Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review
Abstract
:1. Background
1.1. Research Question
1.2. Objectives
2. Methods
2.1. Inclusion Criteria
Search Strategy
2.2. Study Selection
2.3. Data Extraction
2.4. Quality Assessment
3. Results
3.1. Categories from the Data
3.2. Personal
3.2.1. Desire for Self-Realization
Actualized Her Intentions
“I don’t want to be dependent on somebody else… I want stability… and I don’t want to live off a guy either, on his salary, in his apartment!”(Termination of Pregnancy [ToP], 17 years old, [30], p. 176)
Never Give up Education and Career
“I am doing really well on the course at the minute, and I don’t want to give it up…”.(ToP 16 years old, [36], p. 2508)
3.2.2. Unwanted Pregnancy
Dilemma and Justification
“It’s a horrible thing to do but I think it was the best thing”.(ToP, 19 years old, [42], p. 9)
Not Ready to Be a Mother
“I didn’t think I was going to be a good mother because even myself, I still need some care and still need someone’s shoulder to cry on, especially my Mom”.(ToP, adolescent, [29], p. 78)
Worry about Physical Health
“I had loads of problems with pregnancy before … Last time I was pregnant my body was telling me I could cope. This time it didn’t sink in. My body was saying I am not ready”.(ToP, 18 years old, [36], p. 2509)
“If you give birth in quick succession, your body will soon become like an ‘abrewa’ (old woman)”.(ToP, 21 years old, [38], p. 926)
3.3. Interpersonal
3.3.1. Parental Impact
Pressure on Making a Choice Regardless of Her Desire
“… wanted to do it quickly so that nothing [bad] happened and that [her] parents would not realize”.(ToP, 16 years old, [33], p. 49)
“I had an abortion against my own will”.(ToP, 18 years old, [30], p. 176)
“My mother gave me ‘buchinha do norte’, tea pot, [and] cachaça prepared with cinnamon. None of these worked and I ended up in the hospital. […] I got pretty sick […] almost died” and continue she said […] It took a while for me to realize it. […] I felt guilty […]. Today, when I think about all I’ve done, I feel bad. […] I feel angry with my mom and with myself. I should have fought harder”.(ToP, [35], p. 902)
Fear of Rejection and Disappointment
“As I am an orphan, and I live with my uncle, they are going to kick me out. No one would assist me”.(ToP, 20 years old, [40], p. 7)
“My parents would be angry. I didn’t want to disappoint them and I did [it] for them”.(ToP, adolescent, [29], p. 78)
Mediate the Decisions
“I never thought they would understand, but they did and I am grateful to them”.(ToP, adolescent, [29], p. 75)
3.3.2. Reaction of Partner
Unstable Relationship
“As soon as I told him [that] I was pregnant, he didn’t want to know. Haven’t seen him since”.(ToP, 18 years old, [34], p. 10)
“No, I wanted my mother or [my boyfriend] to tell me what to do. When I saw that my cousin was supporting me in what I wanted [to do], when I saw [my boyfriend] with [another young woman], and when the doctor explained everything to me, then I was not afraid anymore”.(ToP, 16 years old, [33], p. 48)
Negative and Unhelpful
“I took the final decision alone. When I told him about it, he wasn’t very happy and we quarreled. Though we are still together, he has not asked anything about it”.(ToP, 22 years old, [38], p. 929)
“I did not tell the man who impregnated me, I know he would not have allowed the abortion”.(ToP, 19 years old, [38], p. 929)
Consulted Him but Ignored Her Preference
“[I asked him] what I should do. He told me, ‘Well, you should have it,’ and I told him he was crazy”.(ToP, 15 years old, [33], p. 49)
“He said, ‘Regardless of what you choose, I’ll support you—but you know what I’d prefer you to do…’ And of course, I wanted to respect that”.(ToP, 18 years old, [30], p. 177)
3.3.3. Roles of Peers and Friends
Supported Decision-Making
3.3.4. Existence of Own Child
Could Not Cope with Another Child
“I thought about my little girl. I don’t want to share my love with another baby”.(ToP, 18 years old, [36], p. 2509)
3.3.5. Lack of Support
Desire Emotional and Physical Support
“I am alone, that is the worst part. I didn’t have anyone to talk to except the people at the clinic and trusted that someone could help me, especially my mom”.(ToP, adolescent, [29], p. 74)
3.4. Social Circumstances
3.4.1. Sexual Crime
Rape and Incest
“I did it because I was raped by my uncle and my parents advised me to terminate [my] pregnancy because they felt that the baby will be a curse to the family and can also be disabled”.(ToP, adolescent, [39], p. 4)
3.4.2. Financial Problem
Lack of Financial Autonomy
“I see poverty as a cause of terminating pregnancy due to poor family background wherein you will find that they depend on social grants of the grandparents”.(ToP, adolescent, [39], p. 3)
“I can’t give it anything, like I want to be able to have a kid when I’ve got money to bring it up”.(ToP, 18 years old, [34], p. 10)
