Let us normalise abortions because let’s face it, many people have more than one

Lets-normalise-abortions-because-lets-face-it-most-people-have-more-than-one

Many women seek out abortions more than once in their lifetime, and we ought to speak more about this occurrence. Read more about why it is important to speak about abortions in the plural here:

By Belinda Munyeza.

Multiple Abortions are common despite the lack of public awareness

In 2007, The Guttmacher Policy Review released a report stating that about half of all women receiving an abortion in the United States (US) have had one before [1]. In 2017, a decade later, the institute published an updated report (based on a 2014 study) stating that 45% of abortion patients in the US had had one or more prior abortions [2]. It is clear from these reports that multiple abortions are not an uncommon occurrence among women who seek the service. What is uncommon, however, is awareness among the public about these statistics.

There is heavy societal stigma globally towards women who are found to have had an abortion, let alone multiple. This has resulted in a lack of informative conversations in many communities that could shed light on the occurrence of multiple abortions and normalize the experience.

In a Rewire News Group article (2017), a few women in the US who have had multiple abortions were interviewed about their experiences. They all shared sentiments of being fearful about the judgement they would face from their communities if anyone found out. This then led these women to seek abortion services with much more secrecy than they did the first time [3], a mode of action women in other parts of the world feel they would have to take as well.

The African Journal of Reproductive Health (2013) reported that a 2002 study of abortion incidences in Africa found that in Zimbabwe, there was a 2.5%–5.3% incidence of more than one abortions among recorded abortions within the year [4]. While more recent statistics on abortions in Zimbabwe are not easily accessible, Plos One (2018) reported that in 2016, 40% of pregnancies in Zimbabwe were unintended and 25% of them were terminated [5]. However, due to societal stigma and legal restrictions in the country, many of these abortions were clandestine and women felt they could not openly talk about their experiences.

In South Africa, while statistics on more than one abortions are not definitive, a 2005 study by BJOG: an International Journal of Obstetrics and Gynaecology, stated that the rates of women seeking clandestine and often unsafe abortions were very high [6]. This was despite abortion being legal in the country. The study found that of the women surveyed, 15% chose this method of abortion because they were unaware of the legality of abortion. However, 17% were aware but were afraid of the stigma they could potentially face from seeking out abortion services from an established health-care facility, therefore they chose the most clandestine option.

Further statistics have shown that while there is still a societal stigma around abortions in the country, it has not resulted in reduced abortion rates but has instead resulted in the rate of clandestine abortions remaining high. A 2016 report by HEARD estimated that 50% of abortions in South Africa were performed outside of designated health-care facilities [7]. It seems that women seeking abortions in the country are significantly influenced by societal stigma. While this stigma has not stopped them from seeking the services, it has significantly reduced the quality of service and support they are likely to receive.

Similarly, in 2019, The Independent reported that 67% of women in the United Kingdom (UK) felt the need to hide their abortion from their families—should they have one—due to the stigma they would face [8]. Furthermore, only 34% of women in this survey said they would feel comfortable speaking to their friends about getting an abortion. Abortion is still treated as an anomaly in the UK, despite the fact that one in three women in the UK has at least one abortion in their lifetime [8]. Even more so, in 2011, the UK Department of Health reported that 34% of abortions performed in England and Wales were consequent abortions, a number that was on the rise [9].

Needless to say, if women who have not had an abortion feel this overwhelming fear of stigma, those women who have had multiple abortions probably fear it even more and are unlikely to disclose their abortions to their communities, which can often lead them to seek unsafe services for fear of judgment in official facilities. But how do we get rid of this stigma surrounding abortions, especially when sought out more than once?

Abortions in the Plural

The first step in destigmatizing abortions—and improving support for women who have them—is to speak about them in the plural. The lack of open conversations around abortions is not the only factor that feeds into the societal stigma. Speaking about abortion in the singular is another factor that leads to women who have had multiple abortions feeling as though their experience is an anomaly. This can only result in those women who have multiple abortions or have considered it feeling even more shame and stigma, making it less likely that they will share their experience with others or utilise safe services if they are available in their respective locations.

