Lesley Hoggart

‘I’m pregnant … what am I going to do?’ An examination of value judgements and moral frameworks in teenage pregnancy decision making

Policy discussion of teenage sexual behaviour has been strongly influenced by a political agenda that characterises teenage pregnancy as a potential ‘risk’ of sexual activity. This presumed risk framework, however, depends upon an assumption of shared value judgements about the social undesirability of teenage parenthood, and the moral undesirability of teenage abortion. Drawing on three qualitative research projects undertaken in England between 2003 and 2009, this article looks at the complex processes of individual pregnancy decision making, in a context of competing values and moralities. It provides insights into, and understandings of, underlying tensions in the processes through which different degrees of personal autonomy may be experienced, and suggests that when autonomous decision making is compromised, often due to tensions in competing value systems, young women may experience ambivalence or regret about the decision they have made.

Teenage pregnancies that end in abortion: what can they tell us about contraceptive risk-taking?

Background and methodology In 1999, the Government set the ambitious target of halving the number of under-18 conceptions by 2010. It is now clear that this target will not be met. Much media and policy attention has been paid to teenage mothers, and yet approximately 50% of teenage conceptions end in abortion not motherhood. In London, where the present research was based, the percentage is significantly higher. The research into teenage abortion and repeat abortion, though based in London, generated insights that could potentially help different areas reduce the number of under-18 conceptions ending in abortion. A qualitative research methodology was adopted and a wide range of interviews were conducted with young women, and professionals, in 10 London primary care trusts. Results Our analysis adds to a substantial body of qualitative research that points to the complexity of sexual decision-making for young women. Contraceptive risk-taking was evident as some young women spoke of the difficulties they experienced with user-dependent methods (primarily the condom and the pill) in often unplanned, sexual encounters. They were also generally poorly informed about different contraceptive methods. Misunderstandings about fertility also emerged as an important issue that can lead young women to draw the wrong conclusions if they do not become pregnant following unprotected sex. Conclusions Young people need improved access to, and informed understanding of, the full range of contraceptive methods available to them. In addition, efforts should be made to enable young women to have a better understanding of their own likely fertility.

Hormonal contraception and regulation of menstruation: a study of young women's attitudes towards ‘having a period’

Background Irregular bleeding is one of the most common side effects of hormonal contraception and a key reason for the discontinuation of hormonal methods. Study design A qualitative study in which 12 young women volunteered to be interviewed in depth, along with six focus group discussions (23 participants). The study had two main research objectives: to document and investigate what young women think and feel about menstruation and contraception, and to explore young womens preferences regarding the intersection of contraceptives and bleeding patterns. Results Although participants held a broad view that menstruation can be an inconvenience, they did ascribe positive values to having a regular bleed. Bleeding was seen as a signifier of non-pregnancy and also an innate part of being a woman. A preference for a ‘natural’ menstruating body was a strong theme, and the idea of selecting a hormonal contraceptive that might stop the bleeding was not overly popular, unless the young woman suffered with painful natural menstruation. Contraceptives that mimicked the menstrual cycle were acceptable to most, suggesting that cyclic bleeding still holds a symbolic function for women. Conclusions When counselling young women about the effect of different contraceptive modalities on their bleeding, practitioners should explore how the women feel about their bleeding, including how they might feel if their bleeding stopped or if they experienced erratic bleeding patterns. Practitioners also need to recognise the subjective understanding of the ‘natural body’ as held by some women, and in these cases to support them in their seeking out of non-hormonal methods of contraception.

Internalised abortion stigma: Young women’s strategies of resistance and rejection:

This paper examines the ways in which young women articulated strategies of resistance to internalised abortion stigma. It does so through secondary analysis of young women’s narratives from two qualitative studies in England and Wales. Whilst participants felt stigmatised by their abortion[s] in different ways, many also resisted stigmatisation. They did this through different stigma resistance strategies that were shaped by a number of different interactions: their socio-economic situations, family and relationships contexts, the circumstances in which they became pregnant, and their beliefs and values with respect to abortion and motherhood. Being able to construct their abortion decision as morally sound was an important element of stigma resistance. Although socio-cultural norms and values on abortion, reproduction, and motherhood were shown to constrain women’s reproductive choices, these norms were all open to challenge. The women were more likely to struggle with their abortion decision-making when they had internalised negativity around abortion.

