nursing case study about abortion

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Ethical Care for Patients with Self-Managed Abortion After Roe

Manns-James, Laura PhD, CNM, WHNP-BC, CNE, FACNM; Pfeifer, Kelly MD; Gillmor-Kahn, Mickey MSN, CNM

Laura Manns-James is an associate professor and Mickey Gillmor-Kahn is course faculty in the Department of Midwifery and Women's Health, Frontier Nursing University, Versailles, KY. Kelly Pfeifer is an abortion provider in Kansas, Arizona, and California, and an abortion policy advocate and consultant. The authors acknowledge Gail Spake for editorial assistance, Kiernan Cobb, BSN, RN, for creating the two featured posters, and Christina Bourne, MD, MPH, Kiernan Cobb, BSN, RN, Jessica Gelsomino, MSN, RN, and Dhalbir Khalsa, MA, PA-C, for providing helpful early reviews of the manuscript. Contact author: Laura Manns-James, [email protected] . The authors have disclosed no potential conflicts of interest, financial or otherwise.

Copyright © 2023 The Author. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

The 2022 Supreme Court decision leaving the regulation of abortion to the states is sure to result in a complex regulatory environment for patients and nurses. In states where abortion is illegal, patients may self-manage abortions using medications they obtain through the mail or by other means. Nurses may care for these patients in multiple settings and may wonder about their own legal and ethical obligations. This article reviews patient privacy as it relates to self-managed abortion, ethical reporting requirements for nurses, and best practices for treating complications of self-managed abortion using a harm reduction framework, with a focus on protecting patients' rights. Recommendations for ethical patient care are also provided.

A review of patient privacy as it relates to self-managed abortion, ethical reporting requirements for nurses, and best practices for treating complications of self-managed abortion using a harm reduction framework, with a focus on protecting patients' rights.

In June 2022, the U.S. Supreme Court ruled in Dobbs v. Jackson Women's Health Organization that states may regulate the provision of abortion services, 1 which could mean criminalizing abortion, including medication abortion. As a result, changing legal environments may create practice challenges for nurses caring for patients presenting with miscarriage or bleeding during early pregnancy. In areas where legal abortion is unavailable, people may seek abortion pills to end their pregnancies without clinician involvement, a practice called self-managed abortion.

Telemedicine and mail-order pharmacies can provide medically safe and effective medications (mifepristone and misoprostol) to terminate early pregnancies safely. Mail-order pharmacies often provide medications without clinician involvement, and evidence to date demonstrates both the safety and efficacy of this option. 2 (See A Quick Guide to Medication Abortion .) Individuals can also obtain misoprostol by visiting countries, such as Mexico, where it may be available over the counter.

However, some pregnant people, lacking timely and legal access to abortion, resort to unsafe methods. 3 As a result, as many as 39,000 women die annually from unsafe abortions, although that number may be underestimated given the poor statistical reporting systems in some countries. 3

Individuals who follow World Health Organization (WHO) protocols to terminate their pregnancies at up to 12 weeks' gestation using mifepristone or letrozole plus misoprostol, or misoprostol alone, are unlikely to need hospital care. (See WHO Medication Abortion Regimens at < 12 Weeks' Gestation . 3, 4 ) These regimens are safe and effective; typically, no additional medical care is needed beyond informational support. 3 Severe complications are extremely rare. 3, 4

Some patients, though, may present to EDs or ambulatory settings with bleeding, pelvic pain, or infection. These patients may require or desire clinicians to complete the abortion or to manage symptoms or complications. What then is the duty of the nurse when the cause of early pregnancy complications is either ambiguous or reported to result from an attempt to end the pregnancy? Does this responsibility change when abortion is criminalized in the state where the nurse practices?

ABORTION IN THE UNITED STATES

Approximately one in four women in the United States has an abortion in her lifetime. 5 Most Americans who obtain an abortion (60%) are in their 20s, and 59% of women who have had an abortion have other children. 6 Although people of all ages, races, ethnicities, and incomes have abortions, most (75%) are disproportionately poor or low income. 6 They are also more likely to be Black, Indigenous, Hispanic, and other people of color 4-8 due to a lack of equitable access to high-quality reproductive health services, resulting in a higher burden of unintentional pregnancy. Structural racism results in longstanding inequities in maternal morbidity and mortality that make continuing a pregnancy to term more dangerous, particularly for Black and Indigenous people. 5 A recent estimate suggests that a nationwide total abortion ban in the United States would result in an increase in the lifetime risk of death from all pregnancy-related causes from 1 in 3,300 to 1 in 2,800 for all women. 9 For non-Hispanic Black women, the risk would increase further, from 1 in 1,300 to 1 in 1,000 9 —three times that of the general population.

In 2019, the latest year for which data are available, the Centers for Disease Control and Prevention stated that 42.3% of all reported abortions in the United States were medication abortions (typically mifepristone followed by misoprostol) at nine weeks' or less gestation and 1.4% were medication abortions at more than nine weeks' gestation. 8 These figures do not include self-managed medication abortions that were not reported to a health system; further, some jurisdictions do not report medication versus other types of abortion. 8

Medication abortion as a proportion of all abortions has risen steadily over time. 10 The increase accelerated in 2021, when the Food and Drug Administration began allowing telemedicine prescribing of abortion medications in response to the coronavirus pandemic. Medication abortions are anticipated to increase in the future, both despite and because of state-based changes in the legality of abortion provision. 10 Online requests for self-managed abortion medications have increased since the Dobbs decision, particularly in states that severely restrict legal abortion access. 11

Laws that criminalize abortion have a long history of causing harm, particularly to those whose position within social hierarchies makes them vulnerable. 12, 13 For this reason, many organizations have publicly opposed making abortion illegal. In its information series on sexual and reproductive health and rights, the UN Office of the High Commissioner for Human Rights says, “Human rights bodies have repeatedly called for the decriminalization of abortion in all circumstances.” 14 The American College of Obstetricians and Gynecologists (ACOG) opposes the criminalization of self-managed and clinician-assisted abortion, as do the National League for Nursing, Nurse Practitioners in Women's Health, American College of Nurse-Midwives, and Association of Women's Health, Obstetric and Neonatal Nurses. 15-19 More than 70 other health care organizations have affirmed safe, legal abortion as an essential element of reproductive health care. 20

ABORTION AND PATIENT PRIVACY

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), developed by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights, requires respect for the privacy and confidentiality of people deciding to self-manage abortion or receive telemedicine services. 21 This means that nurses may risk penalties for HIPAA violations if they report suspected or patient-disclosed attempts at abortion to law enforcement, state agencies charged with the prevention of child abuse (such as child protective services [CPS]), or any other individual or entity not designated by the patient, in the absence of a court order or subpoena.

As of November 2022, no state required the reporting of people who attempt to end their own pregnancies. 22 However, even before the Dobbs ruling, individuals in several states had been investigated owing to suspicions that they attempted to terminate their own pregnancies. 23 Between 2000 and 2020, at least 61 people were criminally investigated because of allegations that they either ended their own pregnancies or helped someone else to do so. 24 Of those 61, 39% were reported to authorities by health care providers and another 6% by social workers. Most (56%) were poor, and people of color were overrepresented. Prosecutors used criminal statutes such as concealment of birth, child abuse and assault, and homicide to charge alleged offenders, and homicide charges were twice as likely to be brought against racially minoritized defendants. Of the 61 cases on record, 87% resulted in arrest. 24

HARMS OF REPORTING AND NURSING ETHICS

Black people and other people of color have historically been disproportionately targeted for the enforcement of laws governing behavior during pregnancy, such as drug use. 25 This policing, which often starts with reports to authorities by professionals, increases distrust in the medical system and health care providers among communities of color. 26 Moreover, clinician bias can influence reporting decisions, 27, 28 so laws criminalizing abortion or risky behaviors during pregnancy will almost certainly contribute to structural racism, health disparities, and family disruption 29 unless clinicians keep health information private.

There is no reason for clinicians to use a decision to terminate a pregnancy as grounds to report patients to CPS, since self-managed abortions do not endanger children in the home. Similarly, minors who use mifepristone and misoprostol to self-manage an abortion are not a danger to themselves or others. 4

The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements 30 may help guide ethical decision-making for nurses who care for patients presenting for abortion-related health care, particularly in jurisdictions where the provision of abortion services is prohibited or restricted. Provisions 1, 3, 4, and 8 are particularly relevant to nursing practice involving pregnant patients in these jurisdictions.

Provision 1 speaks to the rights of patients to self-determination and to be cared for in accordance with their values. Patients have the “right to determine what will be done with and to their own person,” 30 and a nurse must respect patient decisions even when those decisions may conflict with the nurse's own values. The Code of Ethics does not require support for or agreement with patient decisions but does require nurses to establish a relationship of trust, setting aside biases and prejudice.

Provision 3 establishes the duty of the nurse to protect and advocate for the rights, health, and safety of the patient, including the right to privacy and confidentiality. 30 The Code of Ethics explicitly acknowledges the damage to the nurse–patient relationship that can result from a breach of confidentiality, resulting in loss of patient trust and jeopardizing patient well-being. However, the duty to protect confidential information may be limited, such as when disclosure is legally mandated due to public safety or health considerations.

Provision 4 establishes that nurses are accountable for their own conduct, though institutions may at times share responsibility. 30

Provision 8 explicates a duty of the nurse to “advance health and human rights and reduce disparities” by collaborating “with others to change unjust structures and processes that affect both individuals and communities.” 30

None of these provisions include a duty to participate actively in providing abortions or pregnancy terminations; provision 5.3 allows for the exercise of conscience by individual nurses. 30 In nonemergent contexts, nurses may decline to participate in care to which they morally object. 30 Provision 5 does not, however, give nurses the right to decline to participate in emergent care or to break patient confidentiality, nor does it supersede patient rights or duties to the patient.

ETHICAL REPORTING REQUIREMENTS FOR NURSES

Legal and ethical indications for reporting are rare, and the ANA Code of Ethics and federal law should inform nursing practice in the following instances.

Reporting suspicion of induced abortion to law enforcement . Unless state law explicitly requires it, nurses should not proactively report suspicion of abortion to law enforcement. Nurses should not release protected health information (PHI) to law enforcement or any other non-treating provider or agency without a subpoena or court order (in which case the PHI released must be restricted to the PHI requested). Disclosing PHI outside of these limited circumstances is a HIPAA violation and puts the nurse and the hospital at risk for fines and penalties. 21

The following are real-world examples . 21

• A law enforcement official goes to an ED and requests records of pregnancy outcomes for ED patients. Unless the request includes a court order or other legally enforceable mandate, the HIPAA “privacy rule” does not permit the ED to disclose the records or other PHI. Disclosure without a legal mandate is considered a breach of unsecured PHI and requires formally notifying both HHS and the patient.
• A law enforcement official presents an ED with a court order requiring the release of PHI about a particular patient. Only the PHI expressly contained in the court order may be disclosed by the ED.

Reporting intent to terminate a pregnancy . According to ACOG, it is inconsistent with professional standards of ethical conduct to disclose PHI about an individual's plans regarding contraception or pregnancy outcomes to law enforcement or others. 15 The ANA specifically affirms the right to privacy for individually identifiable health information, including oral reporting, in all treatment settings and venues; use or disclosure of this information is prohibited unless required by law. 31

A real-world example: In a state that bans abortion, a patient informs the nurse that she's planning to go out of state to secure an abortion. The nurse believes it appropriate to report the patient's plan to the police, to prevent the abortion. However, the HIPAA privacy rule forbids this disclosure of PHI because the HHS doesn't consider a statement of intent to terminate a pregnancy a “serious and imminent threat to the health or safety of a person or the public.” 21 This act is also contrary to professional ethical standards, would violate the integrity of the nurse–patient relationship, and could harm the patient.

Reporting to CPS . Suspicion of abortion should not be a reason to contact a CPS agency, for these reasons:

• Historical precedent suggests that such reporting will disproportionately disrupt racially minoritized families and children. For instance, despite similar rates of substance use, Black women are more likely to be reported to CPS agencies than White women, 32 and more likely to have parental rights terminated. 33 Indigenous children are most at risk for legal separation from their parents. 33
• There is no evidence that a minor patient or an adult patient's children are at any risk solely due to the patient's decision to end a pregnancy through self-managed abortion. To the contrary, many people ending a pregnancy do so to be better able to care for the children they have. 34 The five-year Turnaway Study, which followed 813 women who presented for abortion, found negative effects on the children of women who were denied an abortion, including poorer maternal–child bonding, greater economic insecurity, greater exposure to interpersonal violence, and a nearly fourfold greater risk of growing up in poverty. 35, 36
• Women who were able to access abortion in the Turnaway Study were three times more likely to be employed, less likely to need public assistance, and less likely to stay in abusive relationships. 35, 36

A real-world example: A patient in a state that bans abortion claims she is having a miscarriage, but the nurse thinks the patient may have caused the miscarriage by using abortion medications. The nurse wants to report this patient to his county CPS agency because he believes the fetus was harmed through the mother's actions. As stated above, regardless of the nurse's personal beliefs, HIPAA does not permit release of PHI to government agencies such as CPS, as pregnancy termination is not considered a CPS-reportable issue.

EVIDENCE-BASED RECOMMENDATIONS FOR NURSES

Nurses come to work with a wide range of personal, religious, and spiritual beliefs regarding pregnancy and contraception. Fortunately, our professional societies provide clear principles to guide our actions in this complex and changing environment. The following recommendations for nurses who treat patients with self-managed medication abortion are supported by current evidence and guidelines.

Take a harm reduction approach . Nurses treat many conditions created by illegal or extralegal behavior that leads to ED visits, such as use of alcohol by minors, illegal drug use, or car accidents caused by excessive speed. None of these are mandated to report to law enforcement. All require nonjudgmental, compassionate care to preserve the patient's trusting relationship with the nurse.

Manage abnormal bleeding as you would spontaneous miscarriage, 4 keeping in mind that the emotional support needs of the patient with self-managed medication abortion may vary significantly. Because bleeding in early pregnancy can have multiple causes, keep initial interview questions open ended so the patient can describe their situation in their own words and manage information disclosure; seek information only to the extent that management decisions may be affected, and support needs determined. 4

Treatment may include uterotonic medications (such as misoprostol) or procedural interventions (dilation and aspiration and/or curettage). 37 As with miscarriage, the presence of uterine debris on ultrasound only requires medical intervention if the patient is having severe pain or hemorrhaging. 38 If the symptoms indicate unsafe methods of self-managed abortion, such as toxic ingestion or self-instrumentation, management proceeds based on the cause of the symptoms. 39 The WHO recommends against the use of anti-D immunoglobulin—also called rho(D) or RhoGAM—at less than 12 weeks' gestation. 3

Consider whether to document evidence of self-managed abortion . Carefully weigh documenting in the health record the use of mifepristone, letrozole, or misoprostol to bring about abortion, or the presence of any medications found in the vaginal vault. This information is usually unnecessary for care; recording it may cause significant harm. 4 Documenting evidence of self-managed abortion may lead to delays in care, stigma, or inappropriate release of medical information to law enforcement by other members of the health care team.

Ensure patients are aware of their options when fetal cardiac motion is present and the pregnant person's health or life is at risk. These situations may include ectopic pregnancy, when urgent intervention is the standard of care, as the risk of expectant management (wait and see approach) can be tubal rupture, hemorrhage, and death; inevitable miscarriage due to medications or spontaneous abortion, where a dilated cervix may require intervention to prevent infection and sepsis; and individualized significant health problems that can be resolved or ameliorated only by terminating the pregnancy (such as obstetrical sepsis, severe early preeclampsia or HELLP [hemolysis, elevated liver enzymes, low platelets] syndrome).

Ensure patients receive an examination and/or treatment in hospital emergency settings. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), when a pregnant patient presents to an ED and requests examination or treatment, the hospital must either provide stabilizing treatment or transfer the patient to another capable hospital that can. In guidance released in July 2022 and updated in October, the Centers for Medicare and Medicaid Services (CMS) clarified that EMTALA requirements preempt state laws and mandates that apply to specific procedures. 40 (Active litigation interpreting the enforceability of the EMTALA guidance is ongoing.) Appropriate emergency care must be provided by physicians and hospital staff regardless of state abortion bans and restrictions.

