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Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care. [ABSTRACT FROM AUTHOR]

Introduction: Method choice is an important component of quality abortion care and qualitative research suggests that abortion stigma can influence provider preference and provision of abortion methods. This study is the first to explore the relationships between abortion providers' method preferences, their provision of medication or instrumentation abortion or both methods, and abortion stigma. Methods: We conducted secondary analysis of a survey of United Kingdom (UK) abortion providers (N = 172) to describe and compare providers' self‐reported method preferences and provision. We used multinomial logistic regression to assess the association between method preference and provider experiences of abortion stigma (measured using a revised Abortion Provider Stigma Scale (APSS)), adjusting for relevant provider and facility characteristics. Results: Almost half (52%) of providers reported that they only provided medication abortion care, while 5% only provided instrumentation abortion care and 43% provided both methods. Most (62%) preferred to provide both methods while 32% preferred to provide only medication abortion and 6% only instrumentation abortion. There was no significant difference in revised APSS scores by provider method preference or provision. Discussion: Most surveyed UK abortion providers prefer to offer both methods, but over half only provide medication abortion. This may reflect patients' preferences for medication abortion, and health system and legal constraints on instrumentation abortion. Addressing these systemic constraints on method provision could expand patient choice. Providers' method preference was not significantly associated with provider stigma but future research should consider the influence of structural stigma on method provision at the health system level. [ABSTRACT FROM AUTHOR]

Young mothers often encounter stigma and discrimination, affecting their lives and that of their children. This paper explores stigma management strategies and their effectiveness for young mothers in rural Nigeria. Ten key informants and 24 young mothers were recruited from Ife-East in South-Western Nigeria. Data from semi-structured interviews showed that societal disapproval of pregnant teenagers and young mothers were common experiences. Women used a range of strategies to actively cope with stigma including: belief in predestination, avoidance, concealment, and cohabitation. These strategies could be seen as tools to mitigate negative stereotypes and discrimination. However, they also had the unintended consequences of compounding many young women’s difficult circumstances and exposing them to adverse outcomes, including gender-based violence, repeat pregnancies, poor mental health, and low uptake of services. The results show the need for policy frameworks to actively combat stigma by addressing the negative framing of early pregnancy and motherhood and promoting supportive environments for young mothers. Health professionals need to be trained to offer de-stigmatising services to encourage young mothers to seek help and reduce pre-existing inequities in access to services, and policies need to include measures that address the rights of young mothers and protect them from violence and abuse. [ABSTRACT FROM AUTHOR]

Continued pregnancy after an abortion attempt is a likely outcome in countries where unsafe abortions prevail. Yet there is a paucity of literature on the consequences and implications of failed abortions. This study explored young women's abortion decision-making, their experiences of failed abortion and its consequences in South-Western Nigeria. It presents findings from semi-structured interviews conducted with 14 women who had become unintentionally pregnant as unmarried teenagers, desired abortions, yet became mothers. Whilst the fear of the stigma associated with young unmarried motherhood gave rise to participants' desire for abortion, restrictive abortion laws influenced their experiences and abortion decision-making. Participants who attempted an abortion failed and were forced to carry their unwanted pregnancies to term. They then experienced continued discrimination, forced motherhood, and a rejection of maternalism. Their experiences are analysed as responses to the complex interplay between social norms, abortion restrictions, stigma and forced motherhood. The paper makes a case for improving women's reproductive autonomy in decision-making, – highlighting the social and mental health consequences of restricted access to abortion, and reinforce the importance of taking a holistic approach to addressing the sexual health of young women, by focusing not only on physical health but also on ensuring wellbeing. [ABSTRACT FROM AUTHOR]

