t t e l l i n g p a r e n t s was, " I t would h u r t them t o o much," o r "They c o u l d n ' t a c c e p t my d e c i s i o n . " S e v e r a l o f t h e s e women e x p l a i n e d t h a t s e x was n o t a s u b j e c t d i s c u s s e d w i t h i n t h e f a m i l y . A c o u p l e o f young women s a i d t h a t they wanted t o t a l k w i t h t h e i r mothers b u t d i d n o t know how t o b r i n g up t h e s u b j e c t . They mentioned t h e i r own f e e l i n g s o f awkwardness and embarrassment. These f i n d i n g s a r e s i m i l a r t o those o f Monsour and S t e w a r t who d e s c r i b e d a " c o n s p i r a c y o f s i l e n c e " i n f a m i l i e s where human sexuality i s a forbidden  subject.3  I n one s i t u a t i o n , t h e mother i n a d v e r t e n t l y d i s c o v e r e d t h a t h e r d a u g h t e r had had an a b o r t i o n . The i n i t i a l r e a c t i o n was  anger and dismay, w h i c h d i d n o t , however, l a s t l o n g ;  r a t h e r , t h e mother and d a u g h t e r began t a l k i n g t o g e t h e r more and  seemed t o r e a c h some new u n d e r s t a n d i n g s .  3see C h a p t e r 2, p. 2 0 .  However, even  51 though d i s c u s s i o n opened up, t h e d a u g h t e r s t i l l  could not  b r i n g h e r s e l f t o c o n f i d e i n h e r mother about h e r o n g o i n g b i r t h control plans. Of t h e t h r e e women who had p r e v i o u s l y g i v e n a c h i l d up f o r a d o p t i o n , one had e x p e r i e n c e d  a nightmarish  where, when p r e g n a n t t h a t t i m e , she had been k e p t a t home ("so t h a t t h e n e i g h b o u r s  situation indoors  won't see t h e d i s g r a c e , " )  and t h e n had been sent i n t o a l a r g e c i t y , a l o n e , f o r t h e d e l i v e r y . Only now, s i x y e a r s l a t e r , was h e r r e l a t i o n s h i p w i t h h e r f a m i l y d e v e l o p i n g w e l l , and she was r e l u c t a n t t o j e o p a r d i z e i t . A n o t h e r woman i n t h i s c a t e g o r y f e l t t h a t h e r p a r e n t s would u r g e h e r t o keep t h e c h i l d a s she i s now m a r r i e d . The t h i r d woman d i d n o t r e a l l y have any f a m i l y t o r e l a t e t o a s she had been r a i s e d a s a f o s t e r c h i l d i n many homes. Only r e c e n t l y had she had t h e o p p o r t u n i t y t o meet h e r n a t u r a l b r o t h e r s and s i s t e r s , and h a d c o n f i d e d i n a b r o t h e r who h a d s u p p o r t e d h e r d e c i s i o n . J u s t one woman i n t h e study who was a l r e a d y a mother chose t o t e l l h e r c h i l d about t h e a b o r t i o n . The s i x y e a r o l d r e a c t e d a n g r i l y and t e a r f u l l y ; t h e mother t r i e d t o g i v e h e r r e a s o n s a s t o why t h i s was n o t an a p p r o p r i a t e f o r another  time  baby.  G e n e r a l l y , t h e n , t h e woman d i s c u s s e d t h i s w i t h h e r b o y f r i e n d o r husband, and r e c e i v e d s u p p o r t  situation from  t h i s r e l a t i o n s h i p . F a m i l i e s ( e s p e c i a l l y o f y o u n g e r women) were seldom I n c l u d e d i n t h e event a t a l l , may  have d e s i r e d i t .  even i f t h e woman  There seemad. t o be so g r e a t an e x p e c t -  52 a t i o n o f c o r r e c t b e h a v i o u r w i t h i n f a m i l i e s t h a t t h e s e women f e l t i t impossible to discuss t h e i r  situations.  NEEDS FOR INFORMATION C o n c e r n i n g t h e Law Women s t a t e d t h a t t h e y needed knowledge r e g a r d i n g t h e l e g a l i t y o f a b o r t i o n . F o u r women thought t h a t they would have t o o b t a i n an i l l e g a l a b o r t i o n . Three were d i s t r e s s e d t o t h i n k t h e y would need t o prove t h e m s e l v e s m e n t a l l y order t o o b t a i n approval  i l l in  f o r an a b o r t i o n . A n o t h e r t h r e e  were f r i g h t e n e d t h a t they would be r e f u s e d f o r b e i n g underage. A l l o f t h e s e c o n c e r n s and o t h e r s r e l a t i n g t o r e s i d e n c y and payment were answered once t h e woman was I n t o u c h w i t h someone k n o w l e d g e a b l e about t h e a b o r t i o n p r o c e d u r e — w h e t h e r t h e g y n e c o l o g i s t , t h e women's r e f e r r a l s e r v i c e , o r t h e r e s e a r c h e r . W h i l e some women had adequate knowledge about t h e l e g a l s i t u a t i o n , o t h e r s mentioned t h a t t h e i r Ignorance o f the l a w gave r i s e t o overwhelming f e a r o f even c o n s i d e r i n g abortion. Concerning the H o s p i t a l Experience The  r e s e a r c h e r was i n t e r e s t e d i n knowing i f t h e women  had needs c o n c e r n i n g  t h e o p e r a t i o n i t s e l f . The a r e a s mentioned  were t y p i f i e d by such comments a s t h e s e :  " I don't know what  i s a c t u a l l y g o i n g t o happen d u r i n g t h e o p e r a t i o n " ;  "I've  h e a r d t h e r e a r e two ways o f d o i n g an e a r l y a b o r t i o n ; what i s the d i f f e r e n c e ? " "Why c a n ' t I e a t o r d r i n k on t h e day o f t h e  53 o p e r a t i o n ? " "I've n e v e r been: i n a h o s p i t a l and I'm a f r a i d because I don't know what t o e x p e c t . " When q u e s t i o n e d  by t h e r e s e a r c h e r , t h e m a j o r i t y  o f t h e women ( f o u r t e e n ) c o u l d e x p l a i n t h e b a s i c p r o c e d u r e o f t h e o p e r a t i o n . They had been p r e p a r e d  by t h e women's .  r e f e r r a l s e r v i c e o r by t h e g y n e c o l o g i s t . ( I n a d d i t i o n , one woman was a n u r s e . ) The r e s e a r c h e r answered any q u e s t i o n s and p r e p a r e d  those who d i d n o t seem t o u n d e r s t a n d t h e p r o -  cedure. Concerning Post-operative  Expectations  None o f t h e women e x p e c t e d any m a j o r p h y s i c a l problems o r c o m p l i c a t i o n s f o l l o w i n g t h e a b o r t i o n , two were t r u l y a f r a i d t h a t they might d i e d u r i n g The  although anaesthesia.  a n t i c i p a t e d minor problems were cramps, b l e e d i n g ,  f a t i g u e , hormonal changes, and i n f e c t i o n . The r e s e a r c h e r d i s c u s s e d p o s t - a b o r t i o n c a r e w i t h each o f t h e women, d e a l i n g w i t h , among o t h e r t o p i c s , h y g i e n e , resumption of sexual  hormonal changes, and  relations.  