Lesley Hoggart, Principal Research Fellow School of Health and Social Care, Univ. of Greenwich, UK
This paper reports on a research project (Hoggart and Phillips 2010) that studied teenage abortion and repeat abortion in London, UK. This research set out to explore factors that might help explain what are currently viewed as disproportionately high rates of teenage abortion, and repeat abortion, in London. This required gathering data on sexual behaviour leading to unintended and unwanted teenage pregnancies; on teenage experiences of abortion; and on post-abortion sexual behaviour.
Utilising a qualitative methodology, interviews were conducted with three groups of participants: focus groups with 14-16 year old girls in London schools; in depth interviews with sexual health practitioners; and in depth interviews with teenagers that had terminated pregnancies. The theoretical approach adopted was to examine how abortion decisions and experiences are mediated by value systems, and localised cultural and social norms (Harden and Ogden, 1999, Henderson, 1999, Hoggart et al., 2006, Lee et al., 2005, Lie et al., 2008, Pearson et al., 1995).
One of the key findings of the research was that the mindset of pregnant teenagers and the extent to which they make an abortion decision by and for themselves may influence their feelings and sexual behaviour following the abortion. Abortion is viewed as ‘immoral’ by many young women in the UK, and this view can make abortion decision-making difficult and stressful. Feeling that abortion is ‘immoral’ is likely to contribute towards any feelings of regret and/or guilt that young women may have following an abortion.
The research also indicates that young women who are able to make their own decision for their own reasons are more likely to establish an effective contraceptive regime following an abortion, than young women who may have been reluctant to end their pregnancies and do not have any plans for their own futures. The research findings have important implications for post-abortion services. They suggest that complex issues would need to be explored around the time of the abortion in order to offer an appropriate individualised post-abortion service.
Marie Stopes International UK Abortion Study: "And then I fell pregnant with my second child". Young women's accounts of multiple unintended conceptions
Lesley Hoggart, Victoria Newton The Open University, Milton Keynes, UK - email@example.com
Objectives: The overall aim of the study was to explore the behavioural, social and service related factors that are associated with one or more unintended and unwanted pregnancy amongst young women (under 25 years). The aim of this paper is to explore the contraceptive journeys and decision-making of young women who have had more than one pregnancy resulting in abortion and/or live birth. Methods: Data is drawn from a longitudinal investigation using in-depth qualitative interviews with 36 young women, 12 of whom had experienced more than one unintended pregnancy. Results: A number of factors contributed towards participants experiencing more than one unintended pregnancy. Of particular importance, was their difficulty in finding a method of contraception they were happy with. For many this was combined with unpredictable personal lives. Some spoke about their difficulty in addressing their ‘need' for contraception due to complex sexual relationships. For each pregnancy, they discussed their decision-making with regard to continuing or terminating the pregnancy based on individualised and situational circumstances. However, their accounts of becoming unintentionally pregnant on more than one occasion were characterised by feelings of shame. Abortion stigma was an integral part of the young women's reflections about their experiences, even when they believed that they had made the right choice. Many were left with feelings of guilt that they had been in the situation more than once. Conclusions: The difficulties that some women experience establishing a contraceptive regimen need to be recognised and respected. It would be helpful to work towards continuing flexible and individualised support, recognising that a contraceptive choice made at the time of abortion may be subject to change. Condoms should be routinely provided following an abortion, and women should also be channelled into their local contraceptive services. Abortion stigma remains an issue that needs to be addressed.
Marie Stopes International UK Abortion Study: "I didn't think it would happen to me". Young women's accounts of pre- and post- abortion contraceptive use.
Lesley Hoggart, Victoria Newton The Open University, Milton Keynes, UK - firstname.lastname@example.org
Objectives: The overall aim of the study was to explore the behavioural, social and service related factors that are associated with one or more unintended and unwanted pregnancy amongst young women (under 25 years). In this paper we explore, qualitatively, the narratives of young women who - for a multitude of reasons - have experienced unwanted pregnancy. Methods: A longitudinal investigation using in-depth qualitative interviews with 36 young women who have had one or more abortion. The study is funded by, and being undertaken in collaboration with, Marie Stopes International. Results: Participant's accounts of unintended and unwanted pregnancy highlight the diverse situational and behavioural scenarios in which women become pregnant when they do not want to be. Most participants in the study had been actively attempting to avoid pregnancy but had experienced a contraceptive failure due to improper use or a misunderstanding about the method. Other participants were sure they had used their method correctly and were uncertain how and why they became pregnant. For those women who were aware they were at risk of an unintended pregnancy, most did not seek emergency contraception. These women recounted finding it difficult to access emergency hormonal contraception (EHC), or being worried about having to pay for it. There was a clear lack of knowledge about the emergency IUD. For the few women who had accessed EHC, there was very little evidence of advice regarding the emergency IUD being given by their provider. Conclusions: An advance supply of EHC would enable women to have it to hand should the need arise. General awareness about the IUD as a method of emergency contraception needs to be raised. Providers should discuss the emergency IUD with women seeking EHC, especially for those who are close to the EHC time limit.
