Women’s demand for late-term abortion – A social or psychiatric issue?
Abstract
Introduction/Aim. Induced termination of unwanted pregnancy after 12th gestational week (late-term abortion) is legally restricted in Serbia as well as in many other countries. On the other hand, unwanted pregnancy very often brings women into the state of personal crisis. Psychiatric indications for legally approved late-term abortion on women’s demand include only severe psychiatric disorders. The aim of this paper was to compare sociodemographic, psychological characteristics and claimed reasons for abortion in the two groups of women with late-term demand for abortion – the group of women satisfying legally prescribed mental health indications, and the group of women not satisfying these indications. The aim of the study was also to determine predictive validity of the abovementioned parameters for late-term abortion as the outcome of unwanted pregnancy. Methods. A total of 62 pregnant women with demand for late-term abortion were divided into two groups according to the criteria of satisfying or not satisfying legally proposed psychiatric indications for late-term abortion after psychiatric evaluation. For the assessment of socio-demographic and psychological parameters sociodemographic questionnaire and symptom checklist – 90 revised (SCL-90®) scale were used, respectively. The outcome of unwanted pregnancy was followed 6 months after the initial assessment. Results. The obtained results showed a statistically significant difference between the groups in educational level, satisfaction with financial situation, elevated anxiety and distress reactions. Unfavorable social circumstances were the main reason for an abortion in both groups and were predictive for an abortion. A 6-month follow-up showed that women had abortion despite legal restrictions. Conclusion. Pregnant women with psychiatric indication for late-term abortion belong to lower socioeconomic and educational level group compared to women without this indication who have more frequently elevated anxiety and distress reactions to unwanted pregnancy. It is necessary to have more accurate guidelines for mental health indications for legally approved late-term abortion, respecting social circumstances. Preventive measures are of great importance in order to lower the risk of illegally performed late-term abortions.
References
Health Care Law and The law on abortion in health care insti-tutions. Official Gazette of RS 2005; 107 No 16/95; 101/2005. (Serbian)
Boland R. Second trimester abortion laws globally: actuality, trends and recommendations. Reprod Health Matters 2010; 18(36): 67−89.
The ICD-10 Classification for mental and behavioural disord-ers. Diagnostic criteria for research. Geneva: World Health Organization; 1993.
Sheehan VD, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M. I. N. I) The development and validation of a structured di-agnostic psychiatric interview for DSM IV and ICD 10. J Clin Psychiatry 1998; 59(Suppl 20): 22−33.
Barker-Collo SL. Culture and validity of the Symptom Check-list-90-Revised and Profile of Mood States in a New Zealand student sample. Cultur Divers Ethnic Minor Psychol 2003; 9(2): 185−96.
Upson K, Reed SD, Prager SW, Schiff MA. Factors associated with contraceptive nonuse among US women ages 35-44 years at risk of unwanted pregnancy. Contraception 2010; 81(5): 427−34.
Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84(5): 478−85.
Mujović-Zornić H. Reproductive rights: The current issue of late abortion. Stanovništvo 2009; 47(1): 49–67. (Serbian)
Medoff MH. Biased abortion counseling laws and abortion de-mand. Soc Sci J 2009; 46(4): 632−43.
Coleman PK, Coyle CT, Shuping M, Rue VM. Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey. J Psychiatr Res 2009; 43(8): 770−6.
Steinberg JR, Russo NF. Abortion and anxiety: What's the rela-tionship. Soc Sci Med 2008; 67(2): 238−52.
Cook RJ, Ortega-Ortiz A, Romans S, Ross LE. Legal abortion for mental health indications. Int J Gynaecol Obstet 2006; 95(2): 185−90.
Coleman PK. Resolution of unwanted pregnancy during adoles-cence through abortion versus childbirth: individual and family predictors and psychological consequences. J Youth Adolesc 2006; 35: 903−11.
Goto A, Yasumura S, Reich MR, Fukao A. Factors associated with unintended pregnancy in Yamagata, Japan. Soc Sci Med 2002; 54(7): 1065−79.
Robotham S, Lee-Jones L, Kerridge T. Late Abortion: A research study of women undergoing abortion between 19 and 24 weeks gestation. London, UK: Marie Stopes International; 2005; 13(26): 163−4.
Ingham R, Lee E, Clements JS, Stone N. Reasons for second tri-mester abortions in England and Wales. Reprod Health Mat-ters 2008; 16(suppl 31): 18−29.
Coleman PK, Reardon DC, Rue V. State founded abortions abor-tus vs. deliveries: a comparison od outpatients mental health claims over four years. Am J Orthopsychiat 2002; 72: 141−52.
Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Tim-ing of steps and reasons for delays in obtaining abortions in the United States. Contraception 2006; 74(4): 334−44.
Tenkku LE, Flick LH, Homan S, Loveland CA, Campbell C, Mcsweeney M. Psychiatric disorders among low-income women and unintended pregnancies. Womens Health Issues 2009; 19(5): 313−24.
Coleman PK, Reardon DC, Rue VM, Cougle J. State-funded abor-tions versus deliveries: a comparison of outpatient mental health claims over 4 years. Am J Orthopsychiatry 2002; 72(1): 141−52.
Hennelly M, Yi J, Batkis M, Chisolm MS. Termination of preg-nancy in two patients during psychiatric hospitalization for de-pressive symptoms and substance dependence. Psychosomat-ics 2011; 52(5): 482−5.
Mavroforou A, Koumantakis E, Michalodimitrakis E. Adolescence and abortion in Greece: women's profile and perceptions. J Pediatr Adolesc Gynecol 2004; 17(5): 321−6.
Coleman PK, Coyle TC, Shuping M, Rue MV. Induced abortion and anxiety, mood and substance abuse disorder: Isolating the effects of abortion in the national comorbidity survey. J Psy-chiatr Res 2009; 43(8): 770−6.