Refer patients who need legal advice to resources such as If/When/How ( www.ifwhenhow.org ), a legal helpline for people who need information about their rights and self-managed abortion or other pregnancy termination services (see Figure 1 ).

Be aware of any harmful action or practice that disproportionately affects racially minoritized and other vulnerable individuals due to biases in reporting and justice system/child welfare system treatment. Endeavor to reduce disparities and promote social justice. Specifically, maintain patient privacy and avoid any reporting to law enforcement or CPS agencies that is not specifically mandated by law (see Figure 2 ).

IMPLICATIONS FOR NURSING PRACTICE

Nurses approach caregiving using personal codes of ethics and moral commitments, and these may sustain us in difficult situations. However, given that religious and spiritual views on reproductive health vary dramatically, nurses must turn to the ANA Code of Ethics for guidance. The Code of Ethics provides important principles to guide practice and behavior, and recent federal directives from the HHS have clarified federal privacy protections, which supersede state law.

Most important, in our care of patients, nurses should do no harm. Reporting patients to law enforcement can have devastating and lasting effects, including disrupting healthy, intact families and precipitating vulnerable families into poverty and homelessness. While nurses may not always agree with patients' choices, we must uphold their right to make decisions based on their own values and keep their health information private whenever we are legally able to do so.

Laws that criminalize abortion may negatively affect nurses as well as patients. Nurses risk moral injury when they wish to practice in accordance with their values and those of their patients but are legally prohibited from doing so. Moral injury can occur when nurses are placed in a situation where it is impossible or nearly impossible to act in a way that's consistent with their moral values. 41 This is especially true when following the law may lead to patient harm.

Historically, “conscience clauses” have allowed nurses to opt out of providing nonemergency care when doing so would cause moral compromise. Nursing ethicists should urgently address the inevitable moral dilemmas nurses will face when they practice in states that criminalize abortion, where participation in necessary health care is prohibited even when it could preserve health and lives. People need access to safe, legal abortion when pregnancy threatens their futures, health, or lives or when pregnancy termination can reduce otherwise inevitable suffering.

If You Have Questions About . . .

• State laws related to reproductive rights:
• https://reproductiverights.org/maps/abortion-laws-by-state
• Filing a complaint related to violation of privacy:
• https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf
• Legal rights related to self-managed abortion or other pregnancy termination services:
• www.reprolegalhelpline.org
• Evidence-based clinical recommendations on comprehensive abortion care:
• www.ipas.org/clinical-update/english/introduction
• Federal privacy protections:
• www.hhs.gov/about/news/2022/08/26/hhs-takes-action-strengthen-access-reproductive-health-care-including-abortion-care.html
• Cited Here |
• View Full Text | PubMed | CrossRef
• View Full Text | PubMed
• PubMed | CrossRef

harm reduction; medication abortion; nursing ethics; reproductive rights; self-managed abortion; social justice

Supplemental Digital Content

• AJN_123_1_2022_11_28_MANNJAMES_0_SDC1.pdf; [PDF] (300 KB)
• AJN_123_01_2022_12_28_MANNJAMES_0_SDC1.jpg; [Image] (338 KB)
• + Favorites
• View in Gallery

Readers Of this Article Also Read

Abortion care in america, ce: suicide prevention: protecting the future of nurses, ableism in health care, skin assessment in patients with dark skin tone, ce: how to write an effective résumé.

6 Abortion (Termination of Pregnancy) Nursing Care Plans

Abortion is the medical term for any interruption of a pregnancy before a fetus is viable (able to survive outside the uterus if born at that time). A viable fetus is usually defined as a fetus of more than 20 to 24 weeks of gestation or weighing at least 500 g. A fetus born before this point is considered a miscarriage or premature or immature birth.

Elective abortion is the planned medical termination of a pregnancy. When the interruption occurs spontaneously, it is clearer to refer to it as a miscarriage . The practice of termination of pregnancy (TOP) covers many aspects of life, is occasionally restricted in many countries, and has versatile legal definitions in different societies (Feldman et al., 2017). The goal of maternal-fetal medicine is to support the treatment of neonates affected by disorders diagnosed during pregnancy. However, the prognosis of several pathologies is so poor that TOP may be considered in countries where it legally exists (Gedikbasi et al., 2010).

The main reason for TOP is central nervous system (CNS) abnormalities. Neural tube defects, especially anencephaly, constituted a substantial cause in the early termination group, while the diagnosis and rate of hydrocephalus increased in the late group. It was found that chromosomal abnormalities are the second most common indication for TOPs, among early and late TOPs. The most common chromosomal abnormality was trisomy 21 , constituting 57.0% of chromosomal abnormalities found by studies (Gedikbasi et al., 2010).

Table of Contents

Nursing problem priorities, nursing assessment, nursing diagnosis, nursing goals, 1. helping patient through anxiety and providing emotional support, 2. providing pain relief and comfort, 3. promoting maternal safety and preventing injuries, 4. preventing hypovolemic shock, 5. preventing infection, 6. initiating patient education and health teachings, recommended resources, references and sources, nursing care plans and management.

For abortion or elective termination , the nursing plan of care for clients includes assessing biopsychosocial status, giving appropriate instruction/information, promoting coping strategies and emotional support, and preventing postprocedural complications.

The following are the nursing priorities for patients who had an abortion:

• Emotional support and counseling
• Pain management and comfort
• Education and information on post-abortion care
• Assessment and monitoring of physical well-being
• Provide contraceptive counseling and options
• Ensure privacy and maintain confidentiality
• Referral and coordination of follow-up care as needed

Assess for the following subjective and objective data :

• Vaginal bleeding , ranging from light spotting to heavy bleeding
• Abdominal pain or cramping , which can be mild to severe
• Passage of tissue or clots from the vagina
• Decrease in pregnancy symptoms, such as breast tenderness or morning sickness
• Back pain or pelvic pressure
• Signs of infection , such as fever , chills, or foul-smelling discharge

Following a thorough assessment , a nursing diagnosis is formulated to specifically address the challenges associated with abortion based on the nurse ’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Goals and expected outcomes may include:

• The client will recognize the presence of anxiety .
• The client will begin to use positive coping strategies to adjust to the situation.
• The client will use resources/support systems effectively.
• The client will report anxiety reduced to a manageable level.
• The client will identify/use methods that provide relief.
• The client will state that discomfort is minimized and/or controlled.
• The client will verbalize accurate information about the reproductive system.
• The client will explain the proper use of desired contraceptive methods.
• The client will demonstrate appropriate follow-through with treatment and aftercare.
• The client will receive Rho(D) immune globulin within 72 hr of termination, if appropriate.
• The client will verbalize the implications of the Rh factor for planning future pregnancies or for receiving blood transfusions.
• The client will discuss beliefs/values about spiritual issues.
• The client will verbalize acceptance of self/decision.
• The client will acknowledge feelings of anxiety/distress related to making difficult decisions.
• The client will verbalize confidence in the decision to terminate the pregnancy.
• The client will meet psychological needs as evidenced by appropriate expression of feelings, identification of options, and use of resources.
• The client will display a relaxed manner and/or calm demeanor, free of physical signs of distress.
• The client will recognize and report signs/symptoms of complications.
• The client will exhibit stable vital signs.
• The client will maintain a normal level of consciousness.
• The client will display palpable peripheral pulses and warm and dry skin.
• The client will exhibit individually appropriate urine output.
• The client will achieve timely wound healing .
• The client will be free of signs of infection, inflammation, purulent drainage, erythema, and fever.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with an abortion may include:

Termination of pregnancy (TOP) is different from other reproductive losses as it involves a “choice” of the woman to terminate a pregnancy or not, but the event itself is a stressful situation and can become traumatic for some women. Posttraumatic stress (PTS) is associated with perinatal grief , depression , and anxiety for pregnant women with prior medical TOP or miscarriage. For women, anxiety was associated with PTS during pregnancy, but for men, anxiety was associated with PTS during and after delivery (Daugirdaite et al., 2015).

Assess the client’s anxiety and encourage them to express their feelings. The client and her partner may be dealing with feelings of guilt, and they typically will go through a grieving process and have symptoms of anxiety and depression. Encourage the client and her partner to allow themselves to grieve. The client and her partner may grieve differently; specifically, they may go through the stages of grief in different orders or at different rates (Griebel et al., 2005).

Assess the client’s and her partner’s cultural beliefs. Polarised debates on abortion result in women being stigmatized and feeling like social outcasts. Abortion laws are also influential as they dictate the timing and medical conditions for which pregnancies can be terminated. The environment in which the client is cared for and the doctor-client relationship also influence the client’s experience. In Vietnam, women’s deference to clinicians prevents them from asking questions, and some women describe feeling ashamed of involving the healthcare provider in an “unpleasant experience.” In contrast, in other medical cultures, women are encouraged to ask questions and, where possible, participate in their care (Lafarge et al., 2014).

Establish a therapeutic relationship , conveying empathy and unconditional positive regard. Above all, women value empathic and compassionate care. They are grateful when health professionals acknowledge that their pregnancy is wanted and care for them in a non-judgmental way. They drive comfort from health professionals’ acts of kindness, which sometimes can stretch beyond the usual health care professional-client boundaries. Receiving respect and dignity for themselves and their baby is critical (Lafarge et al., 2014).

Provide psychological and mental comfort for the client and her partner. Comfort from nurses is unique and expected, routinely offered when infants are lost at term, and has recently been taught to other professions. Clients benefit from the comfort provided by nurses perhaps more than any other time. It is critically important that nurses, regardless of their personal feeling about the type of loss, reach out and offer comfort (Catlin, 2018).

Provide comfort measures such as breathing and relaxation techniques. This can influence physiological responses ( BP , pulse, and respiration). Tense muscles may interfere with the procedure. Offer relaxation techniques such as back massage , guided imagery, and the use of touch , if culturally acceptable. Being relaxed may encourage the client to verbalize feelings, thus reducing anxiety and fear .

Explain procedures before they are performed, and stay with the client to provide concurrent feedback. A physical presence is reassuring and can increase cooperation and promote a sense of security. Counseling about abortion includes help for the client in identifying how she perceives the pregnancy, information about the choices available, and information about the types of abortion procedures (Alden et al., 2019). Providing the client with information enables them to make informed decisions and cope with the termination long-term. Information provision can also be empowering, enabling women to regain control over a situation many feel they have no control over (Lafarge et al., 2014).

Provide a support person/family member to stay with the client, particularly if she is undergoing a second-trimester procedure requiring induction of labor . The presence of a familiar person can help reduce client anxiety and promote relaxation and coping. According to some studies, anxiety symptoms are associated with a higher incidence of depression and poor social support during pregnancy and postpartum (Loren-Guerrero et al., 2017).

Explore spiritual support as a resource. Spiritual support of the family’s choice and community support groups may help the family work through the grief and anxiety of any pregnancy loss.

Encourage questions and provide time for the expression of fears. This may provide an opportunity to identify and clarify misconceptions and offer emotional support. Women value timely, transparent, and unbiased information that they can understand about the abnormality, the termination procedure, and what to expect post-termination (Lafarge et al., 2014).

Pain is a predictable feature of the medical termination process; for some women, pain may be intense. In the first trimester of medical termination, pain is typically most acute following the administration of prostaglandins or their analogs. In addition to uterine cramping, pain during the second-trimester medical termination is increased by the passage of the fetus through the cervical canal (Jackson & Kapp, 2011).

Determine the extent/severity and location of discomfort. Although some discomfort is expected, severe cramping and abdominal tenderness may indicate complications. Predictors of narcotic analgesia use during first-trimester termination include later gestational age, younger client age, and lower parity (Jackson & Kapp, 2011). More pain may be expected with the increasing need for cervical dilation as gestational age advances (Renner et al., 2012).

Assess and systematically monitor the client for a verbal report and objective cues of pain every two hours. Changes in pain indicate an improvement in the client’s condition or the development of complications. Behavioral and physiologic responses clarify the presence of pain when the client is unable to self-report pain.

Explain to the client the nature of discomfort expected. Knowledge helps the client to cope with reality. Cramping pain during and for one week after a first-trimester termination is expected. Clients treated with prostaglandins may experience nausea , vomiting , and diarrhea . The traditional alternative to misoprostol for dilatation of the cervix before an elective termination is the laminaria tent. This method causes considerable discomfort to a large number of women during insertion . In a study, women found that misoprostol is easier to use than the laminaria tent, and they feel less pain during its insertion and have less need for analgesics (Gagne et al., 2010).

Provide comfort measures such as relaxation and breathing techniques. Promoting relaxation is basic to all other methods of pain management and birth preparation, both nonpharmacological and pharmacological. Relaxation techniques require concentration, thus occupying the mind while reducing muscle tension. Cleansing breaths help the client to relax and focus on relaxing and should be the beginning and the end of a breathing pattern .

Position the client for comfort and physiologic response; promote position changes every 30 minutes while the client is awake. Positioning affects anatomic and physiologic responses such as alteration of cardiac output, enhancement or reduction of the effectiveness of uterine contraction, synchronization of abdominal muscle work, and reduction of pressure on the fetal head. Frequent position changes increase comfort and circulation and relieve fatigue .

Provide information about the use of prescription or nonprescription analgesics. In the first trimester, medical abortion has become an increasingly popular alternative to surgical abortion in areas where women have the choice of both methods. A 2006 review of five large British and American case series of analgesia used by women undergoing medical abortion during the first trimester concluded that approximately 75% of women experience the pain of severity requiring narcotic analgesia (Jackson & Kapp, 2011).

Administer narcotic/non-narcotic analgesics, sedatives, and antiemetics, as prescribed. These drugs promote relaxation , decrease pain, and control the side effects of treatment (drug therapy). When compared to women using no prophylactic medications, women using acetaminophen and loperamide during misoprostol-only abortion required less subsequent pain medication and experienced less diarrhea . NSAID medications such as ibuprofen and diclofenac may alleviate pain during both first-trimester abortion and second-trimester abortion using mifepristone+misoprostol and may decrease opioid requirements in women at gestational ages beyond 105 days (Jackson & Kapp, 2011).

Assist with the administration of paracervical block before surgical termination. A randomized trial demonstrated that paracervical block is effective in decreasing client-reported pain at various steps throughout an induced abortion procedure. Although paracervical block administration was painful, it significantly decreased cervical dilatation and uterine aspiration pain (Renner et al., 2012). 

Worldwide, some 5 million women are hospitalized each year for treatment of abortion-related complications such as hemorrhage and sepsis , and abortion-related deaths leave 220,000 children motherless. The main causes of death from unsafe abortion are hemorrhage , infection, sepsis , genital trauma , and necrotic bowel . Even safe abortion in developing nations carries risks that depend on the health facility, the skill of the provider, and the gestational age of the fetus (Haddad & Nour, 2009).

Assess the client for any other methods used if the abortion is self-managed. Though abortion is legal in the United States, at least for now, 2 to 7% of clients seeking this service report efforts to self-induce abortion. Not all methods of self-managed abortion are effective or safe. Women in the United States report using herbs, including rue, sage, St. John’s wort, and black or blue cohosh, among other understudied methods generally thought to be ineffective. Some of these substances have reported toxic reactions and even death, especially rue. In rare cases, women in the United States have also reported the use of other means, such as vaginal insertion of implements or objects or abdominal trauma , to try to disrupt their pregnancy (Harris & Grossman, 2020).

Monitor for excessive nausea and vomiting before and after elective termination. Nausea and vomiting have been linked with elective termination of pregnancy. Clients who considered the termination of pregnancy due to nausea and vomiting reported more severe vomiting , feelings of depression, and adverse effects of nausea and vomiting on their relationships with their partners (Mazzotta et al., 2001). Postoperative nausea and vomiting incidence is high in dilatation and curettage, around 50% to 60%, for clients undergoing general anesthesia (Fujii, 2010).