‘Trust me to be the awkward one’: young women’s
experiences with the contraceptive implant
Hoggart, L; Newton, V
University of Greenwich, UK
This paper will present the ﬁndings of a recently completed
qualitative study examining ‘premature’ implant removal amongst
young women (aged 16–24) in London. The paper will explore
young women’s contraceptive journeys with the implant and
examine how and why the implant was initially selected as a
contraceptive of choice and then removed within one year or less
of ﬁtting. The focus of the paper is on the complex process of
contraceptive decision-making, and how this may change as a
result of bodily experiences subjectively associated with the
implant. The paper will begin by discussing young women’s
reasons for choosing the implant. We will then examine how
individual and collective experiences of the method contribute to
the decision to have the implant removed. These experiences
include a range of perceived side effects, issues concerned with
bodily control, and changes in sexual relationships, as well as
service related factors. The research has shown that young women
who have made a positive choice in favour of the implant will
tolerate a considerable amount of discomfort before reaching a
‘tipping point’ at which they decide to have the implant removed.
During this period they often feel unsupported and isolated, and
even attach blame to themselves for the ‘failure’ of their body to
accept the implant. We also suggest that negative experiences and
a lack of support may contribute towards negative attitudes
towards other long-acting reversible contraceptive methods.
This presentation seeks to generate understandings not only about how women may internalise abortion stigma; but also about how that internalisation may be resisted and rejected. It does this by drawing on a qualitative secondary analysis of young women's narratives in two abortion studies in England. The analysis showed that whilst most women did internalise abortion stigma, many resisted this stigmatisation, and some rejected it. Individually-held moral views interacted with socio-cultural norms around reproduction and motherhood, and shaped women's responses to their abortion. Stigma management strategies were grounded on rejecting notions of blame, and or feelings of shame. Those women who were morally confident about their exercise of bodily autonomy were least likely to struggle with their decision-making or to experience negative post-abortion emotions. The analysis showed that abortion-related stigma is neither universal nor inevitable, and indicates that attempts to normalise abortion may help women avoid internalising abortion stigma.
Women's informal knowledge and understandings about IUC
Victoria Newton1, Lesley Hoggart1, Susan Walker2, Mike Parker2
1The Open University, Milton Keynes, UK, 2Anglia Ruskin University, Chelmsford and Cambridge, UK
Objectives: The aim of the study was to explore the acceptability of intrauterine contraception (IUC) in a UK General Practice setting. There were four arms to the project comprising surveys and interviews with both practitioners and patients. Here we present data from the patient arm of the study.
Methods: We used a mixed method QUAL/quant approach. We interviewed 30 women (aged 18-49), who had never used IUC, to gain insight into their beliefs about and attitudes towards IUC. Incorporating qualitative responses into a questionnaire, we subsequently surveyed 1195 never/ever users aged 18-49 years, about their beliefs and knowledge about IUC methods.
Results: The qualitative interviews revealed four key themes: 1) women were concerned about the procedures for insertion and removal of IUC; 2) women were concerned about the long-term effect of IUC in their body and its impact on reproductive functions; 3) there was an emotional response of distaste for an internal device; 4) social networks were important in knowledge sharing and decision making about contraception.
The quantitative survey confirmed these findings. Women expressed concerns about painful fitting (54.9%), unpleasant removal (55%), womb damage (33.1%), movement of the device inside the body (41.1%), and dislike of the thought of the device in the body (48.5%). Women who reported negative account from friends and family were significantly less likely to use either IUD or IUS (p<0.001).
Conclusions: The beliefs and fears expressed by the women in the study constitute a significant potential barrier to the uptake of IUC. Clinician recognition and discussion of these aspects of women's beliefs about IUC have the potential to remove unnecessary barriers to IUC use, thus allowing women access to highly effective, long term methods of contraception.