Carried out by mother
* The result of rape; ** Seven participants; *** six participants.
In the stories about unwanted pregnancies, mostly personal factors were mentioned as reasons, with some interviewees stating that they felt unable to be a mother at the time of the pregnancy: “ (It) was at the time that I was taking pills that I got pregnant, and I induced abortion because I was not prepared (for motherhood). ” (24 years)
Some had had a bad experience in the past: “ Maybe I would be abandoned and it would be the same. (Sigh)... I learned with my first pregnancy. ” (23 years)
Also, the existence of another child was mentioned as a reason to have an abortion: “ I got pregnant when I was 20, and I had a baby. When I became pregnant again, my daughter was a child, and I could not have another child. ” (23 years)
For other participants, studies were the main reason why the pregnancy was not wanted: “ He was informed about it, and he said that I should keep it. However, as I wanted to continue my studies, I told him no, no (I) do not. ” (17 years)
At the interpersonal level, a lack of support from the partner was often mentioned as a reason for not wanting the baby: “ He said that he recognizes the paternity, but it is not to keep that pregnancy. ” (22 years)
Women frequently mentioned environmental circumstances related to their poor socio-economic situation: “ I am staying at Mom's house; it is not okay to still be having babies there.” (23 years)
“ At home, we do not have any resources to take care of this child! ” (20 years)
In these cases, the decision to abort the pregnancy was not made by the woman herself but imposed by others or by the circumstances.
Some participants reported that their parents/family had decided what had to be done: “ They decided while I was at school. If (it) was my decision I would keep it because I wanted it. ” (18 years).
Other young women indicated the refusal of paternity as a reason to terminate the pregnancy.
“ Because my son’s father did not accept the (second) pregnancy. There was a time, we argued with each other, and we terminated the relationship. Later, we started dating again, and I got pregnant. He said it was not possible. ” (21 years)
“ (he) impregnated me and after that, he dumped me, (smiles)… I went to him, and I said that I was pregnant. He said eee: I do not know, that is not my child. ” (20 years).
Some women told the interviewers that they were convinced by their boyfriend to have an abortion: “ I talked to him, and he said okay we are going to have an abortion and I accepted. ” (22 years)
Others mentioned their partner’s indecision and changing attitude as a reason to get an abortion, even though they did want the baby:
“ I told him I was pregnant. First, he said to keep it. (Next) He was different. Sometimes he was calling me, and other times not. I understood that he did not want me. ” (20 years)
The fear of being excluded from their family due to their pregnancy was another reason reported by participants: “ So I went to talk with my older sister, and she said eee, you must abort because daddy will kick you out of our home. ” (20 years)
“ As I am an orphan, and I live with my uncle, they were going to kick me out. No one would assist me. ” (20 years)
Two young women reported having had the abortion at home by an unskilled provider. It seems that these unskilled providers than the women (i.e. family members, partner) made the decisions.
“ It was mammy and my sister (who provided the induced abortion services). My sister knows these things. ” (18 years)
“ He (the father of the child) came to my house and took me back to his house. It was that moment when I aborted. ” (21 years)
Of the 16 abortions, seven were performed through health services, by a skilled provider. For some of them, the choice for a health service was influenced by the fact of knowing someone at the health facility.
“ I went to talk to her (friend), and she said that “I have an aunt who works at the hospital, she can help you. Just take money”. ” (20 years)
“ I Already knew who could induce it (abortion). No, I knew that person. I went to the hospital, and I talked to her, (and) she helped me. ” (22 years)
Other participants went to the health facility, but due to the lack of money to pay for an abortion at the facilities they sought help out of the health facility: “ They charged us money that we did not have. The ladies did not want to negotiate anything. I think they wanted 1200 mt (17.1 euros) if I am not wrong. He had a job, but he (boyfriend) did not have that amount of money. ” (22 years)
Some participants reported that they had an abortion outside regular facilities because the health provider recommended going to his house: “ She (mother) was the one who accompanied me. She is the one who knows the doctor. We went to the central hospital, but he (the doctor) was very busy, and he told us to go to his house. ” (17 years)
Others reported the fear of signing a document as a reason to seek help outside of official channels: “ I heard that to induce abortion at the hospital it is necessary for an adult to sign a consent form. I was afraid because I did not know who could accompany me. Because at that time I only wanted to hide it from others. ” (22 years).
The women were not able to explain why a particular abortion procedure (i.e., pills or aspiration, curettage) was used. It appears that they were not given the opportunity to choose and that they submitted themselves to the procedure proposed by the provider.