Note dyspnea , wheezing, or agitation. Prostaglandins may cause vasoconstriction or bronchial constriction. Through prostaglandin receptors, prostaglandin can cause many effects in almost every part of the body. The prostaglandin can cause vasoconstriction in vascular smooth muscle cells, induce labor , and regulate hormones. They can also act on the central nervous system to influence pain perception (Malik & Dua, 2022).

Evaluate the level of discomfort. Abdominal pain, tenderness, and severe cramping may indicate retained tissue or uterine perforation. Multivariate analysis confirmed some clinicians’ impression that misoprostol increases the risk of experiencing severe pain after elective termination when compared with the laminaria tent. The use of laminaria tents can also be very painful and difficult for one out of three clients (Gagne et al., 2010).

Stress importance of returning for a follow-up examination. Follow-up is necessary to assess healing. A repeat pregnancy test is sometimes done after early first-trimester procedures to assure the procedure was complete. The client should be certain to keep her follow-up appointment in about 2 weeks for postprocedure ultrasonography or a pregnancy test to ensure the pregnancy has ended and obtain contraceptive counseling so she can avoid a repeat procedure.

Provide a contact person in case of emergency. Providing contact reduces the feelings of fear and anxiety. High levels of depression and anxiety in clients after elective termination of pregnancy suggest the importance of psychological and social support needs. Before or after the procedure, nurses should be informed about identifying and strengthening the client’s social support systems by including the client’s family, friends, and significant others in the process (Topal & Terzioglu, 2019).

Determine cervical status before the procedure. Assist as needed with the insertion of Laminaria tent or prostaglandin (lamicel) gel. These are inserted 24–48 hours before the procedure to soften the cervix. The traditional alternative to misoprostol for dilatation of the cervix before an elective termination is the laminaria tent. Two studies have compared both methods for dilatation of the cervix before a surgical elective termination during the first trimester. One of them showed a better dilatation of the cervix when laminaria tents were used (Gagne et al., 2010).

Monitor white blood cell count (WBC) after prophylactic administration of methotrexate . Some healthcare providers give clients who have had the gestational trophoblastic disease a prophylactic course of methotrexate, the drug of choice for choriocarcinoma. However, prophylactic use must be weighed carefully because the drug interferes with white blood cell formation (leukopenia). If malignancy should occur, it can be treated effectively in most instances with methotrexate at that time.

Administer antiemetic agents as prescribed. Droperidol , a butyrophenone, has been widely accepted as the first-line agent for the management of postoperative nausea and vomiting. Metoclopramide, a benzamide, is an antiemetic widely used in clinical practice , and the efficacy of this drug for the prophylactic management of nausea and vomiting has been studied in women undergoing general anesthesia for elective or therapeutic termination of pregnancy. Serotonin receptor antagonists ondansetron and ramosetron, when given prophylactically, are highly effective in preventing postoperative nausea and vomiting after dilatation and curettage (Fujii, 2010).

Administer RhoGAM to clients with Rh-negative blood after the termination of pregnancy. After a miscarriage or abortion, because the blood type of the conceptus is unknown, all women with Rh-negative blood should receive Rh (D antigen) immune globulin (RhIG) to prevent the build-up of antibodies in the event the conceptus was Rh-positive.

Assist with/review results of ultrasonography before the procedure as indicated. An ultrasound helps in confirming gestational age and the size of products of conception. An ultrasound examination should be performed before a second-trimester abortion is done. Many ectopic pregnancies are diagnosed by an early pregnancy ultrasound. Magnetic resonance imaging (MRI) is also effective use for this.

Assist with any additional treatment or procedures necessary to control complications. IV therapy may need to be instituted, with or without the administration of oxytocin . Elective surgical terminations involve several different techniques, depending on the gestational age at the time the termination is performed. Additional surgery (D & C or hysterectomy) may be needed to control bleeding as indicated. A transfusion may be necessary to replace blood loss . Direct replacement of fibrinogen or another clotting factor may be used to increase coagulation ability.

Bleeding is a common symptom in all methods reported by clients who had an unsafe abortion. Retained conceptive product was the most common complication in clients with unsafe abortions (74.7%). 10 cases had a hypovolemic shock , 7 cases had septic shock , and two cases had sepsis with disseminated intravascular coagulation (DIC) (Srinil, 2011). In a ruptured ectopic pregnancy , the amount of bleeding evident often does not reveal the actual amount present. Blood does not reach the vagina to become evident. Progesterone secretion stops, and uterine decidua begins to slough, causing additional bleeding. If internal bleeding progresses to acute hemorrhage, the client may experience shock.

Monitor vital signs, noting increased pulse rate , severe headache, or flushed face. Changes in vital signs such as (decrease blood pressure , increase heart rate , and increase respiratory rate) indicate a late sign of hypovolemic shock from blood loss. Signs of shock may manifest after 25%-30% blood loss. Begin assessments every 15 minutes and decrease in frequency as her condition improves per agency protocol or health care provider directive. Continue to assess blood pressure every 5 to 15 minutes or continuously with an electronic cuff.

Monitor and assess blood loss. Count and weigh-in or estimate peri pads. Bleeding is normally like a heavy menstrual period. Excessive loss (more than one large pad per hour for four hours) may indicate retained tissue or uterine perforation. Monitor the amount of vaginal bleeding through pad counts and observe for passage of products of conception tissue. Ask the client about the color of the vaginal bleeding (bright red is significant) and the amount. Instruct her to save any tissue or clots passed and bring them with her to the healthcare facility.

Monitor urine output regularly. Monitoring urine output is done frequently, as often as every hour, as an indicator of blood volume adequacy. An indwelling catheter may be inserted to monitor the urine output accurately and assess kidney function as well.

Educate the client regarding reporting signs and symptoms of hemorrhage ad adherence to medications prescribed. The client needs clear instructions on how much bleeding is abnormal and what color changes she should expect in bleeding. She should know that any unusual odor or passing of large clots is also abnormal. Be certain she understands why the medications are being prescribed and the importance of taking them.

Position the client in a flat, supine position if experiencing excessive bleeding. If excessive vaginal bleeding occurs, immediately position the client flat and massage the uterine fundus to aid contraction. This may be impossible with an early pregnancy because a small uterus is not palpable above the symphysis pubis.

Avoid vaginal or rectal examinations. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa may initiate a massive hemorrhage.

Save expelled conceptus ( placenta , membranes, embryo, or fetus). Anything remaining in the uterus contributes to continued bleeding. The healthcare provider will evaluate if the complete or only partial conceptus was passed. Histology studies may be necessary to determine the cause.

Draw blood specimen for blood typing , Rh and antibody screening, CBC, and type and crossmatch as indicated. Blood administration is likely after a massive hemorrhage to replace blood loss. This action anticipates the need for fluid replacement therapy as soon as it is available. Direct replacement of fibrinogen or another clotting factor may be used to increase coagulation ability.

Administer oxygen via face mask at 8-10L/minute. Administering oxygen increases oxygen tension in the circulating blood volume and oxygen delivery to the end organs. A snug face mask more effectively delivers a higher amount per-flow rate.

Administer intravenous fluids as ordered. Start and maintain an IV site as soon as possible if one is not in place already using a large-bore needle. Veins collapse with worsening hemorrhage. Large-bore needles are necessary for blood transfusions and can still be used for the administration of IV fluids . Crystalloid solutions are usually administered in conjunction with plasma expanders or blood products.

Assist with surgical procedures to mitigate the hemorrhage. The therapy for a ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and remove or repair the damaged fallopian tube. A rough suture line on a fallopian tube may lead to another tubal pregnancy, so either the tube will be removed or suturing on the tube be done with a microsurgical technique.

The possibility of infection is minimal when pregnancy loss occurs over a short time, bleeding is self-limiting, and instrumentation is limited. However, there is always a possibility it may occur. Infection tends to develop in clients who have lost appreciable amounts of blood. Such clients need especially close observation to rule out this second and possibly fatal complication. 

Monitor and assess for signs of infection. The client has symptoms of fever and crampy abdominal pain, and her uterus feels tender to palpation . Left untreated, such infection can lead to toxic shock syndrome, septicemia , kidney failure, and death.

Monitor the client’s vital signs, especially the temperature. Fever can be a transient reaction to a period of decreased fluid intake that preceded the procedure. All temperatures higher than 100.4℉ (38.0℃) require careful evaluation to avoid overlooking the possibility that infection is developing. In septic abortion, the client may have symptoms of fever and crampy abdominal pain, and her uterus feels tender to palpation.

Instruct the client to report symptoms indicating complications (e.g., temperature 100.4° F (38.0°C) or greater, chills, malaise, abdominal pain or tenderness, severe bleeding, heavy flow with clots, foul-smelling, and/or greenish vaginal discharge). Clients are in the healthcare facility for a short time. Complications, including bleeding and infection, may be manifested days or weeks after the procedure. Be certain that the client knows the danger signs of infection, such as fever, abdominal pain or tenderness, and a foul vaginal discharge. Fever can be a transient reaction to a period of decreased fluid intake that preceded the abortion.

Perform hand hygiene before and after each care activity. Organisms that cause nosocomial infection are most commonly transmitted by the hands of healthcare providers, nurses, and other hospital personnel. Hand hygiene has often been singled out as the most important procedure in preventing nosocomial infection. Hand hygiene is a simple procedure, but giving good prevention is usually done among hospital nurses (Nasution et al., 2019).

Educate the client about proper perineal hygiene . The organism responsible for infection after miscarriage is usually Escherichia coli (spread from the rectum forward into the vagina). Caution the client to wipe her perineal area from front to back after voiding and particularly after defecation to prevent the spread of bacteria from the rectal area . Caution her not to use tampons to control vaginal discharge because stasis of any body fluid increases the risk of infection.

Educate the client about the importance of universal sexually transmitted diseases (STD) screening for sexually active women. Current recommendations by the US Preventative Services Task Force (USPSTF)  include universal Chlamydia and gonorrhea screening annually for all sexually active women <25 years of age and for all women with an increased risk regardless of age. Many clients who present for abortion services with unintended pregnancies fall within the recommended categories for gonorrhea and Chlamydia screenings as outlined by the USPSTF. If appropriate, screening may be done immediately prior to induced abortion as long as there is a mechanism for contacting and treating all clients with positive results (Achilles & Reeves, 2011).

Emphasize the importance of follow-up checkups. Assuming the client recovers from septic abortion, it may still lead to infertility because of the uterine scarring or fibrotic scarring of the fallopian tubes. If the client caused the infection by trying to self-abort, she needs follow-up counseling to assist her to learn better problem-solving methods in the future.

Maintain sterile technique when performing procedures or providing care. Medical asepsis prevents or limits the introduction of bacteria and reduces the risk of nosocomial infection.

Administer antibiotics as prescribed. Doxycycline is commonly recommended for prophylaxis and is used by over 80% of US abortion providers who use prophylactic antibiotics. Doxycycline has been shown to substantially reduce the risk of post-abortion infection in several randomized placebo-controlled trials when used as a short course at the time of the abortion. A nitroimidazole, such as metronidazole , is an alternate choice. With both doxycycline and metronidazole, there is a very low incidence of allergic reactions, and the major adverse effect is nausea. The Society of Family Planning recommends that antibiotic prophylaxis for surgical abortion be initiated before the procedure to maximize efficacy (Achilles & Reeves, 2011).

Assist in the local application of an antiseptic solution to the vaginal area before the procedure. Chlorhexidine may be more effective than povidone-iodine at reducing bacteria within the vagina, although neither alters the risk of post-procedure infection. The Society of Family Planning finds no evidence that vaginal preparation with chlorhexidine or povidone-iodine is superior to saline alone. However, there appears to be no harm from using these solutions either (Achilles & Reeves, 2011).

Information provision can be seen as a way to empower women to make informed decisions. A lack of information not only generates distress but also maintains women in a state of passivity and uncertainty, leaving them unprepared for the termination and its aftermath. In comparison, women welcome information enabling them to make decisions that are right for them. Information provision can also be empowering, enabling women to regain control over a situation many feel they have no control over (Lafarge et al., 2014).

Assess the level of client knowledge, and provide information about reproduction. Use charts and diagrams. Knowledge is essential to prevent future unplanned pregnancies. Written and visual materials are clearer, more concrete, and easily understood. In Spain, a large increase in elective abortions was associated with a remarkable increase in the number of women who used contraceptive methods and improvements in the education level during the study periods. Inadequate or inconsistent use of contraceptive methods, especially the condom and the pill, may account for the increased utilization of abortion (Dueñas et al., 2011).

Ascertain religious and cultural practices or preferences. The stigma attached to abortion generates an atmosphere of secrecy and shame,e, and many women report a fear of being judged. The Israeli study refers to termination for a fetal abnormality as a “taboo” and describes women facing a “wall of silence.” This leads women to censor themselves, only sharing part of their story, labeling their experience a miscarriage, or only disclosing the full story to a selected few (Lafarge et al., 2014).

Discuss alternative methods of contraception . This provides the client the ability to choose the best contraception for her. Ovulation may occur before menses resume, so contraception needs to be considered at this time. The client and her partner should choose a contraceptive method or methods best suited to them. A variety of contraceptive methods are available with various effectiveness rates, advantages, and disadvantages.

Speak calmly and clearly in words appropriate to the client’s partner’s and family’s understanding. In an already emotionally charged situation, the nurse’s voice can either increase or reduce anxiety. A calm, matter-of-fact approach can be helpful for the nurse. Listening to what the woman has to say and encouraging her to speak is essential. Neutral responses such as “Oh,” “Uh-huh,” and “Umm,” and nonverbal encouragement such as nodding, maintaining eye contact, and the use of touch help set an open, accepting environment.

Give specific written instructions about the contraceptive chosen. The client may have a method of contraception prescribed before discharge. Because of the anxiety and stress associated with the termination, verbal information may not be retained. The woman will need help exploring the meaning of the various alternatives and consequences to herself and her significant others.

Reinforce postabortion instructions concerning the use of tampons and resumption of sexual activity, exercise, and prescribed antibiotics, if applicable. Provide written instructions. The stress/anxiety caused by the procedure can decrease the client’s ability to process and retain information. Written instructions can be reviewed when necessary. Postabortion instructions differ among health care providers. Tampons should not be used for at least 3 days or should be avoided for up to 3 weeks, and resumption of sexual intercourse may be permitted within 1 week or discouraged for 2 weeks. The client may shower daily but should avoid douches of any type.

Identify signs/symptoms to be reported to the healthcare provider. Prompt evaluation/intervention may prevent or limit complications. Instruction is given to watch for excessive bleeding and other signs of complications. A dilatation and curettage has the potential risk of uterine perforation from the instruments used and carries an increased risk of uterine infection because of the greater cervical dilatation.

Provide information about the implications of Rho (D)-negative blood and the need for Rh IgG administration. The client may not be aware of her blood type or the implications for future pregnancies if she is Rho(D)-negative. Understanding may promote positive self-care , enhance cooperation, and help prepare the client for future pregnancies.

Verify Rh-negative status and administer RhIgG. Give 50 mg for early abortion; otherwise, the dosage is the same as for delivery or fetal hemorrhage in the nonsensitized client. Because the blood type of the conceptus is unknown with either medical or surgical termination, all clients with Rh-negative blood should receive Rho(D) immune globulin (RhoGAM or RHIG) within 72 hours after the procedure to prevent the build-up of antibodies in the event the conceptus was Rh-positive. For the Rho(D)-negative client, RhIgG prevents anti-Rh-positive antibody formation so that negative effects on future pregnancies are avoided. Microdoses are given for early abortions, which is sufficient for up to 12 weeks of gestation. Fetal RBCs may be noted as early as 38 days after conception.

Include the client, partner, and family in decision-making as much as possible during hospitalization and follow-up care after discharge. Evidence-based nursing practice stresses the importance of client and family preferences in decision-making . Adequate social support for individuals positively affects their mental and physical health. It was also observed that the depression levels of clients who had adequate social support during the pregnancy period before abortion were low after abortion (Topal & Terzioglu, 2019).

