Scandinavian women's experiences with abortions on request: a systematic review

REVIEW QUESTION/OBJECTIVE: The objective of the review was to explore the experiences of Scandinavian women with abortions on request, that is, before, during and after the intervention.

INTRODUCTION: In Scandinavia, the primary issues surrounding the abortion debate to date have been women's legal rights to an abortion, and, to a lesser extent, how women experience an abortion on request and how society could and should support them. This systematic review investigated Scandinavian women's experiences in relation to this intervention.

INCLUSION CRITERIA: The current review included all studies that focused on adult women (aged 15 and over) living in Scandinavia (Denmark, Sweden and Norway) who have experienced an abortion on request (a medically or surgically induced abortion without a medical indication for the mother or child, described here as an "abortion on request"). The phenomena of interest were Scandinavian women's experiences in relation to an abortion on request, that is, before, during and after the intervention, and self-reported psychosocial or psychological health consequences following the abortion. This systematic review focused on Scandinavian hospital or clinical environments where authorized medical personnel performed abortions on request. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

METHODS: A three-step search strategy was used to identify published and unpublished studies from 1973 to June 2016. The comprehensive literature search identified nine studies that met the inclusion criteria. These nine studies were assessed by two independent reviewers using the standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Six of these studies were deemed to be of sufficient methodological quality for inclusion in this systematic review. Data were extracted from the six included studies using the standardized data extraction tool from JBI. A total of 24 qualitative research findings were pooled using JBI methodology.

RESULTS: A total of six studies met the inclusion criteria, with a total of 80 participants. Twenty-four research findings were extracted and grouped into six categories that were synthesized into three synthesized findings: 1) Experiences in connection with the decision-making process; 2) Experiences in connection with the procedure; and 3) Experiences after abortion. The vast majority of participants were aged 15 to 24 years at the time of the abortion. Conclusions and recommendations for practice apply to Scandinavian women within this age group.

CONCLUSIONS: This systematic review indicates that young Scandinavians consider it a woman's responsibility to obtain and use contraceptives and that young women seeking an abortion on request have little knowledge of their own bodies with respect to fertility and their menstrual cycles. Young Scandinavian women between the ages of 15 and 24 years seeking an abortion on request experience conflicted feelings. They feel both joy and shame about their pregnancies and, during the decision-making process, are torn between the possibility of motherhood and the reasonable and expected choice of abortion that is supported by their parents and friends. The majority of women experience worse-than-expected pain and discomfort in connection with the abortion procedure. The approach of healthcare staff to women's physical needs is described as good and professional, but there is little or no focus on the women's emotional and existential needs. After abortions on request, young women express ambivalence: relief that the pregnancy has been terminated, coupled with a feeling of loss. Some suffer from guilt and some express regret.