A meta-ethnography on the experience and psychosocial implications of providing abortion care

• Published in: Social science & medicine (1982) Vol. 328; p. 115964
• Main Authors: Mills, Lisa, Watermeyer, Jennifer
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2023
• Subjects: Abortion provision; Abortion stigma; Abortion, Induced; Adaptation, Psychological; Anthropology, Cultural; Emotional labour; Female; Health Personnel - psychology; Healthcare providers; Humans; Meta-ethnography; Pregnancy; Psychosocial well-being; Qualitative Research; Stress process model; Psychosocial well-being; Abortion stigma; Stress process model; Meta-ethnography; Emotional labour; Healthcare providers; Abortion provision
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2023.115964

Challenges unique to abortion care have negative implications for access to safe abortion and the psychosocial well-being of healthcare providers. A deeper understanding of the experience of providing abortion care can inform responsive interventions toward supporting abortion providers and strengthening health systems.
A meta-ethnography was conducted to describe the experiences of providing abortion care and offer broad conceptual implications of abortion providers’ experiences on their psychosocial coping and well-being.
International grey and published research reported in English between 2000 and 2020 was identified via Web of Science Core Collection, PsycInfo, PubMed, Science Direct and Africa-Wide. Studies conducted in contexts where elective abortion is legally permitted were included. Study samples included nurses, physicians, counsellors, administrative staff and other healthcare providers involved in abortion care. Qualitative studies and qualitative data from mixed designs were included. The Critical Appraisal Skills Programme tool was used for appraisal and data was analysed using a meta-ethnographic approach.
The review included 47 articles. Five themes arose from the data including the emotional challenges of providing clinical and psychological care, organisational and structural challenges, experiences characterised by stigma, pro-choice narratives, and coping with challenges. Outcomes ranged from moral and emotional alignment, resistance to abortion stigma, and job satisfaction to moral distress, emotional suppression, internalised stigma, selective participation and discontinuation of abortion care. Outcomes were dependent on the nature of interpersonal relationships, working conditions, the internalization of positive or negative messages about abortion, personal history and individual coping styles.
Despite facing significant challenges in their work, the presence of positive outcomes among abortion providers and the moderating role of external and individual-level factors on well-being have encouraging implications for supporting psychosocial wellness among abortion providers.
•Abortion providers face significant challenges related to anti-abortion stigma.•Psychosocial outcomes of abortion care varied among healthcare providers.•Internalization of positive constructions of abortion assisted with wellbeing.•Abortion providers benefitted from collegial support from one another.•Reflexivity and managing emotional investment and detachment improved outcomes.