Determine the client’s religious or spiritual orientation, current involvement, and the presence of conflicts in current circumstances. This provides a baseline for planning care and accessing appropriate resources. It also helps the nurse appropriately address the client and her partner’s or family’s concerns regarding the termination.

Note the sense of futility, feelings of hopelessness and helplessness, and lack of motivation to help self. These thoughts and feelings can result in the client feeling paralyzed and unable to move forward to resolve the situation. The client loses the immediate future they had imagined, having often gone to great lengths to prepare for the infant’s arrival. A loss of reproductive self- esteem is also observed, with some clients feeling that they have failed to bear a healthy child, and failed themselves and those around them (Lafarge et al., 2014).

Determine support systems available to client and partner. The presence or lack of support systems can affect the client’s recovery. Information about community resources for postabortion counseling may be needed. If family or friends cannot be involved, scheduling time for nursing personnel to give necessary support is an essential component of the plan for care.

Assist with problem-solving within the client’s ethical and religious beliefs. The ability to project the consequences of a decision or to explore alternatives may be hindered by anxiety and emotion. Some struggle with their values and spiritual beliefs over the decision to terminate. Most women depict their decision-making as a choice between two “alternatives, both of which are unpleasant,” and deciding to terminate because the situation was hopeless. They feel this is not a real choice and that their agency may be limited. (Lafarge et al., 2014)

Support the client’s decision. The client may have few support systems available at this time and may need a nonjudgmental resource. The client may be grateful when the health care professional acknowledges that their pregnancy is wanted and care for them in a non-judgemental way. They derive comfort from health care professionals’ acts of kindness, which sometimes can stretch beyond the usual nurse-client boundaries (Lafarge et al., 2014).

Note comments indicating feelings of guilt, negative self-concept/self- esteem , and ethical or religious value conflicts. There may be a conflict with family/ significant other (s) regarding the morality of the client’s decision, which can create confusion for the client. Social context greatly impacts women’s experiences. Polarised debates on abortion result in women being stigmatized and feeling like social outcasts (Lafarge et al., 2014).

Listen to expressions of inability to find meaning in life or reason for living. Evaluate for suicidal ideation. This may indicate a need for further intervention to prevent a suicide attempt Abortion is linked to a dramatic increase in suicide risk. This statistical finding is corroborated by interview-based studies, which have consistently shown extraordinarily high levels of suicidal ideation (30-55%) and reports of suicide attempts (7-30%) among women who have had an abortion (Elliot Institute, 2000).

Discuss alternatives to abortion with the client and significant other(s), if present. Maintain a nonjudgmental attitude. A decision based on a rational choice is less likely to result in conflict. The client should be educated that elective termination is not ideal as a method of reproductive life planning but should be used as a remediation for failed contraception. In addition, women should be counseled about other options such as adoption or single parenthood before the procedure.

Use therapeutic communication skills of reflection and active listening. Listening to what the woman has to say and encouraging her to speak is essential. Neutral responses such as “Oh,” “Uh-huh,” and “Umm,” and nonverbal encouragement such as nodding, maintaining eye contact, and use of touch help set an open, accepting environment. Clarifying, restating, and reflecting on statements, open-ended questions and feedback are communication techniques that can be used to maintain a realistic focus on the situation and bring the woman’s concerns into the open.

Explain the grief response that may occur. The client may not expect to feel the loss. Whether the client discloses their full story or not, the client’s grief is disenfranchised as their loss is generally not sanctioned by society. Because theirs is a “chosen loss” and “nobody knew the baby”, the client may feel inadequate in expressing their grief (Lafarge et al., 2014).

Stress the importance of follow-up visits. There may be delayed psychological reactions, which can be assessed at the follow-up visit along with the physical status. The client should be certain to keep her follow-up appointment in about 2 weeks for postprocedure ultrasonography or a pregnancy test to ensure the pregnancy has ended and obtain contraceptive counseling so she can avoid a repeat procedure.

Refer to clergy/spiritual advisors, support groups, or professional counseling. A client’s emotional reaction may vary depending on her desire for this pregnancy and her available support network. Some clients may need additional counseling before and after abortion to help them resolve feelings of conflict or guilt. Referral to a community support group for parents who have experienced a miscarriage can be very helpful during this grief process.

Ascertain circumstances of conception and response of family/significant other. This allows the nurse to determine whether the client/couple has explored alternatives. The decision to terminate a pregnancy may have been based on an inability to problem-solve or a lack of support and resources. Many women set conditions under which they found elective termination acceptable. Some found elective termination only tolerable for women living in extremely adverse circumstances or in situations in which they could not be held responsible for getting pregnant (van Ditzhujizen et al., 2019).

Evaluate the influence of family and significant other(s) on the client. Conflict can arise within the client herself as well as within the family. This may allow the nurse to encourage positive forces or provide support where it is lacking. Clients who experienced high levels of decision difficulty more frequently reported that their sexual partners were unsupportive or had put them under pressure to choose elective termination. The younger ones, especially, experienced pressure from their parents to have an elective termination (van Ditzhujizen et al., 2019).

Note expressions of indecision, dependence on others, and inability to manage own activities of daily living . Clients who experienced high levels of decision difficulty often characterize themselves as indecisive in general, whereas almost none of the clients who experienced low levels of decision difficulty describe themselves as such. Indecisive women found the elective termination decision especially difficult given the irreversibility of the choice. They are also afraid to dismiss important matters when considering options (van Ditzhujizen et al., 2019).

Assess the presence of positive coping skills that have been used in the past. When the individual has coping skills that have been successful in the past, they may be used in the current situation to relieve tension and preserve the client’s sense of control.

Encourage the client to talk about the issues and processes used to problem-solve and make decisions regarding termination. Literature suggests that fears and fantasies around elective termination are commonly present in the decision-maker’s thinking. Perceived pressure from the partner, as well as strong positive feelings towards the pregnancy, negative elective termination views, and experiencing general difficulty in making decisions have been associated with difficulties in decision-making (van Ditzhujizen et al., 2019). Encourage the client to talk about what is happening at this time to gather clues to assist her in coping and regaining equilibrium .

Provide explanations about the procedure desired by the client, pre-procedural and post-procedural tests, examinations, and follow-ups. Lack of knowledge about the procedures, reproduction, or self-care may contribute to the client’s/family’s inability to cope positively with this event which may be behaviorally manifested by the client canceling appointments or verbalizing ambivalence. Ongoing verbalization can foster positive decision-making by eliminating the fear of the unknown and reinforcing the reasons for and appropriateness of the decision.

Assist the client in looking at alternatives and use a problem-solving process to validate the decision. Involve significant others as appropriate. This helps the client reinforce her reasons for her decision and be comfortable that this is the course she wants. Ambivalence is manifested in the decision to terminate the pregnancy as it involves conflicting feelings. It is a subtle balancing act between the baby’s prospects and potential quality of life and the client’s, her partner’s, and children’s needs (Lafarge et al., 2014).

Discuss feelings of self-blame or projection of blame on others. Although these mechanisms are protective at the moment of crisis, they eventually are counterproductive and intensify feelings of helplessness and hopelessness. Similar to clients who experience high levels of decision difficulty, clients who experience low levels of decision difficulty stressed the woman’s responsibility for preventing an unwanted pregnancy. Many blamed themselves for not having used proper birth control and sometimes felt ashamed and foolish for getting pregnant (van Ditzhujizen et al., 2019).

Act as a liaison and lend support to significant other(s). This helps reduce stress and encourages significant other(s) to be supportive of the client. A client’s emotional reaction may vary depending on her desire for this pregnancy and her available support network. Provide both physical and emotional support. In addition, prepare the client and her family for the assessment process and answer their questions about what is happening.

Provide positive feedback for efforts and progress noted. Remembering that this is not a decision taken lightly helps plan nursing care to make an elective termination as nontraumatic as possible. Be certain to provide the client undergoing termination procedures the same kind of explanations and support that clients in labor receive.

Remain with the client during examinations and the procedure. Provide both physical and emotional support. The physical presence of a nurse can help the client feel accepted and reduce stress. Providing sensitive listening, counseling, and anticipatory guidance to the client and her family will allow them to verbalize their feelings and ask questions about future pregnancies.

Obtain/review informed consent. This depends on agency guidelines. No procedure should be performed unless the client freely consents to it. The client must fully understand the alternatives, the types of abortions, and expected recovery. Misinformation and gaps in knowledge are identified and corrected. The record is then reviewed for the signed informed consent, and the client’s understanding is verified.

Review safe options available based on gestation. This assists the client in making an informed decision. Counseling about abortion includes help for the client in identifying how she perceives the pregnancy, information about the choices available (having an elective termination or carrying the pregnancy to term and then either keeping the infant or placing the infant for adoption), and information about the types of abortion procedures.

Refer for additional counseling or resources, if needed. Some clients may be more affected by the decision and may require additional support and/or education or genetic counseling. The majority of clients report they are relieved with their decision following elective termination of pregnancy. Those few who express sadness and guilt may need to be referred for professional counseling so they can integrate and accept this event in their lives.

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care  Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health   Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

Other care plans related to the care of the pregnant mother and her baby:

• Abortion (Termination of Pregnancy) | 8 Care Plans
• Cervical Insufficiency (Premature Dilation of the Cervix) | 4 Care Plans
• Cesarean Birth | 11 Care Plans
• Cleft Palate and Cleft Lip | 7 Care Plans
• Gestational Diabetes Mellitus | 8 Care Plans
• Hyperbilirubinemia (Jaundice) | 4 Care Plans
• Labor Stages, Induced, Augmented, Dysfunctional, Precipitous Labor | 45 Care Plans
• Neonatal Sepsis | 8 Care Plans
• Perinatal Loss (Miscarriage, Stillbirth) | 6 Care Plans
• Placental Abruption | 4 Care Plans
• Placenta Previa | 4 Care Plans
• Postpartum Hemorrhage | 8 Care Plans
• Postpartum Thrombophlebitis | 5 Care Plans
• Prenatal Hemorrhage (Bleeding in Pregnancy) | 9 Care Plans
• Preeclampsia and Gestational Hypertension  | 6 Care Plans
• Prenatal Infection | 5 Care Plans
• Preterm Labor | 7 Care Plans
• Puerperal & Postpartum Infections  | 5 Care Plans
• Substance Abuse in Pregnancy | 9 Care Plans

References and sources to help you further your reading about elective termination.

• Achilles, S. L., & Reeves, M. F. (2011, April). Prevention of infection after induced abortion . Contraception , 83 (4), 295-309.
• Alden, K., Cashion, M. C., Lowdermilk, D. L., Olshansky, E., & Perry, S. E. (2019). Maternity and Women’s Health Care E-Book . Elsevier Health Sciences.
• Catlin, A. (2018, August 1). Pregnancy Loss, Bereavement, and Conscientious Objection in Perioperative Services. Ethics for Perianesthesia Nursing , 33 (4), 553-559.
• Daugirdaite, V., van den Akker, O., & Purewal, S. (2015). Posttraumatic Stress and Posttraumatic Stress Disorder after Termination of Pregnancy and Reproductive Loss: A Systematic Review. Journal of Pregnancy , 2015 (646345), 14.
• Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans : Guidelines for Individualizing Client Care Across the Life Span . F.A. Davis Company.
• Dueñas, J. L., Lete, I., Bermejo, R., Arbat, A., Perez-Campos, E., Martinez-Salmean, J., Serrano, I., Doval, J. L., & Coll, C. (2011, January). Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997–2007. Contraception , 83 (1), 82-87.
• Elliot Institute. (2000, April). Abortion Four Times Deadlier Than Childbirth. The Post-Abortion Review , 8 (2).
• Feldman, N., Melcer, Y., Hod, E., Levinsohn-Tavor, O., Svirsky, R., & Maymon, R. (2017). Termination of pregnancy due to fetal abnormalities performed after 32 weeks’ gestation: survey of 57 fetuses from a single medical center. The Journal of Maternal-Fetal & Neonatal Medicine .
• Fujii, Y. (2010). Prevention of nausea and vomiting during termination of pregnancy. International Journal of Gynecology and Obstetrics , 111 , 3-7.
• Gagne, A., Guilbert, E., Quellet, J., Roy, V., & Tremblay, J.-G. (2010, March). Assessment of Pain After Elective Abortion Relating to the Use of Misoprostol for Dilatation of the Cervix. Journal of Obstetrics and Gynaecology Canada , 32 (3), 244-253.
• Gedikbasi, A., Gul, A., Oztarhan, K., Akun, M. A., Sargin, A., Ozek, S., Kavuncuoglu, S., & Ceylan, Y. (2010). Feldman, N., Melcer, Y., Hod, E., Levinsohn-Tavor, O., Svirsky, R., & Maymon, R. (2017). Termination of pregnancy due to fetal abnormalities performed after 32 weeks’ gestation: survey of 57 fetuses from a single medical center. The Journal of Maternal-Fet. Journal of Turkish-German Gynecological Association , 11 , 1-7.
• Griebel, C. P., Halvorsen, J., Golemon, T. B., & Day, A. A. (2005, October 1). Management of Spontaneous Abortion. American Family Physician , 72 (7).
• Haddad, L. B., & Nour, N. M. (2009). Unsafe Abortion: Unnecessary Maternal Mortality. Reviews in Obstetrics and Gynecology , 2 (2), 122-126.
• Harris, L. H., & Grossman, D. (2020, March 12). Complications of Unsafe and Self-Managed Abortion. The New England Journal of Medicine , 382 , 1029-1040.
• Hasselbacher, L. A., Hebert, L. E., Liu, Y., & Stulberg, D. B. (2020, June 29). “My Hands Are Tied”: Abortion Restrictions and Providers’ Experiences in Religious and Nonreligious Health Care Systems. Perspectives on Sexual and Reproductive Health , 52 (2), 107-115.
• Jackson, E., & Kapp, N. (2011, February). Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review. Contraception , 83 (2), 116-126.
• Lafarge, C., Mitchell, K., & Fox, P. (2014). Termination of pregnancy for fetal abnormality: a meta-ethnography of women’s experiences. Reproductive Health Matters , 22 (44).
• Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing . Elsevier.
• Loren-Guerrero, L., Gascon-Catalan, A., Pasierb, D., & Romero-Cardiel, M.A. (2017, October 25). Assessment of significant psychological distress at the end of pregnancy and associated factors. Archives of Women’s Mental Health , 21 , 313-321.
• Malik, K., & Dua, A. (2022, May 15). Prostaglandins – StatPearls . NCBI. Retrieved June 6, 2022, from
• Mazzotta, P., Stewart, D.E., Koren, G., & Magee, L.A. (2001, March). Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy. Journal of Psychosomatic Obstetrics & Gynecology , 22 , 7-12.
• Nasution, T. A., Yunita, R., Pasaribu, A. P., & Ardinata, F. M. (2019, October 14). Effectiveness Hand Washing and Hand Rub Method in Reducing Total Bacteria Colony from Nurses in Medan. Open Access Macedonian Journal of Medical Sciences , 7 (20), 3380-3383.
• Pillitteri, A. (2010). Nursing Care of a Family Experiencing a Sudden Pregnancy Complication. In Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family (6th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
• Renner, R.-M., Nichols, M. D., Jensen, J. T., Li, H., & Edelman, A. B. (2012, May). Paracervical Block for Pain Control in First-Trimester Surgical Abortion. Obstetrics & Gynecology , 119 (5), 1030-1037.
• Ricci, S. S., Kyle, T., & Carman, S. (2013). Maternity and Pediatric Nursing . Wolters Kluwer Health/Lippincott Williams & Wilkins.
• Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family . Wolters Kluwer.
• Srinil, S. (2011). Factors Associated with Severe Complications in Unsafe Abortion. J Med Assoc Thai , 94 (4), 408-414.
• Swearingen, P. L., & Wright, J. (2019). All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (P. L. Swearingen & J. Wright, Eds.). Elsevier Health Sciences.
• Topal, C. A., & Terzioglu, F. (2019, April 20). Assessment of depression, anxiety, and social support in the context of therapeutic abortion. Perspectives in Psychiatric Care , 55 (4), 618-623.
• van Ditzhujizen, J., Brauer, M., Boejie, H., & van Nijnatten, C. H.C.J. (2019, February 22). Dimensions of decision difficulty in women’s decision-making about abortion: A mixed methods longitudinal study. PLoS ONE , 14 (2).

