Evidence-Based Advocacy: Expanding Our Thinking About “Repeat” Abortions


Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research that activists may not otherwise be able to access.

About 1.2 million abortions are performed in the United States every year, and of women seeking abortions, about half have had an abortion before. Women who have had more than one abortion are often targets of public-health interventions designed to increase women’s use of post-abortion contraception, or, to put it another way, to prevent them from having another abortion. Instead of seeing these women as “repeaters,” it’s time we viewed each abortion as a unique experience with its own set of complex circumstances.

Tracy Weitz and Katrina Kimport, sociologists with Advancing New Standards in Reproductive Health (ANSIRH), analyzed the interviews of ten women who’d had multiple abortions (full disclosure: I interned at ANSIRH this summer). Their research was part of several larger studies. The women interviewed varied in age, race, and geographic location, although most were from the Northeast or the West Coast. Together, they’d had a total of 35 abortions. Weitz and Kimport examined how these women thought about each abortion experience. Were they similar or different from each other? How did the circumstances of each abortion affect women’s emotional outcomes?

The researchers found that women talked about their abortions as separate events. Each abortion came with its own set of unique emotional and social circumstances, some more difficult or easy than others. In other words, a woman who’s had three abortions wasn’t repeating the same experience each time. Health interventions and policies that target women who have had more than one abortion should take into account that each abortion —and the circumstances of that pregnancy—may reflect a different emotional experience.

Weitz and Kimport argue, “It is important to recognize that some abortions can be emotionally easier or harder; it is problematic to instead think about abortion as being harder or easier for some women.” That is, just because a woman has had multiple abortions does not mean that each one was a product of the same circumstance. In fact, women reported that they wanted different types of support based on the circumstances of each abortion.

Similarly, providers should not assume that a woman with a history of multiple abortions will have the same emotional or contraceptive needs after each abortion. In fact, Weitz and Kimport found that some women avoided going to the same provider for each abortion because they feared being judged for having multiple abortions or having to hear the same contraceptive-counseling script. Providers should not make assumptions about their patients’ needs based on the number of abortions they’ve had.

Even our so-called pro-choice allies place judgments on women who have had multiple abortions. Mainstream pro-choice organizations often shy away from acknowledging that some women have more than one abortion. Instead of worrying that discussing multiple abortions will rile up the anti-choice movement, we should focus on de-stigmatizing the experience of abortion, no matter how many times a woman needs to access this service.

Women who have had multiple abortions should not be viewed as a separate class of people from women who have had one abortion. Indeed, it may be that the women who have only one abortion over an average of 35 years of trying not to become pregnant, are the rarer ones. Instead of targeting just the women who have had multiple abortions for public-health interventions, the researchers suggest that we offer emotional support based on the context of each abortion.

We should understand women who have had multiple abortions through their individual life experiences rather than judging them on their pregnancy history. If we want to better meet women’s emotional needs around abortion, we can start by using the phrase “multiple abortions” instead of “repeat abortions,” and moving away from policies that seek to prevent “repeat abortions.” To support women who have had multiple abortions, we need to acknowledge that some abortions may be more difficult than others. 

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  • smiletara

    I wouldn’t trust William Saletan to accurately express/represent the opinions of “pro-choice allies,” being himself the furthest thing from an ally of any kind. Just sayin’!

    Thanks for a great article!

     

     

  • aigiarm

    Why is it even anyone’s business how many abortions a woman has?

  • give-em-hell-mary

    Don’t know if this is true (because anti-choice Dr. Wilke was the source!), but I have read that some women in the old Soviet block countries had as many as 40 abortions each (2 a year) because of no available contraception.  And yet forced birthers keep insisting that available contraception increases abortion rates!  Forcerd birthers just love changing history and facts!

  • thalwen

    Not true of course. I’m sure there have been women that have had 40 abortions, there’s also women that have 20 kids but no one points at them as being representative of any majority.

    Abortion was/is much more acceptable in the former USSR countries but birth control was certainly widely available and used by most women. But abortions and repeat abortions weren’t demonised there like they are here, so women there and from there have a much easier time talking about them. I remember when I first found out when I was pregnant and my nurse, a former Soviet citizen told me about the abortions she had and how it’s just a medical procedure and really calmed me down about the whole matter. I wish we had more people and more dialogues like hers so we could stop with the whole falsehood and stigma surrounding repeat abortions and abortion in general. 

  • crowepps

    It’s my understanding that in the old Soviet block countries, birth control was fairly cheap, and doctors made little by prescribing it, but that they could get extra payment from the State for each abortion that they did, so it was common to say that birth control ‘wasn’t available’ and encourage patients to rely on abortion instead.

    Without any ProLife drama queens throwing hysterical hissy fits outside the clinics, without the expensive publicity relentlessly encouraging women to take a guilt trip on the shame train, it was just a medical procedure and nobody thought much of it — no ‘psychological problems’, no ‘increased risk of suicide’, no groveling in remorse to get absolution from the moralists.  All those are the result not of abortion but of lunatics screaming ‘murderer, don’t kill your baby!’ at women seeking pap smears.

  • purplemistydez

    Whether a woman has one abortion or multiple abortions does not change the fact that she has the right to them.  Financially it is better to use a contraception that works for her, but if she chooses abortions as her primary bc then that is fine also.  To tell a woman how many abortions she can have is as bad as saying she is not allowed to have one in the first place.  I respect a woman’s choice since I do not know what is going on in her life and I trust she knows what ultimately is best.

  • give-em-hell-mary

    Novelist George Feifer (The Girl from Petrovka movie adaption with Goldie Hawn) mentioned the prevalence of abortion in another book, Moscow Farewell, because both contraception and feminine products weren’t widely available among his crowd of Moscow university students (1960s-1970s).  

  • thalwen

    It was more like there were shortages of everything because of the planned economics, people just stole and resold anything they could get their hands on, it would make sense for BC to be included (my family had trouble buying anything as basic as a lemon before we left, much less medicine). Abortion like all other surgeries, requires people and therefore no shortages. Also, big families weren’t really encouraged like they are here.

     

    Of course, the big scary Stalin, who is brought out to show the evils of Communism, banned abortion during his reign and was quite brutal in the enforcement of those bans. It would be an anti-choicer’s wet dream to have conditions like he imposed.