C o n c e r n i n g t h e p o s t - o p e r a t i v e p e r i o d , some women wanted t o know whether they would f e e l extreme g u i l t , r e g r e t , o r d e p r e s s i o n ; whether t h e r e l a t i o n s h i p w i t h t h e male p a r t n e r would undergo s e r i o u s change; o r whether t h e y would f e e l d i f f e r e n t l y about t h e m s e l v e s ( i n t h e sense, f o r i n s t a n c e , of "having a f r e s h s t a r t . " ) . W h i l e o n l y one woman s a i d she had no one (whether husband, b o y f r i e n d , g i r l f r i e n d , t h e r a p i s t , o r p s y c h i a t r i s t )  to  t a l k w i t h about h e r r e a c t i o n s t o t h i s e x p e r i e n c e , s e v e r a l  women mentioned t h e i r a p p r e c i a t i o n i n b e i n g a b l e t o s i t down w i t h t h e r e s e a r c h e r and r e f l e c t a l o u d on what t h e e x p e r i e n c e meant t o them. Concerning Future  Contraception  The f i r s t v i s i t  t o t h e women i n t h i s study i n c l u d e d  d i s c u s s i o n a t l e n g t h about b i r t h c o n t r o l p l a n s and s e x u a l e x p e c t a t i o n s . Of t h e n i n e t e e n women, s i x t e e n had d e c i d e d what method they wanted t o use. These were: Birth Control P i l l  6  I n t r a u t e r i n e Device  8  Diaphragm and J e l l y  1  Tubal L i g a t i o n  1  Unsure  3  O t h e r Needs The  women were asked t o d e s c r i b e any o t h e r a r e a s o f  need w h i c h t h e y h a d e x p e r i e n c e d . T o p i c s mentioned h e r e Included: (a) "We need more b i r t h c o n t r o l I n f o r m a t i o n i n schools.  M  (b) "We need more i n f o r m a t i o n , r e a d i l y  available,  r e g a r d i n g vasectomy and b i r t h c o n t r o l i n g e n e r a l . " (c) A s i n g l e woman mentioned h e r need f o r t r a n s p o r t a t i o n home f r o m t h e h o s p i t a l (she was v e r y p o o r and t h e h o s p i t a l d i d n o t a l l o w women t o l e a v e f r o m t h e e v e n i n g o u t p a t i e n t o p e r a t i o n unaccompanied). The women's h e a l t h  e d u c a t i o n and r e f e r r a l group p r o v i d e d  t h i s service f o r her.  (d) A n o t h e r s i n g l e woman mentioned h e r f e a r t h a t , unless  she had t h e o p e r a t i o n  i n t h e e v e n i n g , she would  m i s s work and be f i r e d f r o m h e r newly a c q u i r e d j o b . (e) An o l d e r woman (37 y e a r s ) w i t h two c h i l d r e n s t a t e d t h a t she f e l t a d i s c r i m i n a t o r y a t t i t u d e on t h e p a r t o f h e r d o c t o r , who s u b t l y i m p l i e d t h a t she s h o u l d have known b e t t e r than t o g e t p r e g n a n t (even though she had had an IUD i n p l a c e ) . She d e s c r i b e d r e l a t i n g to her observation  t h e i m p r e s s i o n she r e c e i v e d a s t h a t s o c i e t y seems t o s a n c t i o n  a b o r t i o n f o r t h e younger woman, a l l o w i n g h e r t o make a m i s t a k e , b u t i s n o t so generous w i t h t h e o l d e r , presumably more r e s p o n s i b l e woman. FIRST FOLLOW-UP V I S I T The two week p o s t - a b o r t i o n  follow-up  interview  f o c u s e d on t h e h o s p i t a l e x p e r i e n c e , t h e p h y s i c a l r e a c t i o n , b i r t h c o n t r o l implementation, the r e l a t i o n s h i p with the s e x u a l p a r t n e r , and g e n e r a l  f e e l i n g s £n r e s p o n s e t o a l l o f  this. Hospital Experience Regarding the h o s p i t a l experience, three o f the seven o v e r n i g h t  p a t i e n t s questioned the n e c e s s i t y of t h i s  e a r l y h o s p i t a l i z a t i o n . One woman s u g g e s t e d  t h a t t h i s time  might w e l l have been spent i n a group d i s c u s s i o n w i t h t h e n u r s e about b i r t h c o n t r o l .  56 The most f r e q u e n t c r i t i c i s m o f t h e h o s p i t a l e x p e r i e n c e (from e i g h t women) was t h a t I t wns " I m p e r s o n a l , " " f e l t l i k e a f a c t o r y , " and was r o u t i n e - o r i e n t e d . T h i s a t t i t u d e was summed up f o r one woman i n a remark she o v e r h e a r d j u s t b e f o r e she was g i v e n t h e a n a e s t h e t i c : one o f two o p e r a t i n g room n u r s e s a w a i t i n g t h e a r r i v a l o f t h e gynec o l o g i s t s a i d t o t h e o t h e r , " I sure don't l i k e b e i n g on t h e abortion run." The o n l y c o n t a c t t h a t t h e m a j o r i t y o f t h e women h a d w i t h a n u r s e was around t a s k - o r i e n t e d p r o c e d u r e s ; i t was an u n u s u a l s i t u a t i o n i n d e e d when a n u r s e s t o p p e d a t t h e b e d s i d e "just to t a l k . " Three women f e l t t h a t t h e y had been t r e a t e d w i t h c o n d e s c e n s i o n by n u r s e s who d i s p l a y e d a m o r a l i s t i c t o t h e p a t i e n t s . S e v e r a l p a t i e n t s mentioned  attitude  t h e i r bafflement  a t r e c e i v i n g such f e e l i n g s f r o m n u r s e s who were a p p r o x i m a t e l y t h e i r own age. C o n t r a s t e d w i t h t h i s was a sense o f unders t a n d i n g and s u p p o r t g i v e n by a c o u p l e o f o l d e r n u r s e s , w h i c h was warmly r e c e i v e d by t h e women i n v o l v e d . One  source o f e m o t i o n a l s u p p o r t f o r t h e women l a y  i n t a l k i n g w i t h o t h e r p a t i e n t s . Women r e l a t e d how t h e y s h a r e d s t o r i e s and a d v i c e i n t h e i r h o s p i t a l rooms. F r e q u e n t l y , o l d e r women assumed a s u p p o r t i v e r o l e w i t h younger,  apprehensive  women. N o n e t h e l e s s , such a s i t u a t i o n d i d n o t always o c c u r . One  woman s t a t e d t h a t when she went i n , none o f t h e a b o r t i o n  p a t i e n t s acknowledged  t h e reason f o r t h e i r presence i n the  h o s p i t a l . She would have p r e f e r r e d a more open atmosphere  57  so t h a t p a t i e n t s might f r e e l y d i s c u s s t h e i r  situation.  An o l d e r woman o b s e r v e d t h a t t h e younger p a t i e n t s seemed t o be t h e ones who wanted most t o t a l k , "as i f they had more w o r k i n g o u t t o do." The women who p r e f e r r e d n o t t o t a l k w i t h o t h e r s k e p t t o t h e m s e l v e s and r e a d . The  husband o f one woman d e s c r i b e d h i s f e e l i n g s w h i l e  w a i t i n g f o r h i s w i f e i n t h e h o s p i t a l s he s a i d he f e l t  "left  o u t " a t a time when he wanted t o be i n v o l v e d i n o r d e r t o r e a s s u r e and c o m f o r t . s i m i l a r emotional  He d e s c r i b e d h i m s e l f a s h a v i n g a  i n v o l v e m e n t a s an e x p e c t a n t  f a t h e r , and  wondered whether t h e r e was any way t h a t men c o u l d be g i v e n a more a c t i v e r o l e i n the h o s p i t a l when t h e i r w i v e s o r f r i e n d s were h a v i n g  abortions.  P h y s i c a l Response Most o f t h e p h y s i c a l r e a c t i o n s t o t h e a b o r t i o n were s e l f - l i m i t i n g and w i t h i n t h e "normal" c a t e g o r y . T h i s i n c l u d e d r e p o r t s o f some cramping, b l e e d i n g , and n a u s e a . One woman r e m a i n e d v e r y n a u s e a t e d and i t was d i s c o v e r e d , a f t e r two more months, t h a t h e r pregnancy had, terminated.  i n f a c t , n o t been  One woman r e q u i r e d t r e a t m e n t  for a pelvic  with  antibiotics  infection.  Contraception The  f o l l o w i n g t a b l e (TABLE X) shows t h e c o n t r a c e p t i v e  c h o i c e s a t t h e two week f o l l o w - u p .  58  TABLE X C o n t r a c e p t i v e C h o i c e s Two Weeks . Following Abortion  Method Birth Control  .  Number . .  