Edna Astbury-Ward

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    Abortion care - the staff perspective

    Edna Astbury – Ward, PhD, M.Sc, RGN, Dip., H. Ed, United Kingdom

    Methods: A qualitative interpretive study. Face to face in depth interviews with 8 staff.

    Results: Working in abortion care presented a unique set of social, emotional and practical challenges for staff. Because of working in abortion care some staff expressed a sense of isolation from other colleagues. They said that those who didn’t work in abortion care considered it an unpopular job and perceived patients requesting abortion as more ‘challenging ‘and ‘problematic’ than other patients, partly because of the additional time required but also because of the emotional investment which is associated with the role. Staff’s sense of isolation was manifested because they felt they couldn’t talk to others about their job. Irrespective of their perceived sense of isolation the desire to provide a service for women in need was a motivational factor for those staff who had chosen to work in this area.

    Although staff said personal opinions did not have a place in the delivery of care some were unable to disassociate themselves professionally from their own deeply held personal convictions. In addition, some said that they felt unable to voice opposition to an expectation that they would work in this area if it was included as part of a wider women’s health remit. They indicated that sometimes their feelings were compromised by this aspect of the role indicating they felt unable to exercise their right to conscientious objection.

    The subject of repeat abortion provoked particularly negative staff emotions for personal and professional reasons, especially if patients repeatedly accessed abortion services because of non use of contraception. Often staff admitted they wanted to ‘lecture’ patients about the issue and some implied that eventually patients may be less likely to receive good care in these instances. However staff reported that women who requested abortion for foetal abnormality were likely to receive more sympathy, understanding and care.

    The practical challenges mainly concerned whether facilities were appropriate, available and accessible for patient care. Staff recommended that facilities ideally shouldn’t be sited near ante-natal or post-natal areas and there should be provision locally for late gestation abortion and swift access.

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    After abortion: women’s emotions

    Edna Astbury-Ward, United Kingdom

    Methods: A qualitative interpretive study. Face to face in depth interviews were conducted with 17 women aged between 22-57 years, whose abortions took place between 4 weeks and 34 years previously.

    Results: Whilst the study set out to explore women's perceptions of abortion care, it was apparent that care was not experienced in a vacuum and that women’s emotions were inextricably linked with the abortion experience. Women described a range of varied feelings after abortion. They included positive emotions such as the realisation the abortion was over and that it was the end of keeping secrets, women expressed how they were looking forward to life again and that they felt empowered, more in tune with themselves and looking forward to the future. They also experienced a range of negative emotions such as remembering with regret, feeling a sense of emptiness and loss, feeling isolated and concerned about the future. Some felt angry and ashamed at what they described as ‘as a loss of life’ some felt they had disappointed themselves and others. The overwhelming emotion was described as relief and this did not change over time although women re-evaluated their abortion experiences differently as a result of the passage of time and intervening life's experiences, some re-evaluated their abortion negatively and others re-evaluated their abortion positively.

    Conclusion: Women's emotions varied in their response to abortion. The initial feeling of relief was re-evaluated over time; most felt it was the right thing to do at that moment and moved on with their lives. Time may have eroded the details, but not the fact of abortion.