Exploring pregnancy termination experiences and needs among Malaysian women: A qualitative study

BMC Public Health

Ravindran Jegasothy³  Sim Poey Choong²  Yut Lin Wong⁴  Wah Yun Low⁵  Wen Ting Tong¹ 

[1] Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia;Klinik Rakyat Family Planning Services SdnBhd, 556-W, Mk 13, BatuUban, Century Garden, 11700, Gelugor, Penang, Malaysia;Department of Obstetrics & Gynaecology, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia;Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia;Dean’s Office, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

关键词: Interview;    Reproductive health;    Family planning;    Sexual health;    Women's health;    Unwanted pregnancy;    Needs;    Experiences;    Abortion;   

Others  :  1163148
DOI  :  10.1186/1471-2458-12-743

 received in 2012-03-02, accepted in 2012-08-31,  发布年份 2012

【 摘 要 】

Background

Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion.

Methods

Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women’s experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically.

Results

Thirty-one women, with ages ranging from 21–43 years (mean 30.16 ±6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2–8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband’s agreement. In terms of the women’s needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up.

Conclusions

The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.

【 授权许可】

   
2012 Tong et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO: Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th edition. Geneva, Switzerland: World Health Organization; 2004.
• [2]WHO: Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. 6th edition. Geneva: World Health Organisation; 2011.
• [3]Shah I, Ǻhman E: Unsafe abortion in 2008: global and regional levels and trends. Reprod Health Matters 2010, 18(36):90-101.
• [4]UN: World Abortion Policies 2007. United States of America: United Nations: Department of Economic and Social Affairs PD, United Nations; 2007.
• [5]Grimes D, Benson J, Singh S, Romero M, Ganatra B, Okonofua F, Shah I: Unsafe abortion: the preventable pandemic. Lancet Sex Reprod Health Ser 2006, 368(9550):1908-1919.
• [6]Tey NP, Ng ST, Yew SY: Proximate determinants of fertility in Peninsular Malaysia. Asia Pac J Public Health 2011, 24(3):489-499.
• [7]Rashidah A, Wong YL: Barriers to access to abortion services in Malaysia: misinformation and stigma. In Abortion in Asia Local Dilemmas, Global Politics Volume 20. Edited by Whittaker A. Oxford. New York: Berghahn Books; 2010.
• [8]Fielding SL, Edmunds E, Schaff EA: Having an abortion using mifepristone and home misoprostol: a qualitative analysis of women's experiences. Perspect Sex Reprod Health 2002, 34(1):34-40.
• [9]Levine K, Cameron ST: Women's preferences for method of abortion and management of miscarriage. J Fam Plann Reprod Health Care 2009, 35(4):233-235.
• [10]Ho PC: Women's perceptions on medical abortion. Contraception 2006, 74(1):11-15.
• [11]Fiala C, Winikoff B, Helstrom L, Hellborg M, Gemzell-Danielsson K: Acceptability of home-use of misoprostol in medical abortion. Contraception 2004, 70(5):387-392.
• [12]Coyaji K, Elul B, Krishna U, Otiv S, Ambardekar S, Bopardikar A, Raote V, Ellertson C, Winikoff B: Mifepristone-misoprostol abortion: a trial in rural and urban Maharashtra, India. Contraception 2002, 66(1):33-40.
• [13]WHO: Frequently asked questions about medical abortion: conclusions of an international Consensus Conference on Medical Abortion in Early First Trimester Bellagio, Italy. Geneva: WHO; 2006.
• [14]WHO: The 17th WHO Model List of Essential Medicines. Geneva: WHO; 2012. Available at: http://www.who.int/selection_medicines/list/en/ webcite
• [15]The Commisioner of Law Revision Malaysia: Laws of Malaysia. Medicines (Advertisement and Sale) Act 1956. The Commisioner of Law Revision M. Malaysia: Percetakan National Malaysia Berhad; 2006:2-20.
• [16]Grossman D, Holt K, Peña M, Lara D, Veatch M, Córdova D, Gold M, Winikoff B, Blanchard K: Self-induction of abortion among women in the United States. Reprod Health Matters 2010, 18(36):136-146.
• [17]Ankomah A, Aloo-Obunga C, Chu M, Manlagnit A: Unsafe abortions: methods used and characteristics of patients attending hospitals in Nairobi, Lima, and Manila. Health Care Women Int 1997, 18(1):43-53.
• [18]Saultes TA, Devita D, Heiner JD: The back alley revisited: sepsis after attempted self-induced abortion. West J Emerg Med 2009, 10(4):278-280.
• [19]Shah N, Hossain N, Noonari M, Khan NH: Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan. J Pak Med Assoc 2011, 61(6):582-586.
• [20]Dalvie S, Barua A, Choong S, Chin O, Ramasami S: A Study of Knowledge, Attitudes and Understanding of Legal Professionals about Safe Abortion as a Woman’s Right in Malaysia. India: Asia Safe Abortion Partnership (ASAP); 2009.
• [21]Dahlback E, Maimbolwa M, Kasonka L, Bergstrom S, Ransjo-Arvidson AB: Unsafe induced abortions among adolescent girls in Lusaka. Health Care Women Int 2007, 28(7):654-676.
• [22]Nyanzi S, Nyanzi B, Bessie K: "Abortion? That's for women!" Narratives and experiences of commercial motorbike riders in south-western Uganda. Afr J Reprod Health 2005, 9(1):142-161.
• [23]Kimport K, Foster K, Weitz TA: Social Social sources of women's emotional difficulty after abortion: lessons from women's abortion narratives. Perspect Sex Reprod Heal 2011, 43(2):103-109.
• [24]Alex L, Hammarstrom A: Women's experiences in connection with induced abortion - a feminist perspective. Scand J Caring Sci 2004, 18(2):160-168.
• [25]Andrews JL, Boyle JS: African American adolescents' experiences with unplanned pregnancy and elective abortion. Health Care Women Int 2003, 24(5):414-433.
• [26]Renne EP: The pregnancy that doesn't stay: the practice and perception of abortion by Ekiti Yoruba women. Soc Sci Med 1996, 42(4):483-494.
• [27]Ogunjuyigbe O, Adedini S: Male attitudes to cases of unwanted pregnancy and their involvement in abortion decision making in southwest Nigeria. In XXVI IUSSP International Population Conference. Morocco: Office of Population Research, Princeton University; 2009.
• [28]Trybulski J: The long-term phenomena of women's postabortion experiences. West J Nurs Res 2005, 27(5):559-576. comment 577–582
• [29]Siti Fathilah K: Cultural constructions of abortion. Akademika 1997, 51:77-93.
• [30]Siti Fathilah K: Urban Malaysian Women's experiences of abortion: some implications for policy. Kajian Malaysia (Journal of Malaysian Studies) 1998, 16(1-&2):53-77.