Reviewed and updated by M. Belleza, R.N.

Leave a Comment Cancel reply

Find anything you save across the site in your account

What Ethical Health Care Looks Like When Abortion Is Criminalized

The Supreme Court’s decision to overturn Roe v. Wade sent the issue of abortion policy back to individual states—which has already led to a flurry of laws in red states limiting or banning women from having the procedure. Last week, I spoke to Louise Perkins King, a surgeon and bioethicist at Harvard, and the vice-chair of the ethics committee at the American College of Obstetricians and Gynecologists ( ACOG ). Her work focusses on the ethical obligations and quandaries faced by medical professionals; the Court’s decision raises significant questions about how doctors who support abortion rights should approach their responsibilities to patients and the law going forward. During our conversation, which has been edited for length and clarity, we discussed how bioethicists think about abortion, how the medical community should approach its own members who are opposed to abortion, and whether it’s ever appropriate for doctors to break the law.

Does the decision to strike down Roe v. Wade change the ethical obligations of doctors in the United States?

It doesn’t change our ethical obligations; it makes them more challenging, because to meet our ethical obligations, to provide abortion—which is health care—in some states physicians will be facing criminal and financial penalties. And, from a utilitarian standpoint, if you meet your ethical obligations and ignore the law and risk those criminal and financial penalties, it may be that you’re then no longer available to treat other patients. Figuring out how to thread that needle is difficult, as is figuring out when you can legally treat women who are pregnant, if they’re facing various emergencies, because it is very difficult to know what you can and cannot do.

Before this decision, the majority of states in the country had some legal restrictions on abortion. How were those existing restrictions—which often limit abortion in the third trimester—balanced with the ethical obligation to provide health care?

My personal opinion is that many of the legislative approaches to abortion that existed were inappropriate. The actual legislation that we have in Massachusetts—the one that I support, and I’m very glad that we have here—is called the ROE Act, and it allows for abortion up to twenty-four weeks. After that time frame, meaning essentially in the third trimester, abortion is still permitted when necessary to save the life of a person who’s pregnant or in the setting of lethal anomalies or anomalies not compatible with life. That allows meaningful access to abortion, the meaningful exercise of people’s rights to bodily autonomy, and a meaningful interaction with teams of doctors, midwives, and other health-care professionals who can help people reach decisions on these matters and who can help determine in that third trimester when abortion is truly necessary—which is exceptionally rare but sometimes important.

One of the criticisms of Roe was that it set standards that were somewhat arbitrary, including the trimester divisions. Ethically, why would the third trimester be different from the first one?

That’s a great question. This concept of viability, which is, from a medical standpoint, an ever-changing and fluid concept—it can’t possibly serve as a line in the sand. The trimester system is just something that is divided into threes, but any particular pregnancy might not correspond to those time frames, might not follow those patterns. There are innumerable complexities that come up in a pregnancy that might lead to different decision-making and different needs at different times.

As an ethicist, I think that there shouldn’t be these lines in the sand. There’s been a dearth of deference to medical expertise, dating back to Gonzales v. Carhart , where they’re simply ignoring what anybody who practices this type of medicine is trying to say. It’s complicated. I can understand the desire for these lines in the sand from both legislators and the public, but that’s not an ethical way to move forward on such a complex issue.

When you sit down with anyone who really wants to create some firm boundaries around abortion because they feel they have to, and then you start explaining to them how complicated things can become, if you’re dealing with severe hydrocephalus, severe cardiomyopathy, hypertension, diabetes, eclampsia, preeclampsia, hemorrhage—and I could go on—all of these nuances of the various complications and difficulties that arise in pregnancy don’t lend themselves to lines in the sand. From an ethics perspective, there really shouldn’t be very many legislative, if any, restrictions on abortion, personally. That’s my view. We should have very clear training for all of our providers and for the public about why that should be the case, whether we can achieve it or not. But a good way to achieve essentially that is what we have in Massachusetts through the ROE Act.

What I’m trying to understand from what you just said is whether the reason a legislative approach to this issue is bad is that pregnancy is really complicated, and you can’t just have a blunt instrument addressing it—or, instead, that a woman should be able to do what she wants with her body. Whatever medical issues she may be having, or whatever complications there are medically, those are not that important to you as an ethicist, because it’s her body and she can do what she wants.

I’ll preface again and say these are my personal views. In terms of a pregnant person’s right to bodily autonomy—in my personal opinion, that is absolute. And so I don’t ask reasons if somebody, for example, is asking for an abortion earlier on in pregnancy. As you get further along in pregnancy, things become more complicated. I don’t know if I would feel comfortable performing a third-trimester abortion for a patient where, if that infant was born, it would probably survive, and the person in front of me is saying, “I just don’t want to be pregnant now.” That would be a little bit difficult.

There are gradations, and there are points at which a pregnant person’s right to bodily autonomy can be called into question. The difficulty that arises for me personally is that if I say no to any abortion, I’m saying to someone, “I think that your right to make a decision about the risk that you wish to take, about the risk of death that you wish to face, is no longer your right.” That’s a statement I don’t think I could make, either. If someone came to me and said, “You are the only match for a kidney, or for bone marrow, or name your body part, for my daughter,” I would have an absolute choice of whether or not I wished to donate that fundamental tissue to her.

In those instances, the risks that I would incur, even if I were having a kidney removed or a portion of my lung or liver removed, are less than when I carried my daughter to term and delivered her. Even after my death, I can refuse to let you use any of those organs to help a family member or anybody else. And yet, if I’m pregnant, at a certain point in time, depending on which legislation you’re looking at, you will be able to say to me, “You no longer have the right to manage the risks for your body, to manage the risks of passing a grown infant through the vaginal canal, the risks of tearing, prolapse, sexual dysfunction, hemorrhage, and death. You no longer get to control whether you’re going to take those risks or not.”

Obviously, if I’m sitting in front of somebody who is in the very early stages of pregnancy, this question is very simple for me. In the early stages of a pregnancy, if they don’t wish to take on those risks, a hundred per cent, they have an absolute right to bodily autonomy in those decisions. If we’re getting into later stages of pregnancy, it becomes quite complex, but really that’s almost a red herring, because it just doesn’t happen. Even with the incredible lack of access that we have in this country to sexual education and contraception, women are not presenting for elective termination in their third trimester. So that question doesn’t happen, and, because it doesn’t, as an ethicist, even though I find a lot of difficulty in that space, in my analysis, I don’t actually have to answer that question. It becomes a red herring, because it constantly does get brought up, even though it’s not really the true issue. It’s an interesting, difficult question to grapple with, but it just doesn’t happen.

I assume you want medical professionals to have a certain amount of autonomy to make their own decisions, and you don’t want them questioning every decision, because then the whole system would break. I’m curious how you think about what role doctors have in making their own decisions about whether they are going to do specific abortion procedures.

It’s a really tough one. Each individual physician obviously needs to be able to govern what they feel comfortable doing. But when that discomfort impedes access to care for so many people in our country, we’ve let the pendulum of professional autonomy swing too far. In the United States, only twelve to fourteen per cent of ob-gyns provide abortion care, and that’s not O.K. We need to have a workforce of obstetrics and gynecology professionals who are not only trained but willing to conscientiously provide this care. And that we don’t is a failing of our professional obligation. So you’re right. I would never say to any individual provider, “You must provide this care.” But when I speak to medical students who are thinking about these questions and trying to figure out where they want to go in their careers, I encourage them to think carefully about their duty, not only as individuals but as members of a group of people providing care.

If they really feel that they cannot provide abortion care, there are many ways to be an excellent women’s-health physician without compromising the access to care for women. It does involve all of us working together. My point of view on this is slightly different from many of my colleagues who provide abortion care. I have to say that, over the years, they’re wearing me down a little bit. The reason I say that is because my position is typically the majority position of most institutions like ACOG —that conscientious objection is appropriate, that we need a professional society to insure we have enough access, but that certain individual physicians could conscientiously object to provide the care.

But that puts an enormous burden on those who do provide the care. And, in this country, that puts a burden on them that includes not being able to disclose their work to people, or their home addresses. I have one colleague who is very circumspect about what she does for a living, because she doesn’t want to put her children at risk. Their lives can be on the line, given the violence that has occurred. If that’s where this is going, then, at the end of the day, I’m starting to come around to the opinion that, as a professional society, we simply can no longer accommodate what I still would defend ethically: conscientious objection.

Can you say more about the real-world manifestation of the difference of opinion you have with the people in your field? What are they arguing?

They might not all believe this, but many of them who have spoken to me have shared that they do not think that you should match into obstetrics and gynecology if you are conscientiously opposed to providing abortion care. It’s a fundamental portion of our training. It’s a fundamental portion of the care that we provide to patients. So, if that’s your strong belief, there are many other opportunities in medicine. There’s no reason for somebody who conscientiously opposes the provision of abortion care to go into a discipline in which that care should be a fundamental part.

I’ve never held that view, because it’s important that we have varied viewpoints within our disciplines, and that we are open to hearing challenges. But when those different viewpoints cross into wholesale removal of rights from half our population, or violence against those who are providing the care, or obstructing care, as is happening in so many different states, then the balance of how we address the issue of conscientious objection has to change. I’ve been slowly modifying my view. I don’t know where I stand.

Just to clarify, when you said that people were wearing you down, you didn’t mean irritating you—you meant making you think hard about this question and its many complications.

I meant bringing me around to their viewpoint.

You broached something earlier that I want to come back to. A doctor may choose not to follow an unethical or immoral law. One of the problems with not following laws, even if they’re bad laws, is that they create all these other second- and third-order utilitarian consequences that can be really, really problematic—which is why, broadly speaking, people should not evaluate every single law every second of the day and just broadly follow the law. I think that’s what most ethicists would say.

Can you talk more about this problem?

Sure. The laws in various states are all slightly different, but, at the end of the day, they’re going to put doctors in a position of deciding when a woman is sick enough for them to intervene, and that’s incredibly difficult to figure out. Sepsis, for example, proceeds very slowly until it doesn’t, and then it kills. That’s the story that happened with Savita Halappanavar in Ireland. The law moves very slowly in its clarification process, through things happening, cases going forward, and then courts deciding whether something was legal or not legal. In the moment, when you’re sitting in front of someone who may be dying , and you’re being told that it might be illegal to help them, that’s not a moment when you can rely on the law to give you guidance.

A physician faced with somebody in exactly Savita’s situation of sepsis—but with electrical activity [in the fetus] and not being able to proceed forward with the termination that would save her life—might go through with that procedure and then, if they’re prosecuted, go through years of the legal process, of trying to figure out if they’ve broken the law or not. During that time, they might not be able to provide care meaningfully to other patients because they’re consumed with defending themselves in court.

From a utilitarian perspective, they’re going to have to adhere as closely to the law as they can and see if they can pinpoint that moment when the life of the patient is truly in danger under the laws that would not allow intervention otherwise. That’s an impossible place to be put in. The moral injury that will ensue for these physicians is equally damaging. We are seeing physicians and midwives leave practice, nurses leave practice, because of all the moral injuries that have happened over the course of our pandemic. This will still surely add to that problem, so we are going to have fewer and fewer people providing care.

What else from a bioethical point of view have you been thinking about since the decision came down?

A lot of stuff, but the main thing I would share with you is that there’s been a lot of talk about how we move on from here. I have a lot of conversations with people who disagree with me, especially students, but also other ethicists, and frequently those discussions are very fruitful. I have an honest respect for people who come to their belief that abortion is morally fraught. I believe them, that they really honestly believe that. What I’ve found has been problematic in discussions of late and has led me to be a bit more circumspect is just a callousness that I hadn’t fully appreciated before—this callousness of, “Well, this decision is a good thing because it will save lives.”

It must come from a place of simply not understanding all the complexities, because we know from very clear statistics that many people will die because of this decision. And so there are all these calls for constructive discussion and being open, but we can only move forward if people on all sides of this topic will accept the clear facts that are established and can be looked up in the W.H.O. or in The New England Journal [ of Medicine ]. This will lead to death and severe morbidity. We have to start from that spot and not be debating that any longer, and then figure out where we’re going to go from there. ♦

More on Abortion and Roe v. Wade

In the post-Roe era, letting pregnant patients get sicker— by design .

The study that debunks most anti-abortion arguments .

Of course the Constitution has nothing to say about abortion .

How the real Jane Roe shaped the abortion wars.

Black feminists defined abortion rights as a matter of equality, not just “choice.”

Recent data suggest that taking abortion pills at home is as safe as going to a clinic. 

When abortion is criminalized, women make desperate choices .

Sign up for our daily newsletter to receive the best stories from The New Yorker .

Where Nurse Organizations Stand on the Overturning of Roe v. Wade

The Supreme Court’s decision to overturn Roe v. Wade is leaving nurses with many questions. How will this impact the care nurses provide? How can healthcare providers follow best-practice care while abiding by the law?

During this challenging time for healthcare professionals, it’s important for the nursing community to stand together to protect patients. Here’s where nursing organizations stand in response to the ruling.

Nursing Organizations Comment on Roe v. Wade Supreme Court Decision

The Supreme Court’s decision to overturn Roe v. Wade came in response to a case called Dobbs v. Jackson Women’s Health Organization. The case questioned whether abortions are a constitutional right.

The Supreme Court concluded the U.S. Constitution does not confer a right to abortion. With the decision, states have the power to ban abortions. They’re now illegal in about half of the states in the U.S.

Many abortion clinics have closed their doors, and abortion-seekers must find new options for safe care. For healthcare providers, halting abortion care is not that simple. Providers like nurses, nurse practitioners, and nurse midwives are faced with difficult decisions — like whether to do what’s best for the patient or face legal repercussions.

Here’s what nursing organizations have to say about the Supreme Court’s decision to overturn Roe v. Wade.

American Nurses Association

In its official statement , the American Nurses Organization (ANA) says that the “U.S. Supreme Court’s decision to overturn Roe vs. Wade is a serious setback for reproductive health and human rights.”

ANA acknowledges the ethical challenges nurses face as a result of the ruling. The statement explains nurses’ ethical obligation to protect patients and communities without coercion from outside influences. ANA recognizes the nurse’s role in assisting patients with making decisions about their sexual and reproductive health, including pregnancy.

The statement continues, “ANA firmly believes that no nurse should be subject to punitive or judicial processes for upholding their ethical obligations to their patients and profession.”

National League for Nursing

The NLN continues, “The resulting health inequity can only exacerbate crises of public health traced directly to social determinants of health that the National League for Nursing has pledged to help eradicate wherever possible and at the very least mitigate, promoting universal access to culturally sensitive, competent healthcare and educational initiatives to maximize diversity and inclusion in nursing education and at all levels of the nation’s healthcare system.”

Read the NLN’s full statement .

National Nurses United

The National Nurses United (NNU) press release’s headline reads, “Nation’s largest union of nurses condemns Supreme Court overturn of constitutional right to abortion.”

National Nurses United is the nation’s largest union and professional association for registered nurses. In its press release, NNU advocates for patients and nurses to make autonomous healthcare decisions.

It says, “Registered nurses understand that abortion is a basic healthcare service, and as a union of healthcare providers dedicated to advocating for the best interests of our patients, National Nurses United opposes any efforts to restrict our patients’ control and choices over their own healthcare and their own bodies.”

Association of Women’s Health, Obstetric and Neonatal Nurses

In its statement , AWHONN defends healthcare providers’ rights to educate and guide patients to making decisions for their sexual and reproductive health.