Pill  9  I n t r a u t e r i n e Device  5  Diaphragm w i t h  1  Jelly  Condoms  1  Foam  1  None  1 Total  18  R e l a t i o n s h i p with Sexual  Partner  A t t h e t i m e o f t h e second i n t e r v i e w , e i g h t o f t h e women s a i d t h a t t h e y b e l i e v e d t h e i r s e x u a l f e e l i n g s towards t h e i r p a r t n e r h a d n o t changed, and t h a t they e x p e c t e d f u t u r e s e x u a l p r a c t i c e would n o t be n e g a t i v e l y by t h e a b o r t i o n  their  influenced  experience'.  Three women s t a t e d t h a t t h e y f e l t much c l o s e r t o t h e i r p a r t n e r now t h a n b e f o r e feeling  t h e a b o r t i o n , and r e l a t e d t h i s  t o h a v i n g s h a r e d an i m p o r t a n t d e c i s i o n . Two o f t h e s e  women mentioned t h a t , because o f t h i s e x p e r i e n c e ,  their  r e l a t i o n s h i p s had moved onto a deeper l e v e l o f u n d e r s t a n d i n g . Two women h a d d i s c o n t i n u e d w i t h t h e s e x u a l  partner  59 and f i v e e x p r e s s e d  v a r i o u s degrees o f anger, r e s e n t m e n t ,  and h o s t i l i t y towards t h e s e x u a l p a r t n e r w h i l e  continuing  i n t h e r e l a t i o n s h i p . S e v e r a l women made n o t e o f t h e f a c t  that  t h e i r p a r t n e r t r i e d t o be s u p p o r t i v e , "but i t j u s t d i d n ' t always come o f f . " I t was e v i d e n t l y d i f f i c u l t f o r t h e men t o know how t o be o f a s s i s t a n c e . F e e l i n g s Related t o the A b o r t i o n The  women d i s c u s s e d t h e i n f l u e n c e o f t h e a b o r t i o n  on t h e i r t o t a l l i v e s . F o r s e v e r a l , q u e s t i o n s o f independence and autonomy were r a i s e d when they were f a c e d w i t h s i t u a t i o n . A couple o f women mentioned t h a t t h e y  this  felt  " i m p o r t a n t " when they f o u n d o u t they were p r e g n a n t . One v e r y young p e r s o n s a i d t h a t she f e l t  " f o r c e d t o be o l d e r  t h a n I am," and t h a t she e x p e r i e n c e d  considerable  i n c o p i n g w i t h t h e p r e s s u r e which t h e s i t u a t i o n  difficulty generated.  Three women mentioned f e e l i n g d e p r e s s e d a f t e r t h e o p e r a t i o n . One m a r r i e d woman s a i d t h a t she h a d n o t wanted t o g e t o u t o f bed i n t h e morning and l a c k e d energy. She d e s c r i b e d h e r r e l a t i o n s h i p w i t h h e r husband a s "shaky," and s a i d t h a t w h i l e i n h o s p i t a l , she h a d n o t wanted t o t a l k w i t h anyone. She was f e e l i n g h o p e f u l now about l o o k i n g f o r a j o b , b e i n g p r e s e n t l y " s a t i a t e d w i t h t h e j o y s o f housework a f t e r solid  three  years." A n o t h e r woman f e l t t h e peak o f h e r d e p r e s s i o n  about  one week a f t e r t h e o p e r a t i o n , when she c r i e d a g r e a t d e a l ; t e l l i n g h e r b o y f r i e n d what was t r o u b l i n g h e r p r o v i d e d  some  60  emotional  relief.  The pressed  t h i r d woman who s t a t e d t h a t she had f e l t de-  s a i d she had n o t r e a l i z e d how "down" she had been  t h r o u g h o u t t h e pregnancy, u n t i l i t was o v e r and she began t o f e e l more e n e r g e t i c . Each o f t h e s e t h r e e women mentioned s p e c i f i c a l l y t h a t i t was h e l p f u l t o be a b l e t o t a l k t o an o u t s i d e r who, t h e y f e l t , would n o t be j u d g i n g them. A n o t h e r woman e x p r e s s e d f e e l i n g s o f s o r r o w t h a t t h e pregnancy was o v e r . She had e n j o y e d h e r m a t e r n a l f e e l i n g s , and was now t r y i n g t o r e - a d j u s t t o a non-pregnant s t a t e . Y e t a n o t h e r p e r s o n (who h a d had an IUD i n p l a c e a t the time o f c o n c e p t i o n ) s a i d t h a t i f she became p r e g n a n t a g a i n , she would attempt t o f i n d t h e economic  resources  which would e n a b l e h e r t o keep t h e c h i l d . She s t a t e d e m p h a t i c a l l y t h a t she would n o t choose t o e x p e r i e n c e abortion  an  again. A mother o f two t e e n a g e r s ,  d e s p i t e an i n t r a u t e r i n e d e v i c e  having h e r t h i r d a b o r t i o n ,  I n s i t u , s t a t e d t h a t she  f e l t c o m p e l l e d t o c o n s i d e r permanent b i r t h c o n t r o l , i n t h e f o r m o f a t u b a l l i g a t i o n . She was k n o w l e d g e a b l e about t h e p r o c e d u r e and had r a i s e d t h e q u e s t i o n w i t h h e r p h y s i c i a n a t h e r r e c e n t check-up. P l a n s f o r t h e o p e r a t i o n were underway. T h i s same woman r e l a t e d t o t h e r e s e a r c h e r an experience  she had had a t t h e time o f t h e second a b o r t i o n .  Because she had f o u n d t h e f i r s t so t r a u m a t i c ,  she had p o s t -  poned g o i n g t o h e r d o c t o r w i t h t h e n e x t pregnancy u n t i l I t was so l a t e t h a t s a l i n e a b o r t i o n was needed. " I f e l t  very  61 shaken a f t e r the s a l i n e ;  i t was a v e r y , v e r y u n p l e a s a n t  e x p e r i e n c e . Once i t was o v e r , I h e a r d one nurse say t o a n o t h e r , ' T h i s i s a good specimen;  l e t ' s keep i t . ' I f e l t  t h a t they were t a l k i n g about a p a r t o f me. I t was d e p r e s s i n g t o t h i n k about. E v e r y t h i n g was bad enough. That was t h e climax.  M  Thus, a t t h e tlmej o f t h e two week f o l l o w - u p i n t e r v i e w , t h e m a j o r i t y o f t h e women d i d n o t have  specific  knowledge needs. R a t h e r , t h e i r comments f o c u s e d  primarily  on t h e need f o r e m o t i o n a l s u p p o r t b o t h i n t h e h o s p i t a l and i n t h e i r own homes, as they coped w i t h t h i s a l t e r a t i o n i n their  lives. SECOND FOLLOW-UP V I S I T  F e e l i n g s I n Response t o t h i s  Event  A t t h e time o f t h e t h i r d v i s i t , a l l o f t h e women f e l t t h a t t h e d e c i s i o n t o have t h e a b o r t i o n h a d been t h e b e s t one, g i v e n t h e c i r c u m s t a n c e s ; however, s e v e r a l  said  they d i d n o t t h i n k they c o u l d make t h e same d e c i s i o n a g a i n . I t would s i m p l y be "too d i f f i c u l t . "  Some had s i n c e " f o r g o t t e n  about i t " o r " r e g a r d e d i t a s a dead i s s u e . " O t h e r s an overwhelming  sense o f r e l i e f  expressed  t h a t t h e y were n o t p r e g n a n t ,  r e a l i z i n g t h a t a t t h e time o f t h e I n t e r v i e w t h e y c o u l d have been s i x months p r e g n a n t . One woman had been making e n q u i r i e s about a d o p t i n g i n these i n t e r v e n i n g f o u r months. She d e s c r i b e d how d i f f i c u l t  i t was t o f i n d a worker i n an agency who would t a k e t h e time to l i s t e n t o h e r c o n c e r n s . M o s t l y , she f e l t , she was " g i v e n the run-around.". I n f a c t , she was n o t a b s o l u t e l y sure t h a t a d o p t i o n was a p a t h she wanted t o f o l l o w . H e r m a r r i a g e was e x p e r i e n c i n g unsure t i m e s , and she thought a g r e a t d e a l about r e t u r n i n g t o work. However, she f e l t s t r o n g l y t h a t the f r a g m e n t a t i o n o f s o c i a l s e r v i c e s (one p e r s o n t o t a l k t o regarding adoption; another f o r marriage c o u n s e l l i n g ; y e t a n o t h e r f o r r e a c t i o n s t o t h e a b o r t i o n ) made i t e x t r e m e l y d i f f i c u l t f o r h e r t o s t a t e h e r needs r e p e a t e d l y t o unknown people. A c o u p l e o f women s t a t e d t h a t they now f e l t more c o n f i d e n t i n t h e m s e l v e s . The e x p e r i e n c e o f b e i n g  pregnant  and n o t wanting a c h i l d seemed t o be a t u r n i n g p o i n t f o r some women. I t c o m p e l l e d them t o r e a l i z e t h a t t h e y d i d , i n f a c t , have some c o n t r o l o v e r t h e d i r e c t i o n o f t h e i r S e v e r a l p e o p l e mentioned  lives.  