Research roundup: Considerations for individuals seeking reproductive health care

Reproductive health care decisions for women, people with the capacity for pregnancy¹, and their loved ones can be challenging and at times stigmatized.

Access to safe reproductive health care options has a complicated history in the United States, even more so for people of color who continue to have, “the poorest pregnancy-related outcomes and treatment” (Altshuler et al., 2021). Studies show that over 334 laws in the United States have been passed to restrict abortion and only 10% of U.S. counties have abortion providers (Ely and Murshid, 2021).

Restrictions on reproductive freedom, like the abortion bans going into effect in several states, may also increase symptoms of stress, anxiety, and depression. Psychologists can play an important role in supporting decision-making, navigating challenges and barriers and addressing emotional responses when working with people who may become pregnant.

¹While most of the studies below include only women participants (and use the term “woman” throughout), it is worth noting that sexual and gender minority populations (SGM) also have the capability for pregnancy (Moseson 2021). SGM populations include, but are not limited to, intersex, nonbinary, transgender, and Two-Spirit individuals.

Note: In addition to reviewing the research summaries, psychologists are encouraged to further explore the literature to determine what may be useful to them in practice, particularly as it relates to patients’ values, culture, and preferences.

Altshuler, A. L., Ojanen-Goldsmith, A., Blumenthal, P. D., & Freedman, L. R. (2021). “Going through it together”: Being accompanied by loved ones during birth and abortionopens in new window. Social Science & Medicine, 284, Article 114234.

Challenging emotions that arise during abortion and birth may be alleviated by the accompaniment of a loved one. This study assessed participants’ experiences of having a loved one accompany them during both abortion and birth to inform each reproductive experience.

Participants were recruited via local print and internet advertisements in Northern California between April and December 2014. Eligible participants were cisgender women between 18–49 years old who had an abortion within the past five years and a birth experience at any point in their lives. Semi-structured, intensive interviews were had with the 24 eligible participants, a majority of whom were Black or Latina with spiritual or religious affiliations. Researchers developed a codebook to quantify participants experiences and field observations were conducted with abortion and birthing facility doulas to further contextualize interview data.

Twenty transcripts were eligible for analysis. All the participants were accompanied by a loved one during their most recent birth. Just over half were accompanied by a loved one during their abortion. Of the individuals who were unaccompanied during their abortion, half of the clinics had policies that did not allow accompaniment.

Researchers identified three themes among participants’ reproductive experiences. Having a loved one bear witness to the reproductive experience and serve as an advocate alleviated negative emotions and offered a sense of security to the person experiencing the abortion or birth. Accompaniment also provided a sense of shared responsibility, especially for those whose partners accompanied them as they were able to experience parenthood from the conception to birth together. This shared responsibility also helped to protect the person with the reproductive experience from embarrassment and shame. While the first two themes highlighted the positive effects of accompaniment, the last theme adds that it may also be burdensome if someone feels they must manage loved ones’ emotions.

Rocca, C. H., Moseson, H., Gould, H., Foster, D. G., & Kimport, K. (2021). Emotions over five years after denial of abortion in the United States: Contextualizing the effects of abortion denial on women's health and livesopens in new window. Social Science & Medicine, 269, Article 113567.

This study presents findings from a subset of data from The Turnaway Study, a longitudinal study on the effects of abortion and denial of an abortion in women between 2008–2016. The Turnaway Studyopens in new window followed almost 1000 women over five years who wanted an abortion to examine the similarities and differences between those who obtained an abortion and those who were denied an abortion. This paper presents research on U.S. women who were denied an abortion. (For more information on The Turnaway Study, see The facts about abortion and mental health and Speaking of Psychology: Abortion and mental health with Antonia Biggs, PhD.)

Individuals were turned away or denied an abortion because they exceeded the gestational age for which the facility could offer an abortion. All eligible participants were women older than 15 years who spoke English or Spanish and had no known fetal abnormalities when presenting at an abortion facility. One hundred sixty-one participants of diverse racial and ethnic backgrounds made up the analytic sample, completing the first survey eight days after presenting for an abortion and then semiannually over the next five years. The survey questions remained constant over time and asked participants which of the six emotions (relief, happiness, regret, guilt, sadness, and anger) they felt and whether they would still have an abortion.

A multivariable mixed-effects linear regression was used to analyze participant’s emotions over time. Overall, negative emotions were strongest one week after the abortion denial and declined over time whereas positive emotions were lowest one week after the abortion denial and highest one year after the birth of their child. One week after the abortion denial, over half of participants answered that they still wished they could have had an abortion, but that percentage shrank to 11% one year after their child was born.

