Marlene Makenzius

Repeat induced abortion - a matter of individual behaviour or societal factors?: A cross-sectional study among Swedish women

ABSTRACT Background Almost 40% of all induced abortions in Sweden are repeat abortions; little is known about the risk factors. Objective To investigate differences between women who had a first-time abortion and those with repeat abortion, and to identify factors associated with repeat abortion. Methods A questionnaire was answered by 798 abortion-seeking women in Sweden during 2009. A regression model was used to assess risk factors for repeat abortions. Results In the age range 20–49 years, 41% of women had experienced at least one previous abortion. Risk factors for repeat abortion were parity (OR 2.57), lack of emotional support (OR 2.09), unemployment or sick leave (OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5). Some women (n = 55) considered economic support and work opportunities could have enabled them to continue the pregnancy. Increased Sex and Relationship Education (SRE), easy access to high-quality contraception and counselling, were suggested (n = 86) as interventions for preventing unintended pregnancies. Conclusions Even in a country with long established SRE and a public health policy to enhance sexual and reproductive health over a third of women requesting abortion have experienced one previously and the rate is maintained. Some specific factors are identified but, overall, a picture of vulnerability among women seeking repeat abortion stands out that needs to be considered in the prevention of unintended pregnancies.

Women and men's satisfaction with care related to induced abortion.

Abstract Objectives To investigate satisfaction with abortion care among women and their male partners, and to identify factors associated with high overall contentment with the care received. Methods A multi-centre cross-sectional questionnaire survey conducted in 2009 among 798 Swedish abortion-seeking women and 590 male partners was analysed with logistic regression. Results Overall care satisfaction was rated high by two-thirds (74%) of the women and half (52%) of the men. For women, factors associated with high overall satisfaction with care were: to be well treated by the health care staff (Odds Ratio [OR] = 11.78), sufficient pain relief (OR = 3.87), adequate information about the gynaecological examination (OR = 2.25), suitable contraceptive counselling (OR = 2.23), and ease of access to the clinic by phone (OR = 1.91). For men, the factors were to be well treated by the health care staff (OR = 5.32), and adequate information about the abortion procedure (OR = 2.64). Conclusion Most women and half of the men were pleased with the attention they had received, but one in four women and half the men were not, or not completely, suggesting improvement is needed, especially with regard to men. For both women and men the human aspect of the care, namely, the consideration showed by the attending staff, appears to be the most important factor associated with satisfaction regarding abortion care.

Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation

BACKGROUND In public health efforts, knowledge about risk-groups is important for creating societal conditions to ensure good health on equal terms. AIM To investigate differences in lifestyle and perceived health among 15-year-old teenagers with experience of sexual intercourse (self-defined) and same-aged teenagers without experience of sexual intercourse. METHODS A two-cluster questionnaire study among 15-year-old Swedish students (n = 2170) in 2009/10. Chi-squared test was used to identify differences between three groups: teenagers who had not had sexual intercourse; teenagers who had had sexual intercourse at age of 14 or younger; and teenagers who had had intercourse at an age of 15. RESULTS Thirty-two per cent (n = 334) of girls and 31% (n = 324) of boys had had sexual intercourse. Teenagers with experience of sexual intercourse at 15 years or younger used more tobacco, alcohol and illicit drugs than same-aged teenagers without intercourse experience did. Furthermore, teenagers with experience of intercourse, especially those with a debut at 14 year or younger, had less positive school experiences, more involvement in injuries and physical violence, were less (girls) and more (boys) physically active, and perceived a poorer health than teenagers without intercourse experience. CONCLUSION Sexual intercourse at the age of 15 or younger is an indicator for a hazardous lifestyle and problematic life situation.

