The nature and dynamics of coping with induced abortion in young adult women
This study was motivated by a strong appeal that more than two decades after the implementation of the Choice on Termination of Pregnancy Act (South Africa, 1996), the promise of access regarding pre- and post-abortion counselling is not yet translated into effective service delivery. In addition, there is a gap in the literature on how South African women experience and cope with induced abortion, as well as the extent to which coping interventions specifically emphasize the self-regulatory, agency-related aspects of coping. The study consists of three substudies, reported in three manuscripts. Manuscript 1 aims to determine what international and South African literature is available on how women experience and cope with induced abortion and to determine to what extent their coping strategies reflect a sense of agency and self-regulation. It presents a rapid review using the guidelines of the National Institute for Health and Clinical Excellence (NICE) (2012) as basic framework and a narrative synthesis (Popay et al., 2006) to synthesize the results. Manuscript 2 explores how a sample of young adult South African women who had undergone an induced abortion perceive the relationship between different aspects of their experience and coping, and to develop a conceptual model based on that. Interactive Qualitative Analysis (IQA) (Northcutt & McCoy, Interactive qualitative analysis. A systems method for qualitative research, 2004) was applied to obtain the findings. Manuscript 3 conceptualizes and provides a stepwise development of counselling guidelines to facilitate effective coping skills in young adult women undergoing an induced abortion. Guidelines were developed according to the framework provided by Gagliardi, Marshall, Huckson, James and Moore, (2015) and Wight, Wimbush, Jepson and Doi (2016), based on the findings of manuscript 1 and manuscript 2. Together, the three substudies found that an unwanted pregnancy and abortion is a complex, intertwined experience which challenges women and affects both their inter- and intra-personal relationships. They often experience a lack of support, negative emotions, isolation or rejection during the abortion process, while positive experiences were limited to relief and some meaning focused coping efforts. The unwanted pregnancy seems to be the starting point of an event that causes a discrepancy between where they want to be regarding important life goals and where they currently are. It motivates them, at the same time, to avoid others to protect themselves from rejection and judgement. The resulting lack of social support and absence of clear problem-focused coping efforts, contribute to the maintenance of negative experiences. It was argued that in order to facilitate psychological growth in these women, their general resources and coping skills should be fostered and broadened (Fredrickson, 2013). In South African public hospitals where facilities are often lacking and stigma often thriving, counsellors could play an important role to set these women on psychological growth trajectories. Based on this, guidelines were developed that emphasize consideration of each woman’s context within a combined person-centred and strengths approach to maximise the effectiveness of three proposed change mechanisms.
- Health Sciences