Much care has been paid to reflexivity, including considering emotional sensitivities in relation to face-to-face interviews. However, less attention has been paid to the impact of sensitivities on the process of data analysis and the presentation of research findings. This paper focuses on what constitutes 'the data' to be analysed, who analyses and interprets the data, what is silenced and what is made public, and what this might mean for feminist research practice in areas considered to be 'sensitive'. It examines these issues by focusing on research on abortion decision-making in which the views and emotions of the researcher were profoundly challenged by women's constructions of narratives containing a theme of abortion regret. The paper demonstrates how theoretical perspectives – in this case, feminist standpoint theory – can be used in sensitive research, to allow the researcher to resolve such tensions by providing a means through which greater attention can be paid to the context of participants' narratives. [ABSTRACT FROM AUTHOR]

In most settings worldwide, abortion continues to be highly stigmatised. Whilst a considerable body of literature has addressed abortion stigma, what is less commonly examined are the ways in which those with experience of abortion describe it in non-negative terms which may resist or reject stigma. Drawing on qualitative secondary analysis of five UK datasets using a narrative inquiry approach, we explore: the use of non-negative language around abortion, potential components of a normalising narrative, and constraints on non-negativity. As such, we present the first empirical UK study to critically examine how a dominant negative abortion narrative might be disrupted. [ABSTRACT FROM AUTHOR]

This paper scrutinises the concepts of moral reasoning and personal reasoning, problematising the binary model by looking at young women’s pregnancy decision-making. Data from two UK empirical studies are subjected to theoretically driven qualitative secondary analysis, and illustrative cases show how complex decision-making is characterised by an intertwining of the personal and the moral, and is thus best understood by drawing on moral relativism. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article focuses on the issues of reproductive rights for feminists and their psychology involved in an abortion. Topics discussed include relationship between abortion and social disapproval; analysis of frameworks for theorising abortion; and comprehensive overview of psychological research on abortion.

An introduction is presented in which the editor discusses articles in the issue on topics including legal context of abortion, social contexts of abortion and health care systems as contexts of abortion.

Background: In recent years there has been growing international interest in identifying risk factors associated with 'repeat abortion', and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives.Study Design: Mixed-methods research study: a quantitative survey of 430 women aged 16-24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15).Results: The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame.Conclusions: This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion. [ABSTRACT FROM AUTHOR]

Objectives: Our research examined the barriers to the uptake of intrauterine contraception (IUC) by women in a general practice (GP) setting in the UK. This study reports predictors of non-use of IUC in this context. Design: We used a mixed method Qual/Quant approach in which the initial qualitative research provides a framework for subsequent larger quantitative surveys. Utilizing findings derived from 30 qualitative interviews, a quantitative survey was developed and distributed to a pragmatic sample of 1,195 women, aged 18-49 years, who were recruited through 32 participating GP practices in an area of England, UK. Outcome measures were percentage of attributes or responses in the sample and use or non-use of IUC. Results were analyzed using descriptive statistical analysis and binary logistic regression, using use/non-use as a binary response variable. Results: Attitudinal variables, which were the strongest predictors of non-use of IUC, were an adverse opinion on long-acting aspect of IUC (odds ratio [OR]=8.34), disliking the thought of IUC inside the body (OR=3.138), concerns about IUC causing difficulties becoming pregnant in the future (OR=2.587), concerns about womb damage (OR=2.224), having heard adverse opinions about levonorgestrel-releasing intrauterine system (Mirena®) (OR=2.551), having an adverse opinion of having light, irregular periods (OR=2.382) and, having an adverse opinion of having no periods (OR=2.018). Conclusion: Concerns about the long-acting nature of IUC and persisting concerns about the safety of IUC may act as barriers to its use. Information for women, tailored to specifically address these concerns, is needed. Implications: Clinicians should provide more reassurance and information to potential users of IUC to increase their confidence about the possibility of removing IUC early or on request. They should also specifically seek to alleviate concerns about internal damage, damage to the womb, or damage to future fertility from using the methods. [ABSTRACT FROM AUTHOR]

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 women's 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. [ABSTRACT FROM AUTHOR]