3.4.3. Limitation of Choice
Fear of Stigma
“I was worried, I feared that people would laugh at me and say bad things about me”.(ToP, adolescent, [32], p. 32)
“a typical teenager who’s got pregnant and doesn’t care about anything”.(ToP, 16 years old, [36], p. 2510)
Perspectives of Religion
“Since my parents are immigrants and Muslims, it was totally out of the question for me to tell them about the pregnancy…. They would have turned me away if they’d known. I felt I was forced to choose between my family and my unborn child”.(ToP, 18 years old, [30], p. 176)
Misconception and Lack of Knowledge
“I don’t know that such a law existed in Ghana”.(ToP, 24 years old, [38], p. 925)
“I very much took that into account. I said, well, I do not think they can put me in jail”.(ToP, 17 years old, [33], p. 51)
3.4.4. Underutilized Healthcare Services
Level of Need for Counseling
“Because I didn’t feel I needed to, because I’ve talked a lot about it with my Mum, I talked about it with my boyfriend, I talked about it with my friend”.(ToP, 18 years old, [34], p. 9)
Unaffordable
“They charged us money that we did not have. The ladies did not want to negotiate anything. I think they wanted 1200 mt (17.1 euros) if I am not wrong. He [boyfriend] had a job, but he did not have that amount of money”.(ToP, 22 years old, [40], p. 8)
Confidentiality and Privacy Issues
“I did not want to come to the hospital because I was worried, I was afraid that the nurses would report me to the police, and the police would arrest me”.(ToP, adolescent, [32], p. 32)
Healthcare Provider’s Negative Attitude
“I was worried because friends told me that people are beaten up when they go to the hospital. So, I was worried that they were going to slap me and add to the pain I was already feeling at the time. After coming here, I know these were lies, I was received and treated well here”.(ToP, [32], p. 32)
Accessibility Barriers
“I think it’s just the fact that a lot of young people don’t know they have access to that kind of stuff”.(Nonpregnancy, 22 years old, [44], p. 204)
4. Discussion
4.1. Barriers to Autonomy of Decision-Making
4.2. Barriers to Accessibility of Healthcare Services
5. Limitations and Strengths
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AN | Antenatal |
AYFHS | Adolescent and Youth-Friendly Health Services |
CASP | Critical Appraisals Skills Programme |
JBI | Joanna Briggs Institute |
PRISMA-ScR | Preferred Reporting Items for Systematics reviews and Meta-Analyses extension for Scoping Reviews |
SRH | Sexual and reproductive health |
ToP | Termination of pregnancy |
WHO | World Health Organization |
Appendix A
#1 | “adolescent pregnancy” or “pregnancy in adolescence” |
#2 | “adolescent” or “teenage” or “teenager” or “young women” or “youth” |
#3 | #1 and #2 |
#4 | “abortion” or “induced abortion” or “termination pregnancy” |
#5 | “decision making” or “choice behavior” or “determinants” or “factor” |
#6 | #3 and #4 and #5 |
#7 | “qualitative” or “qualitative study” or “mixed method” |
#8 | #6 and #7 |
Appendix B
Articles | Reason for Exclusion |
---|---|
Lema et al., 1996 [76] | The aim of the study is different (i.e., assessment of unsafe abortion) |
Finer et al., 2005 [77] | The participants are over 24 years of age. |
Kapil et al., 2005 [78] | There is no interview raw data |
Helström et al., 2006 [79] | There is no interview raw data |
Ratlabala et al., 2007 [80] | The aim of the study is different (i.e., understanding perception and constraints in accessing ToP services) |
Hess RF. 2007 [81] | The participants are over 24 years of age |
Puri et al., 2007 [82] | All the participants are married |
Olsson et al. 2010 [51] | The participants are over 24 years of age |
Biggs et al., 2013 [83] | The participants are over 24 years of age |
Kumi-Kyereme et al., 2014 [84] | The participants are over 24 years of age |
Appiah-Agyekum et al., 2015 [85] | There are no interview raw data and the participants were over 24 years of age |
Aziato et al., 2016 [86] | The study design was different (i.e., a vignette-based focus group approach) |
DePiñeres et al., 2017 [87] | The aim of the study was different (i.e., seeking safe and legal services) |
Kebede, M. T. et al., 2018 [88] | The aim of the study was different (i.e., search of abortion services) |
Oyeniran, A. A. et al., 2019 [89] | The participants are out of target age |
Baum, S. E. et al., 2020 [90] | The participants are out of target age |
Bain et al., 2020 [47] | The aim of the study was different (i.e., stakeholders’ and adolescents’ views of early pregnancy) |
Chareka, S. et al., 2021 [91] | The aim of study was different (i.e., focus young women who sell sex) |
Ituarte et al., 2021 [92] | The article is not in English |
Chainok L. et al., 2022 [93] | The aim of study was different (i.e., search of undergoing legal abortion) |