f e e l i n g s t r o n g e r now i n terms o f  a c t i n g on t h e i r own b e l i e f s . By r a i s i n g t h e q u e s t i o n o f motherhood a s a r e a l p o s s i b i l i t y , some o f t h e women had t o a r t i c u l a t e t o thems e l v e s , perhaps f o r t h e f i r s t t i m e , what e x p e c t a t i o n s t h e y had o f t h e m s e l v e s . I n d o i n g so, some women e x p e r i e n c e d a m a j o r r e o r g a n i z a t i o n i n l i f e s t y l e . S e v e r a l sought more m e a n i n g f u l work, two became engaged o r m a r r i e d , and a t l e a s t two ended l o n g term r e l a t i o n s h i p s . One woman d e s c r i b e d a change I n h e r s e l f - i m a g e t h i s way: "When you're  pregnant  and you r e a l i z e y o u c a n ' t keep t h e baby, i t k i n d o f k i l l s  63  t h e v i s i o n o f how t h i n g s s h o u l d be: t h a t i s , t h a t y o u g e t m a r r i e d and have c h i l d r e n . " All  b u t the woman who was a r r a n g i n g f o r a t u b a l  l i g a t i o n were s t i l l open t o the p o s s i b i l i t y o f someday h a v i n g a c h i l d , and l o o k e d f o r w a r d t o p r o v i d i n g for  adequately  a desired child.  S e x u a l i t y and R e l a t e d Needs One  woman had f e l t l i t t l e o r no s e x u a l d e s i r e d u r i n g  t h e s e f o u r months. She h a d had an i n t r a u t e r i n e d e v i c e i n p l a c e f o r two months, and had f o u n d t h e a s s o c i a t e d d i s comfort  and p a i n u n b e a r a b l e .  She was s u f f e r i n g from a p e l v i c  i n f e c t i o n a t t h e time o f t h e two week f o l l o w - u p , and had s i n c e had c y s t i t i s . She wondered i f a l l t h e p a i n she had e x p e r i e n c e d was "punishment" f o r h e r " s i n " a n d s p e c u l a t e d t h a t by n o t h a v i n g s e x u a l d e s i r e s , she was a t t e m p t i n g t o regain her " v i r g i n a l  self."  Two o t h e r women, s t i l l  i n stable relationships,  d e s c r i b e d changes i n t h e i r s e x u a l a c t i v i t y . One f o u n d  inter-  course p a i n f u l because o f l a c k o f l u b r i c a t i o n , and t h e o t h e r was  v e r y f r i g h t e n e d about becoming pregnant a g a i n . A theme r e p e a t e d by many women was t h a t they h a d  experienced  some change i n t h e i r f e e l i n g s about t h e i r  sex-  u a l i t y . G e n e r a l l y , t h e r e was more awareness shown i n t h i s , s e r i e s o f i n t e r v i e w s about a r e l a t i o n s h i p between s e x u a l i t y and c o n t r a c e p t i o n . I t appeared t o t h e r e s e a r c h e r t h a t many women had I n t e g r a t e d t h e need f o r b i r t h c o n t r o l i n t o  their  s e x u a l i t y and f e l t more c o m f o r t a b l e about t h a t a s p e c t o f t h e i r l i v e s . T h i s was p a r t i c u l a r l y e v i d e n t  i n t h e younger  women who i n i t i a l l y were b a r e l y w i l l i n g t o r e c o g n i z e t h e f a c t t h a t they were s e x u a l l y a c t i v e . A t t h e f o u r month Interview,  s e v e r a l o f them d i s p l a y e d c o n f i d e n c e  i n their  c h a n g i n g r o l e s w i t h t h e i r s e x u a l p a r t n e r s . They no l o n g e r seemed t o f e e l o b l i g e d t o p a r t i c i p a t e i n s e x u a l unless they too d e s i r e d the experience.  intercourse  Two a d m i t t e d t h a t  t h e y were p r e p a r e d t o l e t t h e i r b o y f r i e n d s go i f t h i s new s i t u a t i o n was n o t a c c e p t a b l e  t o them. S u r p r i s i n g l y , these  women s a i d , t h i s d i d n o t happen, b u t i n s t e a d more d i s c u s s i o n about a l l a s p e c t s o f t h e i r r e l a t i o n s h i p s d e v e l o p e d . Contraception This continuing r e s p o n s i b i l i t y f o r b i r t h c o n t r o l was shown i n t h e c o n t r a c e p t i v e  p r a c t i c e s a t t h e time o f  t h e t h i r d i n t e r v i e w . (TABLE X I . ) Three o f t h e women on t h e p i l l had h a d y e a s t i n f e c t i o n s s i n c e t h e a b o r t i o n . One woman had d e v e l o p e d  breast  lumps and was r e f e r r e d t o a s p e c i a l i s t f o r I n v e s t i g a t i o n . A s mentioned, one woman had had an IUD i n p l a c e f o r two months, b u t t h e u n b e a r a b l e p a i n n e c e s s i t a t e d  removal.  65  TABLE X I C o n t r a c e p t i v e P r a c t i c e s Pour Months Following Abortion . Type .  Number .  B i r t h Control P i l l  8  I n t r a u t e r i n e Device  4  Condoms  2  None  1  Unknown ( l o s t t o f o l l o w - u p )  ..  .  .  4  Total  19  O t h e r A r e a s o f E x p r e s s e d Need Two women a t t h i s t h i r d i n t e r v i e w seemed predomin a n t l y concerned about f i n d i n g employment. One s t a t e d she would l i k e a j o b where she c o u l d be w i t h women h a v i n g  abor-  t i o n s , so she c o u l d share what she l e a r n e d f r o m h e r own experience. F o u r women mentioned t h e i r need f o r more b i r t h cont r o l a l t e r n a t i v e s , a s they had e x p e r i e n c e d most r e l i a b l e methods ( p i l l ,  IUD).  importance and n e c e s s i t y o f h a v i n g  problems w i t h t h e  Seven women s t r e s s e d t h e contraceptive  information  e a s i l y a v a i l a b l e and a c c e s s i b l e . One  woman e x p r e s s e d a need f o r a d o p t i o n  information.  