This article reviews literature from a number of disciplines in order to provide an explanation of the political controversy attached to the provision of abortion counselling. It will show how this is an area of health policy debate in which women's reproductive bodies have become a setting for political struggle. The issue of abortion counselling in Britain has undergone a number of discursive shifts in response to political manoeuvring and changing socio-legal framing of abortion. In particular, the article shows how much of the controversial reframing of abortion counselling was a tactical shift by political actors opposed to abortion per se, and this work is critiqued for not contextualising abortion. The article then focuses on women's abortion experiences and discusses research that shows how women's decision-making processes, and responses to an abortion, are related to gendered socio-cultural contexts: the extent to which women having an abortion feel they have transgressed societal norms and values, for example, is likely to affect their abortion experiences. Finally, it is suggested that providing a non-judgemental context, and challenging negative discourses on abortion, may be the most effective way of minimising the possibility of negative emotions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

Although random assignment is generally the preferred methodology in impact evaluations, it raises numerous ethical concerns, some of which are addressed by securing participants' informed consent. However, there has been little investigation of how consent is obtained in social experiments and the amount of information that can be conveyed—and absorbed—prior to consent. This article reports on the implementation of the Employment Retention and Advancement (ERA) program, a large social experiment in the United Kingdom. Procedures to elicit informed consent were generally scrupulously followed, but even so many participants appeared to have only limited understanding of the experiment and their involvement in it. The reasons for this are articulated and recommendations are made to help ensure, to the extent possible, that potential random assignment study participants adequately understand their situation and their choices. [ABSTRACT FROM AUTHOR]

This paper considers young people's sexual decision-making in the context of New Labour's policies on teenage pregnancy. In 1999, the newly formed Social Exclusion Unit sought to understand why the UK had the highest number of teenage conceptions in Europe (SEU 1999). One of the conclusions was that young people in the UK are engaging in "risky" rather than "safe" sex. Although New Labour has since developed policies designed to help young people avoid what is seen as risky sexual activity, there is a tension in sexual health policy between the overall aim of providing young people with the knowledge and confidence to practice "safe sex", and an underlying belief amongst many in the undesirability of "underage sex". This is partly a legacy of disagreements evident in the 1980s and 1990s when some organisations argued against sex education and contraceptive provision for young people on the grounds that it encouraged promiscuous and risky behaviour. The paper shows how alternative meanings of risk and responsibility are present in young mothers' own representations of their sexual decision- making. It does this through an analysis of two research projects on Young Women, Sex and Choices. [ABSTRACT FROM AUTHOR]

Tackling the ‘problem’ of teenage pregnancy was proclaimed as one of the priorities of New Labour. It is an issue that is rarely out of the news and provokes strong opinions from all sides of the political spectrum. This article discusses the social, political and historical context to the current debate. It argues that the centrality of the issues of social inequality and reproductive choice to the debate make it important for socialists and feminists. [ABSTRACT FROM AUTHOR]

The Problem of translating political aims into effective political practice is of longstanding concern for political activists, including feminists. This article considers this problem for socialist feminist political activity around reproductive rights. It includes a consideration of the strategy of feminist alliances with socialist movements in political practice. It does so through a study of the Workers' Birth Control Group in the 1920s and the National Abortion Campaign in the 1970s. Both these feminist organisations attempted the difficult task of taking feminist demands for bodily control into the labour movement. These two cases examine how far successful alliance with a reformist dominated labour movement was facilitated through the promotion of moderate — as opposed to radical — politics on reproductive rights, and, further, how far class and gender politics clashed in the process. [ABSTRACT FROM AUTHOR]

The article invites contributions on abortion in diverse contexts, places and circumstances. Possible topics could be public and social discourses on abortion, the nature of stigmata association with abortion in various national contests and the relation between such stigma and experiences around abortion. Submissions are due on December 10, 2015 and will be subject to the usual process.