“ The abortion was done here at home. They just went to the pharmacy, bought pills and gave them to me. ” (18 years)
None of those treated at the hospital stated that legal procedures were followed. They also mentioned that they had to pay without receiving any official receipt.
“ First we got there and talked to a servant (a helper of the hospital). The servant asked for money for a refreshment so he could talk to a doctor. After we spoke (with servant), he went to the doctor, and the doctor came, and we arranged everything with him. ” (22 years)
“ We went to the health center, and we talked to those doctors or nurses I mean, they said that they could provide that service. It was 1200 mt (17.1 euros), and they were going to deal with everything. They did not give us the chance to sign a document and follow those procedures. ” (20 years)
The objective of this study was to describe abortion procedures and to explore factors influencing the abortion decision-making process among young women in Maputo and Quelimane.
The study pointed out determinants at the personal, interpersonal and environmental level. Analysing the results, we were confronted with four recurring factors that negatively impacted on the decision-making process: (1) women’s lack of autonomy to make their own decisions regarding the termination of the pregnancy, (2) their general lack of knowledge, (3) the poor availability of local abortion services, and (4) the overpowering influence of providers on the decisions made.
The first factor involves women’s lack of autonomy. In our study, most women indicate that decisions regarding the termination of a pregnancy are mostly taken by others, sometimes against their will. Parents, family members, partners, and providers decide what should happen. As shown in the literature, this lack of autonomy in abortion decision-making is linked to power and gender inequality [ 34 , 35 , 36 , 37 , 38 ]. On the one hand, power reflects the degree to which individuals or groups can impose their will on others, with or without the consent of those others [ 34 , 37 , 38 ]. In this case, the power of the parent/family is observed when they, directly or indirectly, influence their daughters to induce an abortion, for instance by threatening to kick them out of their home. On the other hand, gender inequality is also a factor. This refers to the power imbalance between men and women and is reflected by cases in which the partner makes the decision to terminate the pregnancy [ 38 ]. Besides this, the contextual environment of male chauvinism in Mozambique also makes it more socially acceptable for men to reject responsibility for a pregnancy [ 34 , 35 , 37 , 39 , 40 ]. Finally, women’s economic dependence makes them more vulnerable, dependent and subordinated. For economic reasons, women, have no other choice but to obey and follow the family or partner’s decisions. Closely linked with women’s lack of autonomy is their lack of knowledge. Interviewees report that they do not know where abortion services are provided. They are not acquainted with the legal procedures and do not know their sexual rights. This lack of knowledge among women contributes to the high prevalence of pregnancy termination outside of health facilities and not in accordance with legal procedures.
Our participants often report that abortion services are absent at a local level, as has also been pointed out by Ngwena [ 41 ]. This is a particular problem in Mozambique. Not all tertiary or quaternary health facilities are authorized to perform abortions. The fact that only some tertiary and quaternary facilities are allowed to do so creates a shortage of abortion centres to cover the demand. In fact, only people with a certain level of education and a sufficiently large social network have access to legal and proper abortion procedures.
Finally, our study shows that providers mostly decide on the location, the methods used and the legality of abortion procedures. Patients are highly dependent on the health providers’ commitment, professionality and accuracy and the selected procedures are not mutually decided by the provider and the patient. Providers often do not refer the client to the reference health facility or do not inform them of the legal procedures, creating a gap between law and practice that stimulates illegal and unsafe procedures. The reasons for this are unclear. It might be due to a lack of knowledge among health providers too, and, perhaps, provider saw here an opportunity to supplement the low salary [ 42 ]. Participants who seek help at the health facility they do so contacting the provider in particular, as indication given by someone.
This corroborates with studies conducted by Ngwena [ 41 , 43 ], Doran et al. [ 44 ], Pickles [ 45 ], Mantshi [ 46 ], and Ngwena [ 47 ], which pointed out the obstacles related to the availability of services and providers’ attitudes towards safe abortion, although the law grants the population this right [ 41 , 43 , 44 , 45 , 46 , 47 ]. As Ngwena [ 41 , 43 ] argues, the liberalization of abortion laws is not always put into practice and abortion rights merely exist on paper. Braam’ study [ 48 ] therefore highlights the necessity of clarifying and informing women and providers of the current legislation and ensuring that abortion services are available in all circumstances described in the law.
