Abortion experiences of individuals with a history of trauma(s): A qualitative study

Abstract

Objective

Individual trauma is highly prevalent among reproductive age individuals who can become pregnant. We sought to elicit perspectives of individuals with a history of trauma about their abortion experiences, trauma-activating factors in abortion care, and how to optimally incorporate trauma-responsive principles into abortion care.

Study design

Patients with a self-identified history of three types of trauma (sexual assault, interpersonal violence, adverse childhood experience) were recruited from family planning clinics in the Chicago-area to participate in semi-structured phone interviews. Qualitative data was analyzed using ATLAS.ti.

Results

Analysis of thirty interviews identified trauma-activating factors and trauma-responsive strategies throughout the abortion experience. Participants reported that, pre-abortion, restricted access and limited options activated trauma-related feelings of autonomy loss and a desire for unbiased information. During procedures, participants described how physical pain/discomfort and healthcare professional use of insensitive language worsened their experience. In contrast, use of neutral language, warnings prior to touch, proper draping, and checking-in and offering options helped mitigate effects of prior history of trauma(s). Post-procedurally, participants desired mental health support specifically addressing abortion-related stigma, though this resource was rarely available.

Conclusions

Throughout abortion care, numerous opportunities exist to help activate or mitigate trauma responses among individuals with a history of trauma. These opportunities exist at the level of the individual provider as well as the level of the clinic, and must be considered to fully address the needs of individuals seeking abortion who have experienced prior trauma(s).

Implications

Healthcare providers and systems can influence abortion experiences in ways that range from aggravating to ameliorating prior trauma for individuals with prior trauma experience(s). Therefore, trauma-responsive principles must be universally applied throughout abortion care.