It says, “AWHONN supports and promotes a person’s right to evidence-based, accurate, and thorough information, access to all available reproductive healthcare services, and the right to make choices that meet their individual needs.”

The statement continues, “AWHONN opposes legislation and policies that limit, prohibit, or puts a healthcare clinician at risk for criminal prosecution or civil litigation.”

Reproductive Healthcare Nursing Organizations

Several reproductive healthcare nursing organizations released a joint statement on the U.S. Supreme Court ruling. This joint statement was delivered on behalf of Nurse Practitioners in Women’s Health, American College of Nurse-Midwives (ACNM), and AWHONN.

It says, “The women and patients who will be harmed by this SCOTUS ruling are those individuals who experience social and systemic impacts of marginalization – Black, Indigenous, and other people of color; those with low incomes, LGBTQ+ people, and people with disabilities. We are committed to advocating for access to the full spectrum of reproductive health services.”

American College of Nurse-Midwives

ACNM’s statement confirms “the right to access to abortion care as an essential right of those capable of pregnancy. ACNM affirms that everyone has the right to decide what is best for their health, bodies, lives, and families.”

The statement also says, “ACNM will continue to support efforts to increase access to midwives as abortion providers and engage with stakeholders to make abortion care accessible to the people and communities midwives serve.”

The American College of Nurse-Midwives supports nurse midwives who provide safe abortion and postabortion care. Read ACNM’s full statement .

Emergency Nurses Association

The Emergency Nurses Association (ENA) and the American Academy of Emergency Nurse Practitioners (AAENP) gave a joint statement responding to the ruling.

The organizations are committed to providing nurses and nurse practitioners with resources and education as abortion laws continue to change.

It says, “As those events unfold, ENA and AAENP’s unwavering focus is on what the high court’s decision means for emergency nurses and their patients. ENA and AAENP will ensure emergency nurses and advanced practice registered nurses have access to clinical resources and education that prepares them for acute obstetric cases, while remaining committed to the delivery of high-quality care to every patient who visits the emergency department.”

Oncology Nurses Society

According to cancerletter.com , the Oncology Nurses Association is in alignment with the statement from the American Cancer Society (ACS), which says:

“As a nonprofit entity whose mission is improving the lives of people with cancer and their families, the American Cancer Society isn’t taking sides on the decision. However, the decision will impact cancer patients and their families and is likely to disproportionately affect communities of color.”

The American Cancer Society urges states to consider the following as they relate to abortion care:

• Cancer treatment for pregnant patients
• Fertility preservation
• Screening and prevention

You can read ACS’s full statement .

You might be interested in

Supreme Court Overturns Roe v. Wade, Threatens Abortion Access Across America

Find out how the overturning of Roe v. Wade affects nurses and other healthcare providers.

Now What? 10 Actions Nurses Can Take After Roe v. Wade Overturn

Nurses are anticipating new healthcare challenges as a result of the overturning of Roe v. Wade. Learn how nurses can support people who need help.

Roe v. Wade Overturned Explained: What Does It Mean?

The U.S. Supreme Court ruled that abortion bans are not constitutional. Individual states now have the power to ban or limit abortions. Abortions will become illegal in about half of the states in the U.S. Healthcare professionals in some states can be criminally charged for performing an abortion. On June 24, 2022, the United States …

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Rom J Morphol Embryol
• v.61(1); Jan-Mar 2020

A research on abortion: ethics, legislation and socio-medical outcomes. Case study: Romania

Andreea mihaela niţă.

1 Faculty of Social Sciences, University of Craiova, Romania

Cristina Ilie Goga

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. The empirical part presents the results of a sociological survey, based on the opinion survey method through the application of the enquiry technique, conducted in Romania, on a sample of 1260 women. The purpose of the survey is to identify Romanians perception on the decision to voluntary interrupt pregnancy, and to determine the core reasons in carrying out an abortion.

The analysis of abortion by means of medical and social documents

Abortion means a pregnancy interruption “before the fetus is viable” [ 1 ] or “before the fetus is able to live independently in the extrauterine environment, usually before the 20 th week of pregnancy” [ 2 ]. “Clinical miscarriage is both a common and distressing complication of early pregnancy with many etiological factors like genetic factors, immune factors, infection factors but also psychological factors” [ 3 ]. Induced abortion is a practice found in all countries, but the decision to interrupt the pregnancy involves a multitude of aspects of medical, ethical, moral, religious, social, economic, and legal order.

In a more simplistic manner, Winston Nagan has classified opinions which have as central element “abortion”, in two major categories: the opinion that the priority element is represented by fetus and his entitlement to life and the second opinion, which focuses around women’s rights [ 4 ].

From the medical point of view, since ancient times there have been four moments, generally accepted, which determine the embryo’s life: ( i ) conception; ( ii ) period of formation; ( iii ) detection moment of fetal movement; ( iv ) time of birth [ 5 ]. Contemporary medicine found the following moments in the evolution of intrauterine fetal: “ 1 . At 18 days of pregnancy, the fetal heartbeat can be perceived and it starts running the circulatory system; 2 . At 5 weeks, they become more clear: the nose, cheeks and fingers of the fetus; 3 . At 6 weeks, they start to function: the nervous system, stomach, kidneys and liver of the fetus, and its skeleton is clearly distinguished; 4 . At 7 weeks (50 days), brain waves are felt. The fetus has all the internal and external organs definitively outlined. 5 . At 10 weeks (70 days), the unborn child has all the features clearly defined as a child after birth (9 months); 6 . At 12 weeks (92 days, 3 months), the fetus has all organs definitely shaped, managing to move, lacking only the breath” [ 6 ]. Even if most of the laws that allow abortion consider the period up to 12 weeks acceptable for such an intervention, according to the above-mentioned steps, there can be defined different moments, which can represent the beginning of life. Nowadays, “abortion is one of the most common gynecological experiences and perhaps the majority of women will undergo an abortion in their lifetimes” [ 7 ]. “Safe abortions carry few health risks, but « every year, close to 20 million women risk their lives and health by undergoing unsafe abortions » and 25% will face a complication with permanent consequences” [ 8 , 9 ].

From the ethical point of view, most of the times, the interruption of pregnancy is on the border between woman’s right over her own body and the child’s (fetus) entitlement to life. Judith Jarvis Thomson supported the supremacy of woman’s right over her own body as a premise of freedom, arguing that we cannot force a person to bear in her womb and give birth to an unwanted child, if for different circumstances, she does not want to do this [ 10 ]. To support his position, the author uses an imaginary experiment, that of a violinist to which we are connected for nine months, in order to save his life. However, Thomson debates the problem of the differentiation between the fetus and the human being, by carrying out a debate on the timing which makes this difference (period of conception, 10 weeks of pregnancy, etc.) and highlighting that for people who support abortion, the fetus is not an alive human being [ 10 ].

Carol Gilligan noted that women undergo a true “moral dilemma”, a “moral conflict” with regards to voluntary interruption of pregnancy, such a decision often takes into account the human relationships, the possibility of not hurting the others, the responsibility towards others [ 11 ]. Gilligan applied qualitative interviews to a number of 29 women from different social classes, which were put in a position to decide whether or not to commit abortion. The interview focused on the woman’s choice, on alternative options, on individuals and existing conflicts. The conclusion was that the central moral issue was the conflict between the self (the pregnant woman) and others who may be hurt as a result of the potential pregnancy [ 12 ].

From the religious point of view, abortion is unacceptable for all religions and a small number of abortions can be seen in deeply religious societies and families. Christianity considers the beginning of human life from conception, and abortion is considered to be a form of homicide [ 13 ]. For Christians, “at the same time, abortion is giving up their faith”, riot and murder, which means that by an abortion we attack Jesus Christ himself and God [ 14 ]. Islam does not approve abortion, relying on the sacral life belief as specified in Chapter 6, Verse 151 of the Koran: “Do not kill a soul which Allah has made sacred (inviolable)” [ 15 ]. Buddhism considers abortion as a negative act, but nevertheless supports for medical reasons [ 16 ]. Judaism disapproves abortion, Tanah considering it to be a mortal sin. Hinduism considers abortion as a crime and also the greatest sin [ 17 ].

From the socio-economic point of view, the decision to carry out an abortion is many times determined by the relations within the social, family or financial frame. Moreover, studies have been conducted, which have linked the legalization of abortions and the decrease of the crime rate: “legalized abortion may lead to reduced crime either through reductions in cohort sizes or through lower per capita offending rates for affected cohorts” [ 18 ].

Legal regulation on abortion establishes conditions of the abortion in every state. In Europe and America, only in the XVIIth century abortion was incriminated and was considered an insignificant misdemeanor or a felony, depending on when was happening. Due to the large number of illegal abortions and deaths, two centuries later, many states have changed legislation within the meaning of legalizing voluntary interruption of pregnancy [ 6 ]. In contemporary society, international organizations like the United Nations or the European Union consider sexual and reproductive rights as fundamental rights [ 19 , 20 ], and promotes the acceptance of abortion as part of those rights. However, not all states have developed permissive legislation in the field of voluntary interruption of pregnancy.

Currently, at national level were established four categories of legislation on pregnancy interruption area:

( i )  Prohibitive legislations , ones that do not allow abortion, most often outlining exceptions in abortion in cases where the pregnant woman’s life is endangered. In some countries, there is a prohibition of abortion in all circumstances, however, resorting to an abortion in the case of an imminent threat to the mother’s life. Same regulation is also found in some countries where abortion is allowed in cases like rape, incest, fetal problems, etc. In this category are 66 states, with 25.5% of world population [ 21 ].

( ii )  Restrictive legislation that allow abortion in cases of health preservation . Loosely, the term “health” should be interpreted according to the World Health Organization (WHO) definition as: “health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [ 22 ]. This type of legislation is adopted in 59 states populated by 13.8% of the world population [ 21 ].

( iii )  Legislation allowing abortion on a socio-economic motivation . This category includes items such as the woman’s age or ability to care for a child, fetal problems, cases of rape or incest, etc. In this category are 13 countries, where we have 21.3% of the world population [ 21 ].

( iv )  Legislation which do not impose restrictions on abortion . In the case of this legislation, abortion is permitted for any reason up to 12 weeks of pregnancy, with some exceptions (Romania – 14 weeks, Slovenia – 10 weeks, Sweden – 18 weeks), the interruption of pregnancy after this period has some restrictions. This type of legislation is adopted in 61 countries with 39.5% of the world population [21].

The Centre for Reproductive Rights has carried out from 1998 a map of the world’s states, based on the legislation typology of each country (Figure ​ (Figure1 1 ).

The analysis of states according to the legislation regarding abortion. Source: Centre for Reproductive Rights. The World’s Abortion Laws, 2018 [ 23 ]

An unplanned pregnancy, socio-economic context or various medical problems [ 24 ], lead many times to the decision of interrupting pregnancy, regardless the legislative restrictions. In the study “Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008” issued in 2011 by the WHO , it was determined that within the states with restrictive legislation on abortion, we may also encounter a large number of illegal abortions. The illegal abortions may also be resulting in an increased risk of woman’s health and life considering that most of the times inappropriate techniques are being used, the hygienic conditions are precarious and the medical treatments are incorrectly administered [ 25 ]. Although abortions done according to medical guidelines carry very low risk of complications, 1–3 unsafe abortions contribute substantially to maternal morbidity and death worldwide [ 26 ].

WHO has estimated for the year 2008, the fact that worldwide women between the ages of 15 and 44 years carried out 21.6 million “unsafe” abortions, which involved a high degree of risk and were distributed as follows: 0.4 million in the developed regions and a number of 21.2 million in the states in course of development [ 25 ].

Case study: Romania

Legal perspective on abortion

In Romania, abortion was brought under regulation by the first Criminal Code of the United Principalities, from 1864.

The Criminal Code from 1864, provided the abortion infringement in Article 246, on which was regulated as follows: “Any person, who, using means such as food, drinks, pills or any other means, which will consciously help a pregnant woman to commit abortion, will be punished to a minimum reclusion (three years).

The woman who by herself shall use the means of abortion, or would accept to use means of abortion which were shown or given to her for this purpose, will be punished with imprisonment from six months to two years, if the result would be an abortion. In a situation where abortion was carried out on an illegitimate baby by his mother, the punishment will be imprisonment from six months to one year.

Doctors, surgeons, health officers, pharmacists (apothecary) and midwives who will indicate, will give or will facilitate these means, shall be punished with reclusion of at least four years, if the abortion took place. If abortion will cause the death of the mother, the punishment will be much austere of four years” (Art. 246) [ 27 ].

The Criminal Code from 1864, reissued in 1912, amended in part the Article 246 for the purposes of eliminating the abortion of an illegitimate baby case. Furthermore, it was no longer specified the minimum of four years of reclusion, in case of abortion carried out with the help of the medical staff, leaving the punishment to the discretion of the Court (Art. 246) [ 28 ].

The Criminal Code from 1936 regulated abortion in the Articles 482–485. Abortion was defined as an interruption of the normal course of pregnancy, being punished as follows:

“ 1 . When the crime is committed without the consent of the pregnant woman, the punishment was reformatory imprisonment from 2 to 5 years. If it caused the pregnant woman any health injury or a serious infirmity, the punishment was reformatory imprisonment from 3 to 6 years, and if it has caused her death, reformatory imprisonment from 7 to 10 years;

2 . When the crime was committed by the unmarried pregnant woman by herself, or when she agreed that someone else should provoke the abortion, the punishment is reformatory imprisonment from 3 to 6 months, and if the woman is married, the punishment is reformatory imprisonment from 6 months to one year. Same penalty applies also to the person who commits the crime with the woman’s consent. If abortion was committed for the purpose of obtaining a benefit, the punishment increases with another 2 years of reformatory imprisonment.

If it caused the pregnant woman any health injuries or a severe disablement, the punishment will be reformatory imprisonment from one to 3 years, and if it has caused her death, the punishment is reformatory imprisonment from 3 to 5 years” (Art. 482) [ 29 ].

The criminal legislation from 1936 specifies that it is not considered as an abortion the interruption from the normal course of pregnancy, if it was carried out by a doctor “when woman’s life was in imminent danger or when the pregnancy aggravates a woman’s disease, putting her life in danger, which could not be removed by other means and it is obvious that the intervention wasn’t performed with another purpose than that of saving the woman’s life” and “when one of the parents has reached a permanent alienation and it is certain that the child will bear serious mental flaws” (Art. 484, Par. 1 and Par. 2) [ 29 ].

In the event of an imminent danger, the doctor was obliged to notify prosecutor’s office in writing, within 48 hours after the intervention, on the performance of the abortion. “In the other cases, the doctor was able to intervene only with the authorization of the prosecutor’s office, given on the basis of a medical certificate from hospital or a notice given as a result of a consultation between the doctor who will intervene and at least a professor doctor in the disease which caused the intervention. General’s Office Prosecutor, in all cases provided by this Article, shall be obliged to maintain the confidentiality of all communications or authorizations, up to the intercession of any possible complaints” (Art. 484) [ 29 ].

The legislation of 1936 provided a reformatory injunction from one to three years for the abortions committed by doctors, sanitary agents, pharmacists, apothecary or midwives (Art. 485) [ 29 ].

Abortion on demand has been legalized for the first time in Romania in the year 1957 by the Decree No. 463, under the condition that it had to be carried out in a hospital and to be carried out in the first quarter of the pregnancy [ 30 ]. In the year 1966, demographic policy of Romania has dramatically changed by introducing the Decree No. 770 from September 29 th , which prohibited abortion. Thus, the voluntary interruption of pregnancy became a crime, with certain exceptions, namely: endangering the mother’s life, physical or mental serious disability; serious or heritable illness, mother’s age over 45 years, if the pregnancy was a result of rape or incest or if the woman gave birth to at least four children who were still in her care (Art. 2) [ 31 ].

In the Criminal Code from 1968, the abortion crime was governed by Articles 185–188.