Unanticipated bleeding with the etonogestrel implant: advice and therapeutic interventions

The etonogestrel contraceptive implant (Implanon®, Nexplanon®) is widely recognised as a reliable and cost-effective form of contraception.1 However, continuation rates are of concern as the method loses cost effectiveness when discontinued early. It has been calculated that 60% of implant removals are for irregular or unpredictable bleeding.2 Guidelines for standard practice in implant provision emphasise the importance of adequate counselling about side effects, especially bleeding irregularities, before implant insertion.3 In our recently published study4 ,5 we showed that even in cases where young women have been made aware of the possibility of irregular bleeding, the clinicians messages are not always fully absorbed. In this study the women each had their own interpretations of the advice they had been given, and individualised responses to their experience of side effects. It was confirmed that the predominant reason for requests for implant removal was irregular bleeding. It was also evident that: 1 The women had not been prepared for the reality of prolonged bleeding or irregular bleeding patterns, even when they could recall being informed about these at their initial consultation. 2 They often persevered with their implants, waiting for the bleeding pattern ‘to settle’, so often tolerated significant amounts of discomfort and inconvenience. 3 Bleeding in conjunction with other side effects was particularly problematic. Patients are often advised to ‘persevere’ with the method in …

Rewarding Responsibility? Long-Term Unemployed Men and the Welfare-to-Work Agenda

In this paper we explore the responses of a group of long-term unemployed men to chronic labour market insecurity and ‘active’ labour market policies promoting individual responsibility for employability. We draw from an evaluation of a recent pilot scheme: the UK Employment Retention and Advancement Demonstration. We identify a range of responses, shaped through experiences which reflect gender, class, and age divisions. Despite significant labour market disadvantage, some of the men responded by proactively engaging with the employability agenda. Drawing on qualitative longitudinal data, we follow the trajectories of the men in work, examining how they fared in insecure, precarious labour markets. We conclude by looking at the strengths and limitations of the current policy agenda, suggesting that more creative ways need to be found to engage some of the most disadvantaged in the reskilling agenda and that employers are currently a ‘weak link’ in the package of support provided.

The need to improve fertility awareness

Women and men globally are delaying the birth of their first child. In the UK, the average age of first conception in women is 29 years. Women experience age-related fertility decline so it is important that men and women are well-informed about this, and other aspects of fertility. A group of UK stakeholders have established the Fertility Education Initiative to develop tools and information for children, adults, teachers, parents and healthcare professionals dedicated to improving knowledge of fertility and reproductive health.

Abortion in legal, social, and healthcare contexts

Worldwide, abortion is one of the commonest gynaecological procedures (Sedgh et al., 2012). The common occurrence of abortion around the globe, however, belies considerable diversity in the social, political, and ethical meanings of terminating a pregnancy, as well as the practices surrounding abortion. All of these vary from locale to locale, from one historical time to another, and among social groups within particular times and places. In this two-part Special Issue, we present feminist scholarship that addresses some of the diverse contexts and circumstances in which abortion takes place and the psychological implications of such contexts. This issue, Feminism & Psychology, 27(1), is Part 1 of the Special Issue ‘‘Abortion in Context’’; Part 2 will appear in May 2017 as 27(2). The pieces in Part 1 explore the legal, sociocultural, and healthcare contexts of abortion. These contexts set the conditions of possibility for women who seek to terminate a pregnancy and, to some extent, for the practitioners who provide them. Part 2 will be devoted to pieces that focus on women’s experiences of abortion – for example, decision-making, stigma, and post-abortion distress – and that examine how women’s experiences are embedded in the discursive, institutional, and material contexts of their lives. Heretofore, Feminism & Psychology has contained few articles on abortion, unintended pregnancy, or contraception. The paucity of attention to abortion is in sharp contrast to the extensive attention given to heterosexual relations and (hetero)sex. Given that a substantial proportion of women are likely to terminate a pregnancy by abortion at least once during their lives, the topic of abortion merits consideration. We hope that this Special Issue serves to direct the attention of feminist psychologists to questions about abortion.

Comment on ‘Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data’

Whilst we have no criticism of the methodology and presentation of findings of the study by McCall et al., 1 we were disappointed by the use of the phrases ‘repeat abortion’ and ‘repeat termination’. This kind of terminology has been queried before as not appropriate and stigmatising.2 ,3 The term carries connotations of ‘repeat offender’ …

Abortion Embedded And Embodied In Social Relations: Challenges For Feminist Psychology

We are pleased to introduce Part 2 of Feminism & Psychology’s Special Issue on Abortion in Context. In this part, we turn attention to experiences and meanings surrounding an abortion, rather than macro-level issues. The articles focus on individuals’ accounts of processes involved in an abortion – reaching a decision to terminate a pregnancy, undergoing the procedure, and coming to terms with any social disapproval that may follow. The overarching theme of both Part 1 and Part 2 of the Special Issue is that abortion (and women’s reproductive lives more generally) must be seen in context – whether medical, socio-cultural or legal context; or immediate material and interpersonal context. In some parts of the world (e.g. USA and the UK), psychologists have been put in the position of responding to persistent claims that abortion – even when safe and legal – places individuals at risk for later psychiatric illness. A good deal of effort has been expended in challenging such claims. As Robinson, Stotland, Russo, Lang, and Occhiogrosso (2009) point out, studies that purport to draw a causal connection between safe, legal abortions and subsequent psychiatric illness are typically fraught with methodological problems. These include ‘‘poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects’’ (p. 268). Furthermore, social science researchers in North America, the UK and elsewhere have amassed a large corpus of empirical Feminism & Psychology 2017, Vol. 27(2) 133–143 ! The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0959353517704877 journals.sagepub.com/home/fap