Furthermore, speaking about abortions in the singular causes the general public to remain unaware of the several factors that increase women’s likelihood and frequency of unintended pregnancy. For example, according to a Centers for Disease Control and Prevention (CDC) (2005) report, factors such as racism have led to women of color getting poorer quality health care. Because of this reproductive health tools, such as effective contraceptives, are more inaccessible to black women [10]. Medical racism has remained an issue in the United States since then, which may explain why the 2017 Guttmacher Institute report found that 54% of black women abortion patients had had one or more prior abortions, a figure that is above the average of 45% for all abortion patients regardless of race [2].

Other factors that increase women’s likelihood of unintended pregnancy and consequent abortions, according to BMC Public Health (2015), are poverty and being in abusive relationships (among others). The study found that women who cannot afford contraceptives due to poverty and women who are in abusive relationships that they do not wish to bring children into, are at high risk of multiple unintended pregnancies and abortions [11]. These factors were common in multiple countries across the world, from Kenya to Canada.

As these findings show, abortion is a complex experience for women. In general, there is a global lack of understanding and empathy for the difficult experiences that women have with their reproductive health. The world tends to shame women who get abortions and buy into the narrative that these women are simply careless. And while women shouldn’t have to justify getting abortions, speaking of them in the plural can help people recognize and be educated on the complex experience it truly is to get an abortion. This could lead to more support being provided to women seeking it and more public action being taken towards changing those factors that force some women to have multiple abortions.

Abortions are a common experience, regardless of whether we perceive them to be or not. Furthermore, multiple abortions are even more common than the average person thinks them to be. Normalizing abortion and speaking about it in the plural is the best way to make sure that the women receiving it are supported and that the quality of all women’s reproductive health care is improved upon globally.

[1] Cohen, S. A. “Repeat Abortion, Repeat Unintended Pregnancy, Repeated and Misguided Government Policies A Model for a Bilingual University.” Guttmacher Policy Review. 2007, vol. 10, no. 2, www.guttmacher.org/gpr/2007/05/repeat-abortion-repeat-unintended-pregnancy-repeated-and-misguided-government-policies. Accessed January 2021.

[2] Ingerick A, et al. “Repeat Abortion, Which Abortion Patients Have Had a Prior Abortion? Findings from the 2014 U.S. Abortion Patient Survey.” Guttmacher Institute Journal of Women’s Health, 2017, vol. 10, no. 2, www.guttmacher.org/article/2017/08/which-abortion-patients-have-had-prior-abortion-findings-2014-us-abortion-patient. Accessed January 2021.

[3] “People Have Multiple Abortions–And Stigmatizing Them is Counterproductive.” Rewire News Group, 2017, rewirenewsgroup.com/article/2017/09/13/people-multiple-abortions-stigmatizing-counterproductive/. Accessed January 2021.

[4] Prata, N, et al. “Contraceptive Use Among Women Seeking Repeat Abortion in Addis Ababa, Ethiopia.” African Journal of Reproductive Health, December 2013, vol. 17, no. 4, tspace.library.utoronto.ca/bitstream/1807/61908/1/rh13056.pdf. Accessed January 2021.

[5] Sully, E.A, et al. “Abortion in Zimbabwe: A national study of the incidence of induced abortion, unintended pregnancy and post-abortion care in 2016.” PLOS ONE, vol. 13, no. 10, doi.org/10.1371/journal.pone.0205239. Accessed January 2021.

[6] Jewkes, R.K, et al. “Why are women still aborting outside designated facilities in metropolitan South Africa?” BJOG: An International Journal of Obstetrics & Gynaecology, vol. 112, pp. 1236-1242, doi.org/10.1111/j.1471-0528.2005.00697.x. Accessed January 2021.

[7] “Country Factsheet: Unsafe abortion in South Africa.” HEARD, www.heard.org.za/wp-content/uploads/2016/06/south-africa-country-factsheet-abortion-20161.pdf. Accessed January 2021.

[8] “Most Women Would not tell Their Family About Abortion, Survey Finds.” Independent, 2019, https://www.independent.co.uk/life-style/women/abortion-women-tell-family-friends-survey-marie-stopes-a9185946.html. Accessed January 2021.

[9] http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_126769

[10] “Health disparities experienced by black or African Americans – United States.” CDC, 2005, https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a1.htm. Accessed January 2021.

[11] Maina, B, et al. “Factors associated with repeat induced abortion in Kenya.” BMC Public Health, vol. 15, doi: 10.1186/s12889-015-2400-3 www.researchgate.net/publication/282798410_Factors_associated_with_repeat_induced_abortion_in_Kenya. Accessed January 2020.