The Article 185, “the illegal induced abortion”, stipulated that “the interruption of pregnancy by any means, outside the conditions permitted by law, with the consent of the pregnant woman will be punished with imprisonment from one to 3 years”. The act referred to above, without the prior consent from the pregnant woman, was punished with prison from two to five years. If the abortion carried out with the consent of the pregnant woman caused any serious body injury, the punishment was imprisonment from two to five years, and when it caused the death of the woman, the prison sentence was from five to 10 years. When abortion was carried out without the prior consent of the woman, if it caused her a serious physical injury, the punishment was imprisonment from three to six years, and if it caused the woman’s death, the punishment was imprisonment from seven to 12 years (Art. 185) [ 32 ].

“When abortion was carried out in order to obtain a material benefit, the maximum punishment was increased by two years, and if the abortion was made by a doctor, in addition to the prison punishment could also be applied the prohibition to no longer practice the profession of doctor”.

Article 186, “abortion caused by the woman”, stipulated that “the interruption of the pregnancy course, committed by the pregnant woman, was punished with imprisonment from 6 months to 2 years”, quoting the fact that by the same punishment was also sanctioned “the pregnant woman’s act to consent in interrupting the pregnancy course made out by another person” (Art. 186) [ 26 ].

The Regulations of the Criminal Code in 1968, also provided the crime of “ownership of tools or materials that can cause abortion”, the conditions of this holding being met when these types of instruments were held outside the hospital’s specialized institutions, the infringement shall be punished with imprisonment from three months to one year (Art. 187) [ 32 ].

Furthermore, the doctors who performed an abortion in the event of extreme urgency, without prior legal authorization and if they did not announce the competent authority within the legal deadline, they were punished by imprisonment from one month to three months (Art. 188) [ 32 ].

In the year 1985, it has been issued the Decree No. 411 of December 26 th , by which the conditions imposed by the Decree No. 770 of 1966 have been hardened, meaning that it has increased the number of children, that a woman could have in order to request an abortion, from four to five children [ 33 ].

The Articles 185–188 of the Criminal Code and the Decree No. 770/1966 on the interruption of the pregnancy course have been abrogated by Decree-Law No. 1 from December 26 th , 1989, which was published in the Official Gazette No. 4 of December 27 th , 1989 (Par. 8 and Par. 12) [ 34 ].

The Criminal Code from 1968, reissued in 1997, maintained Article 185 about “the illegal induced abortion”, but drastically modified. Thus, in this case of the Criminal Code, we identify abortion as “the interruption of pregnancy course, by any means, committed in any of the following circumstances: ( a ) outside medical institutions or authorized medical practices for this purpose; ( b ) by a person who does not have the capacity of specialized doctor; ( c ) if age pregnancy has exceeded 14 weeks”, the punishment laid down was the imprisonment from 6 months to 3 years” (Art. 185, Par. 1) [ 35 ]. For the abortion committed without the prior consent of the pregnant woman, the punishment consisted in strict prison conditions from two to seven years and with the prohibition of certain rights (Art. 185, Par. 2) [ 35 ].

For the situation of causing serious physical injury to the pregnant woman, the punishment was strict prison from three to 10 years and the removal of certain rights, and if it had as a result the death of the pregnant woman, the punishment was strict prison from five to 15 years and the prohibition of certain rights (Art. 185, Par. 3) [ 35 ].

The attempt was punished for the crimes specified in the various cases of abortion.

Consideration should also be given in the Criminal Code reissued in 1997 for not punishing the interruption of the pregnancy course carried out by the doctor, if this interruption “was necessary to save the life, health or the physical integrity of the pregnant woman from a grave and imminent danger and that it could not be removed otherwise; in the case of a over fourteen weeks pregnancy, when the interruption of the pregnancy course should take place from therapeutic reasons” and even in a situation of a woman’s lack of consent, when it has not been given the opportunity to express her will, and abortion “was imposed by therapeutic reasons” (Art. 185, Par. 4) [ 35 ].

Criminal Code from 2004 covers abortion in Article 190, defined in the same way as in the prior Criminal Code, with the difference that it affects the limits of the punishment. So, in the event of pregnancy interruption, in accordance with the conditions specified in Paragraph 1, “the penalty provided was prison time from 6 months to one year or days-fine” (Art. 190, Par. 1) [ 36 ].

Nowadays, in Romania, abortion is governed by the criminal law of 2009, which entered into force in 2014, by the section called “aggression against an unborn child”. It should be specified that current criminal law does not punish the woman responsible for carrying out abortion, but only the person who is involved in carrying out the abortion. There is no punishment for the pregnant woman who injures her fetus during pregnancy.

In Article 201, we can find the details on the pregnancy interruption infringement. Thus, the pregnancy interruption can be performed in one of the following circumstances: “outside of medical institutions or medical practices authorized for this purpose; by a person who does not have the capacity of specialist doctor in Obstetrics and Gynecology and the right of free medical practice in this specialty; if gestational age has exceeded 14 weeks”, the punishment is the imprisonment for six months to three years, or fine and the prohibition to exercise certain rights (Art. 201, Par. 1) [ 37 ].

Article 201, Paragraph 2 specifies that “the interruption of the pregnancy committed under any circumstances, without the prior consent of the pregnant woman, can be punished with imprisonment from 2 to 7 years and with the prohibition to exercise some rights” (Art. 201, Par. 1) [ 37 ].

If by facts referred to above (Art. 201, Par. 1 and Par. 2) [ 37 ] “it has caused the pregnant woman’s physical injury, the punishment is the imprisonment from 3 to 10 years and the prohibition to exercise some rights, and if it has had as a result the pregnant woman’s death, the punishment is the imprisonment from 6 to 12 years and the prohibition to exercise some rights” (Art. 201, Par. 3) [ 37 ]. When the facts have been committed by a doctor, “in addition to the imprisonment punishment, it will also be applied the prohibition to exercise the profession of doctor (Art. 201, Par. 4) [ 37 ].

Criminal legislation specifies that “the interruption of pregnancy does not constitute an infringement with the purpose of a treatment carried out by a specialist doctor in Obstetrics and Gynecology, until the pregnancy age of twenty-four weeks is reached, or the subsequent pregnancy interruption, for the purpose of treatment, is in the interests of the mother or the fetus” (Art. 201, Par. 6) [ 37 ]. However, it can all be found in the phrases “therapeutic purposes” and “the interest of the mother and of the unborn child”, which predisposes the text of law to an interpretation, finally the doctors are the only ones in the position to decide what should be done in such cases, assuming direct responsibility [ 38 ].

Article 202 of the Criminal Code defines the crime of harming an unborn child, pointing out the punishments for the various types of injuries that can occur during pregnancy or in the childbirth period and which can be caused by the mother or by the persons who assist the birth, with the specification that the mother who harms her fetus during pregnancy is not punished and does not constitute an infringement if the injury has been committed during pregnancy or during childbirth period if the facts have been “committed by a doctor or by an authorized person to assist the birth or to follow the pregnancy, if they have been committed in the course of the medical act, complying with the specific provisions of his profession and have been made in the interest of the pregnant woman or fetus, as a result of the exercise of an inherent risk in the medical act” (Art. 202, Par. 6) [ 37 ].

The fact situation in Romania

During the period 1948–1955, called “the small baby boom” [ 39 ], Romania registered an average fertility rate of 3.23 children for a woman. Between 1955 and 1962, the fertility rate has been less than three children for a woman, and in 1962, fertility has reached an average of two children for a woman. This phenomenon occurred because of the Decree No. 463/1957 on liberalization of abortion. After the liberalization from 1957, the abortion rate has increased from 220 abortions per 100 born-alive children in the year 1960, to 400 abortions per 100 born-alive children, in the year 1965 [ 40 ].

The application of provisions of Decrees No. 770 of 1966 and No. 411 of 1985 has led to an increase of the birth rate in the first three years (an average of 3.7 children in 1967, and 3.6 children in 1968), followed by a regression until 1989, when it was recorded an average of 2.2 children, but also a maternal death rate caused by illegal abortions, raising up to 85 deaths of 100 000 births in the year of 1965, and 170 deaths in 1983. It was estimated that more than 80% of maternal deaths between 1980–1989 was caused by legal constraints [ 30 ].

After the Romanian Revolution in December 1989 and after the communism fall, with the abrogation of Articles 185–188 of the Criminal Code and of the Decree No. 770/1966, by the Decree of Law No. 1 of December 26 th , 1989, abortion has become legal in Romania and so, in the following years, it has reached the highest rate of abortion in Europe. Subsequently, the number of abortion has dropped gradually, with increasing use of birth control [ 41 ].

Statistical data issued by the Ministry of Health and by the National Institute of Statistics (INS) in Romania show corresponding figures to a legally carried out abortion. The abortion number is much higher, if it would take into account the number of illegal abortion, especially those carried out before 1989, and those carried out in private clinics, after the year 1990. Summing the declared abortions in the period 1958–2014, it is to be noted the number of them, 22 037 747 exceeds the current Romanian population. A detailed statistical research of abortion rate, in terms of years we have exposed in Table ​ Table1 1 .

The number of abortions declared in Romania in the period 1958–2016

Source: Pro Vita Association (Bucharest, Romania), National Institute of Statistics (INS – Romania), EUROSTAT [ 42 , 43 , 44 ]

Data issued by the United Nations International Children’s Emergency Fund (UNICEF) in June 2016, for the period 1989–2014, in matters of reproductive behavior, indicates a fertility rate for Romania with a continuous decrease, in proportion to the decrease of the number of births, but also a lower number of abortion rate reported to 100 deliveries (Table ​ (Table2 2 ).

Reproductive behavior in Romania in 1989–2014

Source: United Nations International Children’s Emergency Fund (UNICEF), Transformative Monitoring for Enhanced Equity (TransMonEE) Data. Country profiles: Romania, 1989–2015 [ 45 ].

By analyzing data issued for the period 1990–2015 by the International Organization of Health , UNICEF , United Nations Fund for Population Activity (UNFPA), The World Bank and the United Nations Population Division, it is noticed that maternal mortality rate has currently dropped as compared with 1990 (Table ​ (Table3 3 ).

Maternal mortality estimation in Romania in 1990–2015

Source: World Health Organization (WHO), Global Health Observatory Data. Maternal mortality country profiles: Romania, 2015 [ 46 ].

Opinion survey: women’s opinion on abortion

Argument for choosing the research theme

Although the problematic on abortion in Romania has been extensively investigated and debated, it has not been carried out in an ample sociological study, covering Romanian women’s perception on abortion. We have assumed making a study at national level, in order to identify the opinion on abortion, on the motivation to carry out an abortion, and to identify the correlation between religious convictions and the attitude toward abortion.

Examining the literature field of study

In the conceptual register of the research, we have highlighted items, such as the specialized literature, legislation, statistical documents.

Formulation of hypotheses and objectives

The first hypothesis was that Romanian women accept abortion, having an open attitude towards this act. Thus, the first objective of the research was to identify Romanian women’s attitude towards abortion.

The second hypothesis, from which we started, was that high religious beliefs generate a lower tolerance towards abortion. Thus, the second objective of our research has been to identify the correlation between the religious beliefs and the attitude towards abortion.

The third hypothesis of the survey was that, the main motivation in carrying out an abortion is the fact that a woman does not want a baby, and the main motivation for keeping the pregnancy is that the person wants a baby. In this context, the third objective of the research was to identify main motivation in carrying out an abortion and in maintaining a pregnancy.

Another hypothesis was that modern Romanian legislation on the abortion is considered fair. Based on this hypothesis, we have assumed the fourth objective, which is to identify the degree of satisfaction towards the current regulatory provisions governing the abortion.

Research methodology

The research method is that of a sociological survey by the application of the questionnaire technique. We used the sampling by age and residence looking at representative numbers of population from more developed as well as underdeveloped areas.

Determination of the sample to be studied

Because abortion is a typical women’s experience, we have chosen to make the quantitative research only among women. We have constructed the sample by selecting a number of 1260 women between the ages of 15 and 44 years (the most frequently encountered age among women who give birth to a child). We also used the quota sampling techniques, taking into account the following variables: age group and the residence (urban/rural), so that the persons included in the sample could retain characteristic of the general population.

By the sample of 1260 women, we have made a percentage of investigation of 0.03% of the total population.

The Questionnaires number applied was distributed as follows (Table ​ (Table4 4 ).

The sampling rates based on the age, and the region of residence

Source: Sample built, based on the population data issued by the National Institute of Statistics (INS – Romania) based on population census conducted in 2011 [ 47 ].

Data collection

Data collection was carried out by questionnaires administered by 32 field operators between May 1 st –May 31 st , 2018.

The analysis of the research results

In the next section, we will present the main results of the quantitative research carried out at national level.

Almost three-quarters of women included in the sample agree with carrying out an abortion in certain circumstances (70%) and only 24% have chosen to support the answer “ No, never ”. In modern contemporary society, abortion is the first solution of women for which a pregnancy is not desired. Even if advanced medical techniques are a lot safer, an abortion still carries a health risk. However, 6% of respondents agree with carrying out abortion regardless of circumstances (Table ​ (Table5 5 ).

Opinion on the possibility of carrying out an abortion

Although abortions carried out after 14 weeks are illegal, except for medical reasons, more than half of the surveyed women stated they would agree with abortion in certain circumstances. At the opposite pole, 31% have mentioned they would never agree on abortions after 14 weeks. Five percent were totally accepting the idea of abortion made to a pregnancy that has exceeded 14 weeks (Table ​ (Table6 6 ).

Opinion on the possibility of carrying out an abortion after the period of 14 weeks of pregnancy

For 53% of respondents, abortion is considered a crime as well as the right of a women. On the other hand, 28% of the women considered abortion as a crime and 16% associate abortion with a woman’s right (Table ​ (Table7 7 ).

Opinion on abortion: at the border between crime and a woman’s right

Opinions on what women abort at the time of the voluntary pregnancy interruption are split in two: 59% consider that it depends on the time of the abortion, and more specifically on the pregnancy development stage, 24% consider that regardless of the period in which it is carried out, women abort a child, and 14% have opted a fetus (Table ​ (Table8 8 ).

Abortion of a child vs. abortion of a fetus

Among respondents who consider that women abort a child or a fetus related to the time of abortion, 37.5% have considered that the difference between a baby and a fetus appears after 14 weeks of pregnancy (the period legally accepted for abortion). Thirty-three percent of them have mentioned that the distinction should be performed at the first few heartbeats; 18.1% think it is about when the child has all the features definitively outlined and can move by himself; 2.8% consider that the difference appears when the first encephalopathy traces are being felt and the child has formed all internal and external organs. A percentage of 1.7% of respondents consider that this difference occurs at the beginning of the central nervous system, and 1.4% when the unborn child has all the features that we can clearly see to a newborn child (Table ​ (Table9 9 ).

The opinion on the moment that makes the difference between a fetus and a child

We noticed that highly religious people make a clear association between abortion and crime. They also consider that at the time of pregnancy interruption it is aborted a child and not a fetus. However, unexpectedly, we noticed that 27% of the women, who declare themselves to be very religious, have also stated that they see abortion as a crime but also as a woman’s right. Thirty-one percent of the women, who also claimed profound religious beliefs, consider that abortion may be associated with the abortion of a child but also of a fetus, this depending on the time of abortion (Tables ​ (Tables10 10 and ​ and11 11 ).

The correlation between the level of religious beliefs and the perspective on abortion seen as a crime or a right

The correlation between the level of religious beliefs and the perspective on abortion procedure conducted on a fetus or a child

More than half of the respondents have opted for the main reason for abortion the appearance of medical problems to the child. Baby’s health represents the main concern of future mothers, and of each parent, and the birth of a child with serious health issues, is a factor which frightens any future parent, being many times, at least theoretically, one good reason for opting for abortion. At the opposite side, 12% of respondents would not choose abortion under any circumstances. Other reasons for which women would opt for an abortion are: if the woman would have a medical problem (22%) or would not want the child (10%) (Table ​ (Table12 12 ).