I n t h i s s t u d y , t e n women spoke o f t h e need f o r a combined a b o r t i o n and c o u n s e l l i n g s e r v i c e , p r e f e r a b l y l o c a t e d I n a separate  c l i n i c , away f r o m a h o s p i t a l . .Nurses  were f r e q u e n t l y mentioned as "being a p p r o p r i a t e p e o p l e f o r these women t o t u r n t o i f such a s e r v i c e e x i s t e d . A t p r e s e n t , a c c o r d i n g t o these women, n u r s e s i n t h e h o s p i t a l c o n s i s t e n t l y seem t o be o r i e n t e d towards e f f i c i e n c y r a t h e r t h a n towards t h e p a t i e n t , and c o n s e q u e n t l y were n o t v i e w e d as p o t e n t i a l c o u n s e l l o r s w i t h i n t h e h o s p i t a l . Most p e o p l e had n o t had e x p e r i e n c e w i t h a P u b l i c H e a l t h Nurse a n d were n o t aware o f t h e i r a v a i l a b i l i t y . Many women agreed t h a t n u r s e s w o r k i n g i n t h e community would be a v a l u a b l e r e s o u r c e i n terms o f p r e p a r a t i o n f o r t h e e x p e r i e n c e o f t h e a b o r t i o n i t s e l f and f o r f o l l o w - u p l a t e r . The women s t r e s s e d t h a t " u n d e r s t a n d i n g " was an i m p o r t a n t q u a l i t y f o r such n u r s e s t o p o s s e s s . SUMMARY In  t h i s s t u d y , t h e n , t h e i n i t i a l needs e x p r e s s e d  by t h e women i n t e r v i e w e d were f o r i n f o r m a t i o n c o n c e r n i n g v a r i o u s a s p e c t s o f t h e a b o r t i o n i t s e l f and f o r e m o t i o n a l s u p p o r t . The women showed I n t e r e s t i n l e a r n i n g a b o u t a s u i t a b l e b i r t h c o n t r o l method. A t t h e t i m e o f t h e second i n t e r v i e w , some women d i s c u s s e d t h e i r need f o r e m o t i o n a l s u p p o r t d u r i n g hosp i t a l i z a t i o n and l a t e r a t home. The f i n a l  i n t e r v i e w gave  t h e women t h e o p p o r t u n i t y t o v i e w t h e e x p e r i e n c e from a d i s t a n c e . Needs mentioned a t t h i s v i s i t h a d t o do w i t h changes e x p e r i e n c e d I n s e l f - i m a g e and i n e x p e c t a t i o n s  c o n c e r n i n g the f u t u r e . S u g g e s t i o n s were g i v e n f o r making the h o s p i t a l e x p e r i e n c e b e t t e r , o r even u n n e c e s s a r y providing better b i r t h control alternatives.  by  Chapter 5 CONCLUSION  The  purpose o f t h i s p a p e r was t o e x p l o r e t h e abor-  t i o n e x p e r i e n c e f r o m the woman's p o i n t o f view, t o d i s c o v e r any unmet needs. SUMMARY. The  g r e a t e r p a r t o f r e s e a r c h done on women's needs  a f t e r an a b o r t i o n h a s h a d a p a t h o l o g i c a l f o c u s . There has been a s e a r c h f o r t h e u n u s u a l . Only r e c e n t l y have s t u d i e s begun t o d e s c r i b e what t h i s e x p e r i e n c e h a s meant t o t h e woman's o n g o i n g l i f e , a n d whether i t h a s h a d a s i g n i f i c a n t e f f e c t on h e r f a m i l y r e l a t i o n s h i p s , h e r f e e l i n g s about h e r s e l f , h e r motivation f o r e f f e c t i v e c o n t r a c e p t i o n , and h e r i d e a s about c h i l d - r e a r i n g and m o t h e r i n g . The  r e s e a r c h e r was i n t e r e s t e d i n e x p l o r i n g t h e s e  Ideas f u r t h e r , t o add t o n u r s i n g knowledge on t h e c a r e o f women u n d e r g o i n g a b o r t i o n . By s t u d y i n g how d i f f e r e n t women adapt t o t h i s u n s e t t l i n g l i f e understand  event, n u r s i n g can b e t t e r  t h e dynamic i n f l u e n c e s which o p e r a t e  In this  sit-  u a t i o n . W i t h t h i s knowledge, n u r s i n g i n t e r v e n t i o n c a n be planned,  a p p r o p r i a t e , and o p e r a t i v e I n t h e p r e v e n t i v e The  stages.  study I n c l u d e d I n t e r v i e w s w i t h n i n e t e e n women a t  t h r e e d i f f e r e n t s t a g e s : b e f o r e t h e o p e r a t i o n , two weeks 68  6 9  f o l l o w i n g , and f o u r months a f t e r t h e o p e r a t i o n . A b a s i c a l l y unstructured,  open-ended i n t e r v i e w method was u s e d , a l l o w i n g  f o r e x p l o r a t i o n o f a r e a s i m p o r t a n t t o t h e women. R e f e r r a l s t o t h e study were made by (1) a l a y women's h e a l t h and a b o r t i o n r e f e r r a l group, and (2) a p r i v a t e The  education  gynecologist.  f i n d i n g s were d e s c r i b e d by u s i n g f r e q u e n c i e s  of cate-  g o r i e s a r i s i n g from the data. The r e s u l t s o f t h i s s t u d y s u g g e s t t h a t women h a v i n g a b o r t i o n s do e x p e r i e n c e unmet needs. I n i t i a l l y t h e s e needs r e v o l v e around t h e a v a i l a b i l i t y o f a b o r t i o n . O t h e r a r e a s o f need f o r many women a r e : p r e p a r a t i o n f o r t h e p h y s i c a l e x p e r i e n c e o f a b o r t i o n ; d i s c u s s i o n about what t h i s e x p e r i e n c e means t o them i n terms o f s e l f - p e r c e p t i o n and r e l a t i o n s h i p s w i t h o t h e r s ; d i s c u s s i o n about a v a i l a b l e b i r t h c o n t r o l  op-  t i o n s ; and d i s c u s s i o n o f s e x u a l i t y i n r e l a t i o n t o t h e s e v a r i o u s a r e a s . O t h e r needs d i s c u s s e d by some o f t h e women were: t h e need f o r a s t a b l e r e l a t i o n s h i p w i t h a man; t h e n e e d f o r improved economic c i r c u m s t a n c e s ;  and t h e need t o  share some o f t h e e m o t i o n a l a n d p s y c h o l o g i c a l a s p e c t s o f h a v i n g an a b o r t i o n w i t h a n o n - j u d g m e n t a l p e r s o n . The most f r e q u e n t l y mentioned area of need c e n t r e d on questions  about b i r t h c o n t r o l , i n p a r t i c u l a r , and s e x u a l i t y ,  i n g e n e r a l . The s t u d y s u g g e s t s t h a t , i n t h e e x p e r i e n c e o f many women h a v i n g a b o r t i o n s , these two needs a r e n o t seen as r e l a t e d ; t h a t i s , r e f u s i n g t o r e c o g n i z e  their sexuality,  t h e y p e r c e i v e no need f o r r e l i a b l e b i r t h c o n t r o l . Many young women e x p r e s s e d a d e s i r e t o share  their  experiences with t h e i r f a m i l i e s , but d i d not, l a c k i n g a  70 framework f o r d i s c u s s i n g s e x u a l i t y i n t h e i r homes. S e v e r a l women wondered about t h e f u t u r e o f t h e i r s e x u a l  relation-  s h i p s ; i n f a c t , some r e l a t i o n s h i p s ended a f t e r t h i s e x p e r i e n c e w h i l e o t h e r s d e v e l o p e d i n t o a deeper l e v e l o f understanding. The l a c k o f a v a i l a b i l i t y o f a b o r t i o n i n f o r m a t i o n was commonly c i t e d as i n c r e a s i n g t h e woman's f e e l i n g s o f f e a r and d e s p e r a t i o n . Some women e x p r e s s e d the decision-making  process  a need f o r h e l p i n  so t h a t they c o u l d  adequately  consider a l l the f a c t o r s involved. A t t h e two week f o l l o w - u p i n t e r v i e w , many women s a i d t h a t they would have a p p r e c i a t e d more o p p o r t u n i t i e s t o t a l k w i t h t h e h o s p i t a l n u r s e s who f r e q u e n t l y seemed busy and u n i n t e r e s t e d i n them. A g r e a t e r sense o f r e s p o n s i b i l i t y f o r s e x u a l i t y and c o n s e q u e n t l y  f o r b i r t h c o n t r o l was e v i d e n t  a t t h i s s e r i e s o f i n t e r v i e w s , i n t h e m a j o r i t y o f t h e women. A s e l f - l i m i t i n g d e p r e s s i o n was d e s c r i b e d by t h r e e women during this period. A t t h e time o f t h e t h i r d i n t e r v i e w , many o f t h e women d e s c r i b e d changes i n t h e i r s e x u a l r e l a t i o n s h i p s r e l a t e d t o t h e i r i n c r e a s e d f e e l i n g s o f c o n t r o l and d e t e r m i n a t i o n . The c o n s i s t e n c y between r e c o g