Existential experiences and needs related to induced abortion in a group of Swedish women: a quantitative investigation

Objective: To investigate the prevalence of existential experiences and needs among women who have requested an induced abortion. Methods: A questionnaire was used to collect information from 499 women who had requested an induced abortion. A principle component analysis resulted in three components of existential experiences and needs: existential thoughts, existential practices, and humanisation of the foetus. These components were analysed in relation to background data and other data from the questionnaire. Results: Existential experiences and needs were common. For 61% of women existential thoughts about life and death, meaning and morality were related to the abortion experience. Almost 50% of women reported a need for special acts in relation to the abortion; 67% of women thought of the pregnancy in terms of a child. A higher presence of existential components correlated to difficulty in making the abortion decision and poor psychological wellbeing after the abortion. Conclusion: Women’s experiences of abortion can include existential thoughts about life, death, meaning and morality, feelings of attachment to the foetus, and the need for symbolic expression. This presents a challenge for abortion personnel, as the situation involves complex aspects over and above medical procedures and routines.

Risk factors among men who have repeated experience of being the partner of a woman who requests an induced abortion

Background: Prevention of unintended pregnancies is a public health objective; however, the profiles of male partners of women who choose to abort are relatively unexplored. Objective: To investigate risk factors among men who have repeated experience of being the partner of a woman electing an induced abortion. Methods: A questionnaire was used to collect information from 590 men recruited through their pregnant partner who applied for an abortion in Sweden during 2009. A binary logistic regression model assessed risk factors associated with repeated experience of abortion. Results: One-third of the men had previous experience of a pregnant partner electing an induced abortion. Univariate analysis indicated these men were older, had a lower educational level and less emotional support, and were more often tobacco users than men for whom it was the first experience of a partner choosing to abort. Independent risk factors were being a victim of physical, psychological, or sexual violence or abuse over the past year (OR 2.62, 95% CI 1.36–5.08), unemployment or sick leave (OR 2.58, 95% CI 1.57–4.25), and having children (OR 2.00, 95% CI 1.22–3.28). The men suggested improved sex and relationship education in school and lower unemployment rates could prevent unintended pregnancies and abortions. Conclusions: Men with experience of repeat abortions present a picture of vulnerability that should be recognised in the prevention of unintended pregnancies. Increased work opportunities might be one important intervention to reduce the number of abortions.

Autonomy and dependence – experiences of home abortion, contraception and prevention

BACKGROUND Few studies have explored experiences and needs in relation to an induced medical abortion with the final treatment at home. OBJECTIVE To explore womens and mens experiences and needs related to care in the context of a home abortion as well as to elicit their views on contraception and prevention of unwanted pregnancies. METHOD Qualitative interviews were carried out with 24 women and 13 men who had experienced a home abortion; they took place in Sweden during 2009/10. RESULTS Two overarching themes were identified: Autonomy--the decision to undergo an abortion and the choice of method were well considered by the woman, supported by the partner. The home environment increased their privacy and control, which helped them freely express and share their emotions. They were motivated to avoid a subsequent abortion and considered it an individual responsibility; however, contraceptive follow-up visits were rare. Dependence--a desire to be treated with empathy and respect by care providers and to receive adequate information. In the prevention of unwanted pregnancies, financial resources, improved communication/education and subsidized contraceptives were considered important. CONCLUSION Home abortion increases autonomy, and women and partners demonstrate self-care ability. This autonomy, however, is related to dependence: a desire to be treated with empathy and respect on equal terms and to receive adequate information tailored to their self-care needs. Routines in abortion care should be continuously evaluated to ensure care satisfaction, safety and security as well as contraceptive adherence.

Swedish public health policy: Impact on regional and local public health practice and priorities

We evaluated the Swedish National Public Health Policy to determine its impact on public health priorities and practice at regional and local levels between 2004 and 2013. We conducted a survey by questionnaire in February 2013 among Swedish county councils/regions (n=19/21), and municipalities (n=219/290). The National Public Health Policy facilitated systematic public health practice, particularly for planning, for high priority concerns, including conditions during childhood and adolescence, physical activity, and tobacco prevention. Respondents expressed need for a comprehensive monitoring system with comparable indicators nationwide and explicit measurable objectives. To ensure effective monitoring and follow-up, the measurable outcomes need direct relevance to decision making and high-priority public health issues addressing Sweden’s “overarching public health goal” – to create societal conditions for good health on equal terms for the entire population.