Potential reasons for carrying out an abortion

Most of the women want to give birth to a child, 56% of the respondents, representing also the reason that would determine them to keep the child. Morality (26%), faith (10%) or legal restrictions (4%), are the three other reasons for which women would not interrupt a pregnancy. Only 2% of the respondents have mentioned other reasons such as health or age.

A percentage of 23% of the surveyed people said that they have done an abortion so far, and 77% did not opted for a surgical intervention either because there was no need, or because they have kept the pregnancy (Table ​ (Table13 13 ).

Rate of abortion among women in the sample

Most respondents, 87% specified that they have carried out an abortion during the first 14 weeks – legally accepted limit for abortion: 43.6% have made abortion in the first four weeks, 39.1% between weeks 4–8, and 4.3% between weeks 8–14. It should be noted that 8.7% could not appreciate the pregnancy period in which they carried out abortion, by opting to answer with the option “ I don’t know ”, and a percentage of 4.3% refused to answer to this question.

Performing an abortion is based on many reasons, but the fact that the women have not wanted a child is the main reason mentioned by 47.8% of people surveyed, who have done minimum an abortion so far. Among the reasons for the interruption of pregnancy, it is also included: women with medical problems (13.3%), not the right time to be a mother (10.7%), age motivation (8.7%), due to medical problems of the child (4.3%), the lack of money (4.3%), family pressure (4.3%), partner/spouse did not wanted. A percentage of 3.3% of women had different reasons for abortion, as follows: age difference too large between children, career, marital status, etc. Asked later whether they regretted the abortion, a rate of 69.6% of women who said they had at least one abortion regret it (34.8% opted for “ Yes ”, and 34.8% said “ Yes, partially ”). 26.1% of surveyed women do not regret the choice to interrupted the pregnancy, and 4.3% chose to not answer this question. We noted that, for women who have already experienced abortion, the causes were more diverse than the grounds on which the previous question was asked: “What are the reasons that determined you to have an abortion?” (Table ​ (Table14 14 ).

The reasons that led the women in the sample to have an abortion

The majority of the respondents (37.5%) considered that “nervous depression” is the main consequence of abortion, followed by “insomnia and nightmares” (24.6%), “disorders in alimentation” and “affective disorders” (each for 7.7% of respondents), “deterioration of interpersonal relationships” and “the feeling of guilt”(for 6.3% of the respondents), “sexual disorders” and “panic attacks” (for 6.3% of the respondents) (Table ​ (Table15 15 ).

Opinion on the consequences of abortion

Over half of the respondents believe that abortion should be legal in certain circumstances, as currently provided by law, 39% say it should be always legal, and only 6% opted for the illegal option (Table ​ (Table16 16 ).

Opinion on the legal regulation of abortion

Although the current legislation does not punish pregnant women who interrupt pregnancy or intentionally injured their fetus, survey results indicate that 61% of women surveyed believe that the national law should punish the woman and only 28% agree with the current legislation (Table ​ (Table17 17 ).

Opinion on the possibility of punishing the woman who interrupts the course of pregnancy or injures the fetus

For the majority of the respondents (40.6%), the penalty provided by the current legislation, the imprisonment between six months and three years or a fine and deprivation of certain rights for the illegal abortion is considered fair, for a percentage of 39.6% the punishment is too small for 9.5% of the respondents is too high. Imprisonment between two and seven years and deprivation of certain rights for an abortion performed without the consent of the pregnant woman is considered too small for 65% of interviewees. Fourteen percent of them think it is fair and only 19% of respondents consider that Romanian legislation is too severe with people who commit such an act considering the punishment as too much. The imprisonment from three to 10 years and deprivation of certain rights for the facts described above, if an injury was caused to the woman, is considered to be too small for more than half of those included in the survey, 64% and almost 22% for nearly a quarter of them. Only 9% of the respondents mentioned that this legislative measure is too severe for such actions (Table ​ (Table18 18 ).

Opinion on the regulation of abortion of the Romanian Criminal Code (Art. 201)

Conclusions

After analyzing the results of the sociological research regarding abortion undertaken at national level, we see that 76% of the Romanian women accept abortion, indicating that the majority accepts only certain circumstances (a certain period after conception, for medical reasons, etc.). A percentage of 64% of the respondents indicated that they accept the idea of abortion after 14 weeks of pregnancy (for solid reasons or regardless the reason). This study shows that over 50% of Romanian women see abortion as a right of women but also a woman’s crime and believe that in the moment of interruption of a pregnancy, a fetus is aborted. Mostly, the association of abortion with crime and with the idea that a child is aborted is frequently found within very religious people. The main motivation for Romanian women in taking the decision not to perform an abortion is that they would want the child, and the main reason to perform an abortion is the child’s medical problems. However, it is noted that, in real situations, in which women have already done at least one abortion, most women resort to abortion because they did not want the child towards the hypothetical situation in which women felt that the main reason of abortion is a medical problem. Regarding the satisfaction with the current national legislation of the abortion, the situation is rather surprising. A significant percentage (61%) of respondents felt as necessary to punish the woman who performs an illegal abortion, although the legislation does not provide a punishment. On the other hand, satisfaction level to the penalties provided by law for various violations of the legal conditions for conducting abortion is low, on average only 25.5% of respondents are being satisfied with these, the majority (average 56.2%) considering the penalties as unsatisfactory. Understood as a social phenomenon, intensified by human vulnerabilities, of which the most obvious is accepting the comfort [ 48 ], abortion today is no longer, in Romanian society, from a legal or religious perspective, a problem. Perceptions on the legislative sanction, moral and religious will perpetual vary depending on beliefs, environment, education, etc. The only and the biggest social problem of Romania is truly represented by the steadily falling birth rate.

Conflict of interests

The authors declare that they have no conflict of interests.

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Nursing Care for Mothers with Incomplete Abortions: Case Study

Journal of Vocational Nursing

Introduction: Incomplete abortion is bleeding in pregnancy before 20 weeks, where some of the products of conception have come out of the uterine cavity through the cervical canal left in the decidua or placenta. Methods: This research uses a case study design. Data collection from assessment to nursing evaluation was carried out in the jasmine room of Dr Soegiri Lamongan Hospital in February 2019. Participant care at the hospital for three days—data collection techniques using interviews, observation, and documentation. Data analysis uses narrative analysis based on the analysis of relevant facts and theories. Results: The assessment of the two participants was the first and second pregnancies, with gestational ages of 12 and 16 weeks, experiencing vaginal bleeding and abdominal pain. There is abdominal tenderness, a pain scale of 5, and uterine contractions on examination. The nursing diagnosis was acute pain associated with uterine contractions and fluid volume deficit related to...

Related Papers

Agnes Oyeniran

Jurnal Aisyah : jurnal ilmu kesehatan

Kenneth Adde

Introduction Abortions remain one of the highest contributors to maternal deaths in Ghana. In 2003, a policy on post-abortion care was introduced to help reduce abortion-related mortality and morbidity. However, depending on the method of pregnancy termination; women encounter varying experiences. This study examines the experiences of women seeking post-abortion care services in a Regional Hospital in Ghana. Materials and methods In-depth interview technique was used to collect data from 20 purposively selected post-abortion care clients at the Volta Regional Hospital. Data were analysed manually using a qualitative content analysis technique. Results The study found that medical abortion was the main method of pregnancy termination used by women who participated in the study to induce abortion. Spontaneous abortion, however, was attributed mainly to engaging in activities that required the use of excessive energy and travelling on bad roads by pregnant women. The study also reveal...

Contraception

Hailemichael Gebreselassie

BMC Health Services Research

Lalini Rajapaksa

BJOG: An International Journal of Obstetrics & Gynaecology

Journal of Nepal Medical Association

INTRODUCTION: Unsafe abortion is a significant cause of maternal morbidity and mortality in developing countries despite provision of adequate care and legalization of abortion. The aim of this study was to find out the contribution of unsafe abortion in maternal mortality and its other consequences. METHODS: A retrospective study was carried out in the Department of Obstetrics and Gynecology in BPKIHS between 2005 April to 2008 September analyzing all the unsafe abortion related admissions. RESULTS: There were 70 unsafe abortion patients. Majority of them (52.8%) were of high grade. Most of them recovered but there were total 8maternal deaths. CONCLUSIONS: Unsafe abortion is still a significant medical and social problem even in post legalization era of this country. Keywords: abortion, legalization, maternal death, unsafe.

Journal of Family Medicine and Primary Care

Suchira Suranga

Gessessew Bugssa

Background: Unsafe abortion is one of the leading causes of maternal mortality and morbidity worldwide accounting for 13% of maternal deaths globally. Objective: To assess quality and determinant factors of post-abortion care in governmental Hospitals of Tigray, Ethiopia. Method: Institution based Cross-sectional study was conducted from January to May 2013. Four hundred twenty post apportion care clients were interviewed and 60 clients were observed to obtain qualitative data. Data was collected using pre prepared structured checklist and analyzed using SPSS version 16.00. The association between dependent and in dependent variables was assessed and presented using descriptive statistics, and logistic regression. Results: Majority (46.9%) of the study subjects fall in to the age category of 14-19 years. The study depicted that only 40.6% of the clients were satisfied. Client satisfaction was significantly associated with educational and occupational status, laboratory prescription and toilet access. Only 48 % of study subjects were informed about the available family planning methods and supplied with. The observational study revealed that 88.3% of the clients did not get the opportunity to pose questions or concerns. Only one of the health institutions has functional sink with adequate water supply in the abortion room. No more than 22.2 % of the care providers got refresher training on relevant areas. Conclusion: This study has identified main concerns that could have great input on the improvement of post abortion care. Hence, we can conclude that patient satisfaction is low and there is lack of refreshments trainings especially on counseling and supporting. Besides, there are shortage of materials and supplies. This all could have synergetic effect on compromising the quality of post abortion care. For this reason, it is recommended to skill up the providers with evidence based trainings to enhance quality of post abortion care.

Reproductive health

Angela Kelly-Hanku

In Papua New Guinea induced abortion is restricted under the Criminal Code Law. Unsafe abortions are known to be widely practiced and sepsis due to unsafe abortion is a leading cause of maternal mortality. We undertook a six month, prospective, mixed methods study at the Eastern Highlands Provincial Hospital. Semi structured and in depth interviews were undertaken with women presenting following induced abortion. This paper describes the reasons why women resorted to unsafe abortion, the techniques used, decision to seek post abortion care and women&#39;s reflections post abortion. 28 women were admitted to hospital following an induced abortion. Reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors. Misoprostol was the most frequently used method to end the pregnancy. Physical and mechanical means, traditional herbs and spiritual beliefs were also reported. Women sought care post abortion due to excessive vagin...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

RELATED PAPERS

JURNAL KEPERAWATAN CIKINI

Wiwit Kurniawati

BMC Women's Health

Natja Mellerup

melkamu hailu

Anand Tamang

Medical journal of Zambia

Bellington Vwalika

IJAR Indexing

International Journal of Health

Dr Omona Kizito , Nalubega Margrete Joy

African Journal of Reproductive Health

I. Sunday-Adeoye

Women's Health Issues

Diana Taylor

International Journal of Scientific and Research Publications (IJSRP)

Stanslaus musyoki

Evidence Based Women's Health Journal

Online Brazilian Journal of Nursing

Dirce Bellezi Guilhem

Nepalese Medical Journal

Sunita Bhandari

Journal of Advanced Nursing

Davina Porock

Revista gaucha de enfermagem

Mariana Gervasio

Reproductive Health Matters

Tine Gammeltoft

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Nurses in abortion care: identifying and managing stress

Affiliation.

• 1 Faculty of Health, Sport and Medicine, University of Glamorgan, Pontypridd, Wales, UK.
• PMID: 19379113
• DOI: 10.5172/conu.673.31.2.108

The psychological impact of abortion on the women undergoing the procedure is well researched, but little is known about the potential psychological impact on nurses working in abortion care. The proportion of medical abortions in the UK is rising compared to surgical abortions. A recent research study found that being more directly involved in the procedure places more emotional demands on the nurses. This emotional labour required by nurses working in abortion care may increase their stress levels. This paper examines the potential increase in stress in nurses caused by medical abortions. A model of stress comprising stressors, moderators and stress outcomes was used as a framework for this examination. Research on abortion and mental health nursing was applied to managing stress in abortion care; this included coping mechanisms, prevention and intervention strategies. This showed that stress, burnout and coping are important issues in abortion care. On this basis, recommendations for practice have been formulated to inform practice for nurses and managers in abortion care.

PubMed Disclaimer

Similar articles

• Stigma in abortion care: application to a grounded theory study. Lipp A. Lipp A. Contemp Nurse. 2011 Feb;37(2):115-23. doi: 10.5172/conu.2011.37.2.115. Contemp Nurse. 2011. PMID: 21692583
• The experience of Italian nurses and midwives in the termination of pregnancy: a qualitative study. Mauri PA, Squillace F. Mauri PA, et al. Eur J Contracept Reprod Health Care. 2017 Jun;22(3):227-232. doi: 10.1080/13625187.2017.1318846. Epub 2017 May 2. Eur J Contracept Reprod Health Care. 2017. PMID: 28463062
• The impact of midtrimester abortion techniques on patients and staff. Kaltreider NB, Goldsmith S, Margolis AJ. Kaltreider NB, et al. Am J Obstet Gynecol. 1979 Sep 15;135(2):235-8. doi: 10.1016/0002-9378(79)90351-x. Am J Obstet Gynecol. 1979. PMID: 474678
• The role of nurses and midwives in the provision of abortion care: A scoping review. Mainey L, O'Mullan C, Reid-Searl K, Taylor A, Baird K. Mainey L, et al. J Clin Nurs. 2020 May;29(9-10):1513-1526. doi: 10.1111/jocn.15218. Epub 2020 Feb 29. J Clin Nurs. 2020. PMID: 32045070 Review.
• The experiences of nurses and midwives who provide surgical abortion care: A qualitative systematic review. Qian JL, Pan PE, Wu MW, Zheng Q, Sun SW, Liu L, Sun YP, Yu XY. Qian JL, et al. J Adv Nurs. 2021 Sep;77(9):3644-3656. doi: 10.1111/jan.14853. Epub 2021 Apr 14. J Adv Nurs. 2021. PMID: 33855749 Review.
• Validation of the German Version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP) and Its Correlation to the Second Victim Phenomenon. Trifunovic-Koenig M, Strametz R, Gerber B, Mantri S, Bushuven S. Trifunovic-Koenig M, et al. Int J Environ Res Public Health. 2022 Apr 16;19(8):4857. doi: 10.3390/ijerph19084857. Int J Environ Res Public Health. 2022. PMID: 35457724 Free PMC article.
• An ethical issue: nurses' conscientious objection regarding induced abortion in South Korea. Ko CM, Koh CK, Lee YS. Ko CM, et al. BMC Med Ethics. 2020 Oct 27;21(1):106. doi: 10.1186/s12910-020-00552-9. BMC Med Ethics. 2020. PMID: 33109174 Free PMC article.

Publication types

• Search in MeSH

LinkOut - more resources

Full text sources.

• Taylor & Francis
• MedlinePlus Health Information

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Mental Health Implications of Abortion and Abortion Restriction: A Brief Narrative Review of U.S. Longitudinal Studies

Information & authors, metrics & citations, view options, mental health after abortion.

Mental Health After Abortion Versus After Denial of Abortion

Conclusions

Key points/clinical pearls, acknowledgments, information, published in.

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu .

To download the citation to this article, select your reference manager software.

There are no citations for this item

View options

Login options.

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR ® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Share article link

Copying failed.

PREVIOUS ARTICLE

Next article, request username.

Can't sign in? Forgot your username? Enter your email address below and we will send you your username

If the address matches an existing account you will receive an email with instructions to retrieve your username

Create a new account

Change password, password changed successfully.

Your password has been changed

Reset password

Can't sign in? Forgot your password?

Enter your email address below and we will send you the reset instructions

If the address matches an existing account you will receive an email with instructions to reset your password.

Your Phone has been verified

As described within the American Psychiatric Association (APA)'s Privacy Policy and Terms of Use , this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.