n i t i o n o f s e x u a l i t y and u t i l i z a t i o n o f r e l i a b l e c o n t r a c e p t i o n was e v i d e n t i n t w e l v e o f t h e f i f t e e n women seen f o u r months l a t e r . Some women e x p r e s s e d  a need f o r e m o t i o n a l  support  i n their devel-  opment o f a new r o l e . A l a r g e number o f those  i n t e r v i e w e d ( t e n ) mentioned  the need f o r a combined a b o r t i o n and c o u n s e l l i n g c l i n i c , p r e f e r a b l y l o c a t e d apart from a l a r g e h o s p i t a l . The l a s t i n t e r v i e w r e v e a l e d t h a t a l l o f t h e women f e l t t h a t they had made t h e b e s t d e c i s i o n a t t h a t  time;  n e v e r t h e l e s s , s e v e r a l s a i d they c o u l d n o t go t h r o u g h w i t h an a b o r t i o n a g a i n . T h i s event was p r o f o u n d l y  d i s t u r b i n g to  them and t h e i r p h i l o s o p h i c a l b e l i e f s . T h i s a s p e c t o f t h e women's l i v e s does n o t g i v e r i s e t o a need o f t h e same  order  a s the o t h e r s ; r a t h e r , i t i s an a r e a t o be a p p r e c i a t e d and understood, b u t i t i s n o t s u b j e c t t o s p e c i f i c i n t e r v e n t i o n .  I n summary, t h e n , t h e main needs i d e n t i f i e d were: 1. t h e need f o r t h o r o u g h d i s c u s s i o n o f b i r t h c o n t r o l options coupled with d i s c u s s i o n o f s e x u a l i t y ; 2.  the need f o r r e a d i l y a v a i l a b l e i n f o r m a t i o n  regarding a l l aspects of a b o r t i o n ; 3. t h e need f o r a b o r t i o n c o u n s e l l i n g , i n c l u d i n g discussion of a l t e r n a t i v e s to abortion; 4.  t h e need f o r e m o t i o n a l  support  during  hospital-  i z a t i o n and, p o s s i b l y , a f t e r w a r d ; 5.  t h e need t o e x p l o r e t h e meaning o f t h i s event  i n the c o n t e x t o f t h e woman's l i f e i n terms o f e x p e c t a t i o n s o f s e l f and r e l a t i o n s h i p s w i t h o t h e r s .  72 IMPLICATIONS The  f i n d i n g s o f t h i s study s u g g e s t t h a t t h e r e a r e  s e v e r a l d i s c r e p a n c i e s b o t h i n t h e way i n w h i c h h e a l t h i s provided  care  i n an a r e a o f s p e c i a l c o n c e r n t o women, and i n  t h e way i n w h i c h women r e g a r d t h e i r own s e x u a l i t y . An  i m p l i c a t i o n of the f i r s t discrepancy  i s that the  p r e s e n t h e a l t h care system does n o t c o n s i s t e n t l y g i v e adequate c o n s i d e r a t i o n t o t h e needs o f women r e q u i r i n g an a b o r t i o n . T h i s statement i s s u p p o r t e d by t h e f a c t t h a t many women h a d t o make s e v e r a l c o n t a c t s b e f o r e  they obtained the  r e q u i r e d a s s i s t a n c e w i t h i n t h e h e a l t h care Another discrepancy  system.  i s obvious i n the l a c k of  emphasis on a n d a v a i l a b i l i t y o f p r e v e n t i v e  s e r v i c e s and  c o u n s e l l i n g . Women i n t h i s s t u d y o f t e n s t a t e d t h a t t h e y d i d n o t f e e l c o n f i d e n t about t h e i r b i r t h c o n t r o l p r a c t i c e s b u t t h e y "do n o t know what t o do about i t .  w  That I m p l i e s  that  h e a l t h c a r e p r o f e s s i o n a l s have n o t been i n s t r u m e n t a l i n ensuring  t h a t such s e r v i c e s a r e p r o v i d e d  time. Nursing,  a t an a p p r o p r i a t e  i n p a r t i c u l a r , s t a n d s i n an i d e a l p o s i t i o n  t o take an a c t i v e r o l e I n c h a n g i n g t h i s s i t u a t i o n . The r e l a t i o n s h i p s w h i c h n u r s e s have w i t h young p e o p l e i n s c h o o l s and women i n t h e community c o u l d w e l l be t h e f o u n d a t i o n s f o r b r i d g i n g an e x i s t i n g gap i n t h e d e l i v e r y o f h e a l t h  care  between t h e woman and t h e g y n e c o l o g i s t . Yet another discrepancy  i n t h e h e a l t h care  system,  w h i c h i s o s t e n s i b l y c o n c e r n e d about t h e h e a l t h o f a l l I t s  73 members, has t oflow i t h t h e way i n w h i c h women  experiencing  a b o r t i o n s i n a h o s p i t a l s e t t i n g a r e t r e a t e d . Many women mentioned, n o t t h a t they had been t r e a t e d c r u e l l y o r w i t h o b v i o u s p h y s i c a l n e g l e c t , b u t t h a t t h e y h a d n o t been r e g a r d e d as i n d i v i d u a l s . I n t h e p r o c e s s o f b e i n g h o s p i t a l i z e d t h e y f e l t t h a t they had become p a r t o f a huge system w h i c h o p e r a t e d by s c h e d u l e s and r u l e s and w h i c h d i d n o t seem t o c o n s i d e r them a s d i f f e r e n t women w i t h d i f f e r e n t needs and f e a r s . Thus, i n t e r a c t i o n w i t h t h e h e a l t h w o r k e r s was f o r malized  and o r i e n t e d towards a s p e c i f i c f u n c t i o n . Such  h o s p i t a l experience suggests that h e a l t h p r o f e s s i o n a l s a r e educated t o d e a l w i t h i l l n e s s o r pathology r a t h e r than w i t h i n d i v i d u a l s h a v i n g p a r t i c u l a r needs and p r o b l e m s . The i m p l i c a t i o n o f t h i s f o r a l l h e a l t h workers, but p a r t i c u l a r l y f o r n u r s e s , i s t h a t * l i k e o t h e r p a t i e n t s , t h e woman who i s h a v i n g an a b o r t i o n a p p r e c i a t e s  being t r e a t e d as a t h i n k i n g  and f e e l i n g b e i n g who wants t o be c o n s u l t e d about what i s b e i n g done t o h e r and i n v o l v e d more d i r e c t l y i n h e r own care. The  l a c k o f i n t e g r a t i o n between s e x u a l i t y and c o n t r a -  c e p t i o n i m p l i e s t h a t h e a l t h w o r k e r s have n o t done enough comprehensive t e a c h i n g .  Some e f f o r t has i n d e e d been made  t o d i s p e n s e a d v i c e and i n f o r m a t i o n about b i r t h c o n t r o l , b u t t h a t does n o t seem t o be enough. An i m p l i c a t i o n o f t h e s e f i n d i n g s i s t h a t h e a l t h w o r k e r s must u n d e r s t a n d human sexu a l i t y , and must f e e l c o m f o r t a b l e i n o p e n l y i n i t i a t i n g c u s s i o n about t h i s a s p e c t o f l i v i n g .  dis-  74  RECOMMENDATIONS The  i m p l i c a t i o n s o f t h i s study suggest s e v e r a l  recommendations f o r change: 1. A c c e s s t o a b o r t i o n  s e r v i c e s and c o u n s e l l i n g  should  be made more r e a d i l y a v a i l a b l e by e s t a b l i s h i n g a network t o c a r r y t h i s o u t . E x i s t i n g s e r v i c e s , such a s t h o s e o f t h e women's h e a l t h e d u c a t i o n and a b o r t i o n r e f e r r a l g r o u p , s h o u l d be  s t r e n g t h e n e d t o e n a b l e them t o f u n c t i o n w i t h i n a b r o a d e r  community. 2.  