Fifteen participants agreed to qualitative interviews which provided insight into their changing emotions vis a vis their life circumstances over time. Two independent researchers coded the qualitative interviews, developing a codebook to produce analytic summaries. Of these women, two placed their babies for adoption. These two women experienced higher negative emotions overtime and continued to wish they could have had an abortion. Among all 15 women, social support was critical in shifting participants emotions from negative to more positive over time.

While it is important to note that those denied an abortion in general did shift their emotional responses over time, the women in The Turnaway Study who obtained an abortion had better public health and socioeconomic outcomes than the women denied an abortion. Additionally, some of the women who received an abortion and later bore a child were better able to bond with those children than the women denied an abortion.

Siegel, D. P. (2021). Wanting a “feminist abortion experience”: Emotion work, collective identity, and pro‐choice discourseopens in new window. Sociological Forum, 36(2), 471–490.

The ability to manage one’s emotions and still hold true to one’s identity may impact the psychological aspect of an abortion experience. The author, an abortion counselor, sought to explain how a feminist and pro-choice identity impacted the emotions of a person seeking and completing an abortion.

Fifty facilities were contacted between August 2017–July 2018 in two, Northeastern U.S. cities seeking participants to self-select for the study. Twenty-seven people over the age of 18 who had an abortion within the past five years met the criteria for the study. Participants identified as cisgender women or genderqueer, most had a high level of education and were of diverse racial and ethnic backgrounds. Most had abortions within the first trimester.

The author examined how participants internalized a feminist identity, navigated their identity within the feminist and pro-choice community, and how their abortion story may impact others. All participants expected their emotions to align with the feeling rules—or rules that dictate the proper emotion for a situation—of their communities and felt guilty when they didn’t. Participants who self-identified as activists more strongly internalized their feelings when those feelings (e.g., shame or guilt) did not align with those expected of a feminist (i.e., relief, empowerment, and lack of attachment to pregnancy) and were more likely to want to modify their emotions compared to nonactivists. This led some participants to feel obligated to shape their stories depending on the situation and potential outcome leading to a disconnect between their actual and presented experience.

Ely, G., & Murshid, N. (2021). The association between intimate partner violence and distance traveled to access abortion in a nationally representative sample of abortion patientsopens in new window. Journal of Interpersonal Violence, 36(1-2), NP663–NP689.

Intimate partner violence (IPV) negatively impacts women’s reproductive health and in turn, impedes problem solving and decision-making skills. Using the most recent data from the Guttmacher Institute’s Abortion Patient Survey (2008), the authors used indicators to determine the association between physical and sexual IPV on distance traveled to an abortion facility. Data from 7,290 women were collected via questionnaire as they waited to be seen at an abortion facility. 

Over 80% of women traveled within 50 miles to receive an abortion. The majority noted the pregnancy was mistimed and over half had never had an abortion before. Individuals who experienced physical violence, but not sexual IPV, traveled longer distances to obtain an abortion. This may be explained by the woman’s need to navigate the violence first which is shown to impede problem solving and self-awareness and therefore the pregnancy may not be recognized right away and delays to care occur. Physical IPV is a potential factor to receiving adequate and timely reproductive health care.

Practitioners may find themselves working with clients who are presenting or may be at risk for reproductive health challenges. Assessing for pregnancy and risk factors (e.g., intimate partner violence) early may be critical in providing clients with appropriate care. Before conducting such assessments, psychologists will want to explain the limits of confidentiality and what and how protected health information is documented in the health care record (for more information, see the two FAQs under Related and Recent.) Exploring relevant factors during therapy can facilitate the clients’ decision-making regarding reproductive health care options, including when and where to access care and whether to ask someone to accompany them. Providing an open, non-judgmental space to discuss concerns allows individuals to carefully consider their decision and to identify and manage their emotions.

Research shows that individuals who seek and receive abortions have low decision uncertainty, felt it was the right decision years later, and have better quality of life than those denied an abortion (Rocca et al., 2021), however, individuals may still need time and space to identify and manage their emotional responses. These research studies highlight the importance of having social support during the reproductive experience (birth, abortion, and adoption) and to process and manage emotions. For some individuals, their personal identities and beliefs may facilitate or complicate their emotional experience and openness to exploring that intersection will be therapeutically beneficial. Finally, the last article underscores the complications of IPV and how that might impact access to care and the importance of clinicians gauging that possibility and assessing for safety and options.