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PCC Framework | Inclusion Criteria | Exclusion Criteria |
---|---|---|
Population | Adolescents aged 10–19 years Young women aged 10–24 years (Defined by WHO [26]) | |
Concept | Research factor of decision-making abortion Influence the choice behavior of pregnancy outcome Research view of abortion Qualitative study, mixed methods narrative story, interview, diary | Research examining miscarriage, abortion of fetus Research examining abortion procedures and option Research examining abortion of biased target Research examining adolescent sexual behaviors or activities, and contraception Research examining the effectiveness of interventions or pregnancy prevention programs |
Context | Any institution, health facility, and country | |
Language | English | Non-English |
Publication type | Original studies Primary research articles | Only abstracts Conference proceedings Trial registrations Reviews (e.g., scoping review, systematic review) |
Publication date | All articles published on the database up to October 2023 |
Domains | Category | Subcategory | Mpshe et al., 2002 [29] | Ekstrand et al., 2009 [30] | Jejeebhoy et al., 2010 [31] | Chamanga et al., 2012 [32] | Tatum et al., 2012 [33] | Brown S., 2013 [34] | Domingos et al., 2013 [35] | Bell et al., 2014 [36] | Hasselbacher et al., 2014 [37] | Oduro et al., 2014 [38] | Ramakuela et al., 2016 [39] | Frederico et al., 2018 [40] | Bain et al., 2019 [41] | Hoggart L. 2019 [42] | Ouedraogo et al., 2020 [43] | Botfield et al., 2020 [44] | Chiweshe et al., 2021 [45] | Griffin et al., 2023 [46] |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Personal | Desire for self-realization | Actualized her intentions | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Never give up education and career | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Unwanted pregnancy | Dilemma and justification | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||
Not ready to be a mother | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||
Worry about physical health | ✓ | ✓ | ||||||||||||||||||
Interpersonal | Parental impact | Pressure on making a choice regardless of her desire | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
Fear of rejection and disappointment | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||
Mediate the decisions | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||
Reaction of partner | Unstable relationship | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||
Negative and unhelpful | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||
Consulted him but ignored her preference | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Roles of peers and friends | Supported decision-making | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Existence of own child | Could not cope with another child | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||||||
Lack of support | Desire emotional and physical support | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||
Social circumstances | Sexual crime | Rape and incest | ✓ | ✓ | ✓ | ✓ | ||||||||||||||
Financial problem | Lack of financial autonomy | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Limitation of choice | Fear of stigma | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||
Perspectives of religion | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||||
Misconception and lack of knowledge | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||
Underutilized healthcare services | Level of need for counseling | ✓ | ✓ | ✓ | ✓ | |||||||||||||||
Unaffordable | ✓ | ✓ | ✓ | |||||||||||||||||
Confidentiality and privacy issues | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||||
Healthcare provider negative attitude | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||||||||
Accessibility barriers | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Koiwa, Y.; Shishido, E.; Horiuchi, S. Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. Int. J. Environ. Res. Public Health 2024, 21, 288. https://doi.org/10.3390/ijerph21030288
Koiwa Y, Shishido E, Horiuchi S. Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. International Journal of Environmental Research and Public Health. 2024; 21(3):288. https://doi.org/10.3390/ijerph21030288
Chicago/Turabian StyleKoiwa, Yui, Eri Shishido, and Shigeko Horiuchi. 2024. "Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review" International Journal of Environmental Research and Public Health 21, no. 3: 288. https://doi.org/10.3390/ijerph21030288
APA StyleKoiwa, Y., Shishido, E., & Horiuchi, S. (2024). Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. International Journal of Environmental Research and Public Health, 21(3), 288. https://doi.org/10.3390/ijerph21030288