H e a l t h p r o f e s s i o n a l s must r e c o g n i z e  as a p r i o r i t y t h e p r e v e n t i v e  and e s t a b l i s h  aspects of contraception  combined w i t h d i s c u s s i o n o f s e x u a l i t y . I n t h i s way, more m e a n i n g f u l i n t e g r a t i o n o f t h e whole e x p e r i e n c e o f s e x u a l i t y w i t h i n t h e woman's l i f e  i s encouraged. N u r s e s w o r k i n g i n  t h e community s h o u l d t r y , whenever p o s s i b l e , t o f a c i l i t a t e d i s c u s s i o n between young p e o p l e and t h e i r p a r e n t s about human s e x u a l i t y . 3. N u r s e s s h o u l d r e c o g n i z e  t h e p o t e n t i a l psycho-  s o c i a l d i f f i c u l t i e s e x p e r i e n c e d by women h a v i n g and  intervene  accordingly.  abortions  Some o f t h e s e d i f f i c u l t i e s  g a i n i n g a c c e s s t o an a b o r t i o n  include  s e r v i c e ; making t h e d e c i s i o n  t o have t h e a b o r t i o n ; e x p e r i e n c i n g  changes i n r e l a t i o n s h i p s  w i t h s i g n i f i c a n t o t h e r s ; d e c i d i n g upon an a p p r o p r i a t e  method  o f b i r t h c o n t r o l ; and w o r k i n g t h r o u g h f e e l i n g s i n r e l a t i o n to s e l f i n the context of t h i s experience.  4.  H e a l t h workers should recognize the value of  i n c l u d i n g t h e p u t a t i v e f a t h e r as much as p o s s i b l e i n t h e c o u n s e l l i n g p r o c e s s . I n t h i s way, g r e a t e r u n d e r s t a n d i n g o f a l l t h e i n t e r p e r s o n a l dynamics w i l l be a t t a i n e d , and so more b e n e f i c i a l l y a c t e d upon. RECOMMENDATIONS FOR FUTURE RESEARCH T h i s s t u d y has i d e n t i f i e d , f r o m a s m a l l sample, c e r t a i n unmet needs e x p e r i e n c e d by a b o r t i o n p a t i e n t s . A r e a s which r e q u i r e f u r t h e r r e s e a r c h a r e suggested by t h i s r e p o r t and c e n t r e around t h e f o l l o w i n g q u e s t i o n s : 1. What a r e t h e most e f f e c t i v e ways t o meet t h e i d e n t i f i e d needs? 2. What a r e t h e l o n g e r range e f f e c t s on a woman's a b i l i t y t o cope w i t h t h e a b o r t i o n , and on h e r l i f e g e n e r a l l y , o f m e e t i n g t h e s e needs? 3. How c a n t h e c o n c e p t s o f s e x u a l i t y and r e s p o n s i b i l i t y be i n t e g r a t e d e f f e c t i v e l y i n t o s e x e d u c a t i o n courses i n high schools? 4.  I f a woman has p r e v i o u s l y g i v e n a c h i l d up f o r  a d o p t i o n , what d i f f e r e n c e s does she e x p e r i e n c e i n h e r psychos o c i a l r e a c t i o n t o an a b o r t i o n as opposed t o h e r r e a c t i o n s t o g i v i n g t h e c h i l d up? 5. I s t h e r e a s i g n i f i c a n t d i f f e r e n c e i n t h e way i n w h i c h a t h i r t y y e a r o l d woman copes w i t h an a b o r t i o n a s compared t o a seventeen  year old?  76 6.  What p r o p o r t i o n of p r e - o p e r a t i v e  anxiety i s  r e l a t e d p r i m a r i l y to f e a r of the s u r g i c a l procedure as such and VThat p r o p o r t i o n i s r e l a t e d to concern about the a b o r t i o n itself?  BIBLIOGRAPHY  77  BIBLIOGRAPHY A. BOOKS  C a l l a h a n , D a n i e l . A b o r t i o n ; Law, C h o i c e and M o r a l i t y . London, The M a c M i l l a n Company, 1970. F e r r i s , P a u l . The Nameless: A b o r t i o n i n B r i t a i n Today. London: H u t c h i n s o n & Co. ( P u b l i s h e r s ) L t d . , 1 9 6 6 . H a l l , R o b e r t E. ( e d . ) . A b o r t i o n i n a Changing W o r l d . 2 v o l s . New York: C o l u m b i a U n i v e r s i t y P r e s s , 1970. Maloney, E. I n t e r p e r s o n a l R e l a t i o n s . Dubuque: C. Brown Co., 1960^ P e l r l n e , E l e a n o r W r i g h t . A b o r t i o n I n Canada. T o r o n t o : new p r e s s , 1971. S c h a e f e r , George ( e d . ) . C l i n i c a l O b s t e t r i c s and Gynecology: L e g a l A b o r t i o n s i n New Y o r k S t a t e ; M e d i c a l , L e g a l , N u r s i n g , S o c i a l A s p e c t s ( J u l y 1-December 3 1 . 1970)• New Y o r k : H a r p e r & Row, P u b l i s h e r s , 1971'. Shaw, R u s s e l l . A b o r t i o n on T r i a l . Ohio: P f l a u m P r e s s , 1968. S m i t h , D a v i d T. ( e d . ) . A b o r t i o n and t h e Law. C l e v e l a n d : The P r e s s o f Western Reserve U n i v e r s i t y , 19^7. T r i p o d i , Tony A. e t . a l . S o c i a l Program E v a l u a t i o n . I t a s c a : Peacock P u b l i s h e r s , 1971. W e s t o f f , L e s l i e A l d r i d g e and C h a r l e s F. W e s t o f f . From Now t o Z e r o : F e r t i l i t y , C o n t r a c e p t i o n and A b o r t i o n i n A m e r i c a . T o r o n t o : L i t t l e , Brown and Company, 1971.  B. PERIODICALS A t h a n a s i o u , R o b e r t e t . a l . " P s y c h i a t r i c Sequelae t o Term B i r t h and Induced E a r l y and L a t e A b o r t i o n : A L o n g i t u d i n a l Study," Family Planning P e r s p e c t i v e s , 5 : 4 , F a l l , 1973, 227—231. 78  79 B r o d y , H a r r y , S t e w a r t M e i k l e , and R i c h a r d G e r r i t s e , " T h e r a p e u t i c A b o r t i o n : A P r o s p e c t i v e Study. 1 . , " A m e r i c a n J o u r n a l o f O b s t e t r i c s and G y n e c o l o g y , 1 0 9 : 3 , F e b r u a r y 1, 1971, 347-353Claman, D a v i d A., e t . a l . "Impact on H o s p i t a l P r a c t i c e o f L i b e r a l i z i n g A b o r t i o n s and Female S t e r i l i z a t i o n s , " Canadian Medical A s s o c i a t i o n J o u r n a l , 105, J u l y 10, 1971,  35-41.  Danon,. A r d i s H y l a n d . " O r g a n i z i n g an A b o r t i o n S e r v i c e , " Nursing Outlook, 21:7, J u l y , 1973, 4 6 0 - 4 6 4 . D a v i d , Henry P. " A b o r t i o n : P u b l i c H e a l t h Concerns and Needed P s y c h o s o c i a l R e s e a r c h , " A m e r i c a n J o u r n a l o f P u b l i c H e a l t h , 6 l : 3 , March, 1971, 510-516. . " A b o r t i o n Trends i n European S o c i a l i s t C o u n t r i e s and i n the U n i t e d S t a t e s , " A m e r i c a n J o u r n a l o f O r t h o p s y c h i a t r y , 4 3 : 3 , A p r i l , 1973, 3 7 6 - 3 « 3 . E h r l l c h , P a u l and J o h n P. H o l d r e n . " A b o r t i o n and M o r a l i t y , " C a n a d i a n N u r s e , 6 8 : 6 , J u n e , 1972, 37« F o r d , C h a r l e s V., P i e t r o C a s t e l n u o v o - T e d e s c o , and K a h l i l a D. Long. "Women Who Seek T h e r a p e u t i c A b o r t i o n : A Comparison w i t h Women who Complete T h e i r P r e g n a n c i e s , " A m e r i c a n J o u r n a l o f P s y c h i a t r y , 1 2 9 : 5 , November, 1 9 7 2 , 58-64. H a r p e r , W., B e t t y R. Marcom, and V i c t o r D. W a l l . " A b o r t i o n : Do A t t i t u d e s o f N u r s i n g P e r s o n n e l A f f e c t t h e P a t i e n t ' s P e r c e p t i o n o f Care?" Nursing Research, 21:4, August, 1972, 327-331. K e l l e r , C h r i s t a and Pamela C o p e l a n d . " C o u n s e l l i n g the A b o r t i o n P a t i e n t I s More Than T a l k , " A m e r i c a n J o u r n a l o f N u r s i n g , 72:1, J a n u a r y , 1972, 1 0 2 - 1 0 9 . Marder, Leon. " P s y c h i a t r i c E z p e r i e n c e w i t h a L i b e r a l i z e d . A b o r t i o n Law," A m e r i c a n J o u r n a l o f P s y c h i a t r y , 1 2 6 : 9 , March, 1 9 7 0 , 64^75^ ~ Monsour, Karem J . and B a r b a r a S t e w a r t . " A b o r t i o n and S e x u a l B e h a v i o r i n C o l l e g e Women," A m e r i c a n J o u r n a l o f O r t h o p s y c h l a t r y , 4 3 : 5 , O c t o b e r , .1973, 804-814-. R o g e r s , J o a n M. " T h e r a p e u t i c A b o r t i o n : A M u l t i d i s c i p l i n e d Approach t o P a t i e n t Care from a S o c i a l Work P e r s p e c t i v e , " C a n a d i a n J o u r n a l o f P u b l i c H e a l t h , 6 4 : 3 , May/June, 1 9 7 3 , 254-259. ' '  80  Ryder, Norman B. " C o n t r a c e p t i v e F a i l u r e i n t h e U n i t e d S t a t e s , " F a m i l y P l a n n i n g P e r s p e c t i v e s , 5 : 3 , Summer, 1973, 133-142. S c h o r r , Thelma M. " I s s u e s o f C o n s c i e n c e , " of N u r s i n g , 7 2 : 1 , J a n u a r y , 1972, 6 l .  