Christine McKnight


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    Aim: To explore women’s experiences of returning for subsequent abortions and the experiences of staff who provide abortions.
    Background: While overall abortion rates are decreasing in the UK, the percentage of women undergoing more than one abortion has increased.  Between 2006-2016 there was a 6% increase in the number of women requesting repeat abortions, rising from 32% to 38% despite historical improvements in medical interventions for contraceptive technology.  Previous quantitative research has focussed on what is different about women who request multiple abortions and how to get them to uptake and adhere to long acting reversible contraception.  Rather than their personal experiences.
    Methodology: Qualitative semi structured interviews with 10 women who have had multiple abortions and 12 semi structured interviews with staff who work in an abortion service.  All interviews were transcribed verbatim.  Interviews were analysed using thematic analysis.
    Results: Four overarching themes emerged which were guilt, shame, coping and perfect contraception.  Women experience guilt at multiple levels from the legal framework, to service and individual level; whereas staff struggle with their own guilt regarding provision of services.  Stigma is expressed in the language used, by both women and staff, surrounding abortion and by the issue of woman returning for multiple procedures.  Coping describes the different ways that women coped with their abortions and how they coped differently with each one, examining how patterns of behaviour may emerge.  Accounts evidence a sense of deep shame around returning for abortions which links closely with guilt where both women and staff apportion and internalise blame. 
    Conclusions: Abortion is a stigmatised medical procedure for both women and the staff who provide them. Women and staff use a variety of mechanisms to reduce that stigma some of which may fail to address ongoing problems with contraception.  However, women who return for multiple abortions are diverse and so are their experiences, procedural and service issues may need to re-examine implicit attitudes to abortion.