Finally, despite cultural differences between Maputo and Quelimane, the result did not suggest differences between two areas studied regarding factors influencing the decision to terminate and how the abortion is done. However, the Figure 1 suggests that there was trend to have more participants from Maputo reporting abortion episode in her life than Quelimane. This difference maybe be because Maputo is much more multicultural and the people of this city have more access to information that gives them the opportunity to learn about matter of reproductive health including abortion, than Quelimane. So, due to this there is trend decrease the taboo relation to abortion in Maputo than in Quelimane.
These abortion stories illustrate the lack of autonomy in decision-making process given the power and gender inequalities between adults and young women, and also between man and women . They also show the lack of knowledge not only on the availability of abortion services at some health facilities, as well as, on the new law on abortion. All these lacks that women have are reinforced by poor availability of abortion services and the fact that the providers we not taking their role to help those women, as it is exposed in the next sections.
This study interviewed young women who had an induced abortion at some point in their lives (15 years up to their age at interview date). As such, it does not provide any information on the factors behind the decisions of those who did not terminate their pregnancy.
The results presented in this paper only reflect the perceptions of the young women who had an induced abortion, not those of their parents or partners. The paper is based on qualitative data that provides insights into factors influencing abortion decision-making. Since the sample included in the study is not representative for the population of young women in Mozambique, the results cannot be generalized.
Based on the results of the study, we recommend the following measures to improve the abortion decision-making process among young women:
First, strategies should be implemented to increase women's autonomy in decision-making: The study highlighted that gender and power inequalities obstructed young women to make their decision with autonomy. We reiterate the Chandra-Mouli and colleges [ 49 ] message. There is a need to address gender and power inequalities. Addressing gender inequality, and promotion of more equitable power relations leads to improved health outcomes. The interventions to promote gender-equitable and power relationships, as well as human rights, need to be central to all future programming and policies [ 49 ].
Second, patients and the whole population should be better informed about national abortion laws, the recommended and legal procedures and the location of abortion services, since, despite the decision to terminate pregnancy resulted to the imposition, if they were well informed on that, maybe they could be decide on safe and legal abortion, avoiding double autonomy deprivation. At the same time, providers must be informed about the status of national abortion laws. Additionally, they should be trained in communication skills to promote shared decision-making and patient orientation in abortion counseling.
Third, the number of health facilities providing abortions services should be increased, particularly in remote areas.
Finally, health providers should be trained in communication skills to promote shared decision-making and patient orientation in abortion counseling.
The abortion decision-making by young women is an important topic because it refers the decision made during the transitional period from childhood to adulthood. The decision may have life-long consequences, compromising the individual health, career, psychological well-being, and social acceptance. This paper, on abortion decision-making, calls attention to some attitudes that lead to the illegality of abortion despite it was done at a health facility.
Authors gratefully acknowledge the support, contribution, and comments from all those who collaborated direct or indirectly, especially Olivier Degomme, Eunice Remane Jethá, Emilia Gonçalves, Cátia Taibo, Beatriz Chongo, Hélio Maúngue and Rehana Capruchand.
All authors contributed significantly to the manuscript. Mónica Frederico collected data and developed the first analysis. The themes were intensively discussed with Kristien Michielsen, Carlos Arnaldo and Peter Decat. The subsequent versions of the article were written with the active participation of all authors.
The authors declare no conflicts of interest.
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Documentation of these effects is important for advocacy, policy change, and resource allocation. The White et al. paper wisely uses care in describing the data they have as "documented facility-based abortions," acknowledging the now-frequent practice of non-facility-based self-managed abortion with pills.
Abstract. Abortion services are a vital component of reproductive health care. Since the Supreme Court's 2022 ruling in Dobbs v. Jackson Women's Health Organization, access to abortion services has been increasingly restricted in the United States. Jung and colleagues review current practice and evidence on medication abortion, procedural ...
Abstract. This article presents a research study on abortion from a theoretical and empirical point of view. The theoretical part is based on the method of social documents analysis, and presents a complex perspective on abortion, highlighting items of medical, ethical, moral, religious, social, economic and legal elements.
Policy Points. The historic 2022 Supreme Court Dobbs v Jackson Women's Health Organization decision has created a new public policy landscape in the United States that will restrict access to legal and safe abortion for a significant proportion of the population.; Policies restricting access to abortion bring with them significant threats and harms to health by delaying or denying essential ...
A study by Benson et al. evaluated evidence on the impact of abortion policy reforms on maternal death in three countries, Romania, South Africa, and Bangladesh, where reforms were immediately followed by strategies to implement abortion services, scale up accessibility, and establish complementary reproductive and maternal health services ...