American J o u r n a l  S c h w a r t z , R i c h a r d A. "The S o c i a l E f f e c t s o f L e g a l A b o r t i o n , " 6 2 : 1 0 , October, 1972, 1331-1335Schwenger, Cope W. " A b o r t i o n i n Canada a s a P u b l i c H e a l t h P r o b l e m and a s a Community H e a l t h Measure," C a n a d i a n J o u r n a l o f P u b l i c H e a l t h , 6 4 : 3 , May/June, 1973, 223-  ~2~29:  Smith, E l i z a b e t h M. "A F o l l o w - u p Study o f Women who Request A b o r t i o n , " A m e r i c a n J o u r n a l o f O r t h o p s y c h i a t r y , 43:4, J u l y , 1973,.574-585. " C o u n s e l i n g f o r Women who Seek A b o r t i o n , " S o c i a l Work, 1 7 : 2 , March, 1972, 6 2 - 6 8 . T i e t z e , C h r i s t o p h e r and Sarah L e w i t t . " J o i n t Program f o r the Study o f A b o r t i o n ( J P S A ) : E a r l y M e d i c a l C o m p l i c a t i o n s of Legal A b o r t i o n , " Studies i n Family Planning, 3 : 6 , June, 1972, 9 7 - 1 1 9 - . W h i t t l n g d o n , H.G. " E v a l u a t i o n o f T h e r a p e u t i c A b o r t i o n a s an Element o f P r e v e n t i v e P s y c h i a t r y , " A m e r i c a n J o u r n a l o f P s y c h i a t r y . 1 2 6 : 9 , March, 1970, 5 8 - c ^ C.  UNPUBLISHED MATERIALS  Model f o r N u r s i n g , U n i v e r s i t y o f B r i t i s h C o l u m b i a S c h o o l o f N u r s i n g , Vancouver, 1973- (Mimeographed.) "A Study t o I d e n t i f y Problems E x p e r i e n c e d by P a t i e n t s H a v i n g T h e r a p e u t i c A b o r t i o n s on t h e One-Day S u r g i c a l S l a t e , " P r o j e c t D i r e c t o r : Mary L. Richmond-MacBean, N a t i o n a l H e a l t h Grant ( P r o j e c t No. 6 1 0 - 2 1 - 2 5 ) , J u n e , 1972, Vancouver.  81 D. OTHER B a b i e s by C h o i c e N o t by Chance. 2 v o l s . O u t r e a c h S e r v i c e s , S o c i a l P o l i c y a n d R e s e a r c h D e p a r t m e n t , U n i t e d Comm u n i t y S e r v i c e s o f G r e a t e r V a n c o u v e r A r e a , J u n e , 1973. T i e t z e , C h r i s t o p h e r a n d D e b o r a h A. Dawson. " I n d u c e d . A b o r t i o n s A F a c t b o o k , " R e p o r t s on P o p u l a t i o n / F a m i l y P l a n n i n g , 1 4 , D e c e m b e r , 1973, 1-55-  APPENDIX A: THE PACE SHEET  82  THE FACE SHEET PLACE OF INTERVIEW: NAME: HOME ADDRESS: PHONE: DATE: AGE: NEXT OF K I N : NATIONALITY: RELIGIOUS OR CULTURAL BACKGROUND: STUDENT, WORKING, AT HOME: FAMILY.SIZE: LIVING ARRANGEMENT: LAST NORMAL MENSTRUAL PERIOD: WEEKS OF GESTATION: SCHEDULED FOR OPERATION: 83  APPENDIX Bs BROCHURE  84  BROCHURE  ABORTION RESEARCH PROJECT I am i n t e r e s t e d i n t a l k i n g w i t h y o u about y o u r r e a c t i o n s t o h a y i n g an a b o r t i o n , because I b e l i e v e t h a t your experience women f o r t h i s  c o u l d be v a l u a b l e i n p r e p a r i n g  other  experience.  I t i s my p l a n t o v i s i t w i t h you once b e f o r e t h e o p e r a t i o n and t w i c e f o l l o w i n g , t o e x p l o r e y o u r f e e l i n g s , r e a c t i o n s , and needs r e g a r d i n g t h i s  event.  T h i s r e s e a r c h i s b e i n g done a s one o f t h e r e q u i r e ments f o r a M a s t e r o f S c i e n c e i n N u r s i n g program a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . A l l i n f o r m a t i o n w i l l be c o n f i d e n t i a l . I f you a r e i n t e r e s t e d , please i n d i c a t e s o , and I w i l l c o n t a c t y o u t o e x p l a i n f u r t h e r . L o o k i n g f o r w a r d t o m e e t i n g and t a l k i n g w i t h y o u ,  R e t a McKay, R.N.  85  APPENDIX C: CRIMINAL CODE OF CANADA, SECTION 251, SUBSECTIONS I TO 4  86  CRIMINAL CODE OF CANADA, SECTION 251. 251.  (1) E v e r y one who, w i t h i n t e n t t o p r o c u r e t h e m i s -  c a r r i a g e o f a female p e r s o n , whether o r n o t she i s p r e g n a n t , u s e s any means f o r t h e purpose  of c a r r y i n g out h i s i n t e n t i o n  i s g u i l t y o f an i n d i c t a b l e o f f e n c e and i s l i a b l e f o r imprisonment f o r l i f e . (2) E v e r y f e m a l e p e r s o n who, b e i n g p r e g n a n t , w i t h i n t e n t t o p r o c u r e h e r own m i s c a r r i a g e , u s e s any means o r p e r m i t s any means t o be used f o r t h e purpose  of c a r r y i n g  o u t h e r i n t e n t i o n i s g u i l t y o f an i n d i c t a b l e o f f e n c e and i s l i a b l e t o Imprisonment f o r two y e a r s . (3) I n t h i s s e c t i o n , "means" i n c l u d e s (a) t h e a d m i n i s t r a t i o n o f a d r u g o r o t h e r noxious  thing,  (b) t h e use o f an i n s t r u m e n t , and ( c ) m a n i p u l a t i o n o f any k i n d . (4) S u b s e c t i o n s (1)  and (2) do n o t a p p l y t o  (a) a q u a l i f i e d m e d i c a l p r a c t i t i o n e r , o t h e r t h a n a member o f a t h e r a p e u t i c a b o r t i o n committee f o r any h o s p i t a l , who i n good f a i t h uses i n an a c c r e d i t e d o r approved h o s p i t a l any means f o r the purpose  of c a r r y i n g out h i s i n t e n t i o n t o  p r o c u r e t h e m i s c a r r i a g e o f a female p e r s o n , o r (b) a f e m a l e p e r s o n who, b e i n g p r e g n a n t , 87  permits  88  a q u a l i f i e d m e d i c a l p r a c t i t i o n e r t o use i n an a c c r e d i t e d o r approved h o s p i t a l any means d e s c r i b e d i n p a r a g r a p h (a) f o r t h e purpose of c a r r y i n g o u t h e r i n t e n t i o n t o p r o c u r e h e r own m i s c a r r i a g e , i f , b e f o r e t h e use o f t h o s e means, t h e t h e r a p e u t i c  abortion  committee f o r t h a t a c c r e d i t e d o r approved h o s p i t a l , by a m a j o r i t y o f t h e members o f t h e committee and a t a m e e t i n g of t h e committee a t which t h e case o f such female p e r s o n has been r e v i e w e d , (c) has by c e r t i f i c a t e i n w r i t i n g s t a t e d t h a t i n i t s o p i n i o n the c o n t i n u a t i o n of the pregnancy o f such f e m a l e p e r s o n would o r would be l i k e l y t o endanger h e r l i f e o r h e a l t h , and (d) has caused a copy o f such c e r t i f i c a t e t o be g i v e n t o t h e q u a l i f i e d m e d i c a l p r a c t i t i o n e r .  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0093006/manifest

Comment

Related Items