Her research is focused on reproductive health, abortion policy and politics, teenage pregnancy, and sexual health. She has published widely on women's abortion experiences, abortion policy and practice, and reproductive control. Her work has been published in Contraception, Health, Risk and Society, and Sociology Compass.
abortion and diminish the number of quali fied medical pro-fessionals who can provide abortion care. In 32 states, abor-tions can be performed only by a licensed physician, 18 a requirement that limits the practice of advanced-practice clinicians. Research has shown no differences in outcomes of medication and aspiration abortion in relation ...
Legal abortion is a safe clinical procedure, with extremely low rates of complications and death. 1 Conversely, the risk of death associated with childbirth is 14 times that associated with legal ...
Background A country's abortion law is a key component in determining the enabling environment for safe abortion. While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, with the majority of them moving away from an absolute ban. However, the implications of these reforms on women's access to and use ...
Abortion is a common medical or surgical intervention used to terminate pregnancy. Although a controversial and widely debated topic, approximately 73 million induced abortions occur worldwide each year, with 29% of all pregnancies and over 60% of unintended pregnancies ending in abortion. Abortions are considered safe if they are carried out using a method recommended by WHO, appropriate to ...
Under the opposite and also extreme scenario in which those with unknown outcomes had ten times lower odds of an incomplete abortion, effectiveness would be 98.2% (95% CI = 97.9-98.6%) and ...
Introduction. In March 2022, the World Health Organization (WHO) released updated guidelines consolidating the current evidence and best practices for quality abortion care. 1 Undergirded by a framework of human rights standards and in recognition of the centrality of an enabling environment, the new set of recommendations span law, policy, clinical services, and mechanisms for service delivery.
Research on abortion opinion itself activates abortion patient perceptions, as evidenced by an outsized emphasis on abortion context, reasons informing a decision, and stigma . The pervasiveness of imagination in abortion opinion calls for deeper inquiry into the ways that everyday Americans imagine abortion and abortion patients, or what we ...
The CDC says that in 2021, there were 11.6 abortions in the U.S. per 1,000 women ages 15 to 44. (That figure excludes data from California, the District of Columbia, Maryland, New Hampshire and New Jersey.) Like Guttmacher's data, the CDC's figures also suggest a general decline in the abortion rate over time.
Policy Points The historic 2022 Supreme Court Dobbs v Jackson Women's Health Organization decision has created a new public policy landscape in the United States that will restrict access to legal and safe abortion for a significant proportion of the population. Policies restricting access to aborti …
Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court's ruling. More than half of U.S. adults - including 60% of women and 51% of men - said in March that women should have a greater say than men in setting abortion policy.
from a variety of perspectives. Thus, we present IPSRH: Focus on Abortion, a special supplement of articles and other content examining the many face. s of abortion around the world.In calling for submissions, we imposed no restrictions on subject matter beyond the general theme of abortion in low- and middle- income countries; accordingly, the ...
In March 2022, the World Health Organi-zation (WHO) released updated guidelines consolidating the current evidence and best practices for quality abortion care.1 Under-girded by a framework of human rights standards and in recognition of the centrality of an enabling environment, the new set of recommendations span law, policy, clinical ...
The Standardizing Abortion Research (STAR) outcomes project aims to define a core outcome set for abortion-related research. Abortion is a common experience worldwide, with an estimated 73 million abortions annually . Robust, well-developed clinical trials and guidelines on abortion provide information that can enhance safety, effectiveness ...
From the May 2022 issue: The future of abortion in a post-Roe America. The policy impact of the Turnaway research has been significant, even though it was published during a period when states ...
A high-level overview of state abortion restrictions and protections enacted post-Dobbs. developed by the Center for Public Health Law Research at Temple University in partnership with the Society of Family Planning. A prospective longitudinal study examining the effects of unwanted pregnancy on women's lives.
Introduction. Globally, access to safe abortion is limited. As a result, an estimated 25 million unsafe abortion occur each year, and at least 22 800 women die from resulting complications, almost all in low- and middle-income countries. 1 This is often due to restrictive laws which prohibit abortion; but even in contexts where abortion is legal, other barriers, such as cost, distance and ...
JD Vance, as he was dipping his toe into politics, praised the Heritage Foundation report — 29 essays opposing abortion and seeking to instruct Americans on how to raise children — as ...
1. Introduction. Abortion among adolescents and youth is a major public health issue, especially in developing countries. Estimates indicate that 2.2 million unplanned pregnancies and 25% (2.5 million) unsafe abortions occur each year, in sub-Saharan Africa, among adolescents [].In 2008, of the 43.8 million induced abortions, 21.6 million were estimated to be unsafe, and nearly all of them (98 ...