'Problem representations' in post-abortion contraception: a critical review of UK literature.

Abstract

Objective: To critically review post-abortion contraception literature from the UK based on Bacchi's 'What's the Problem Represented to Be?' (WPR) approach.

Methods: A systematic search of six electronic databases - complemented by a grey literature search encompassing reports, policy documents and government publications - identified a total of 31 publications: 19 peer-reviewed articles and 12 items of grey literature.

Results: Multiple - and sometimes conflicting - 'problem representations' coexisted across the texts, operating at different levels of abstraction. Applying the WPR approach, six 'problems' were identified: existing abortion rates and repeat abortion; risky groups; meeting service users' needs; organisational capacity; knowledge of contraceptive methods; and abortion stigma.

Conclusions: While some problem representations focused on service user needs, care satisfaction and organisational capacity, the dominant framing positioned abortion rates - particularly subsequent abortions - as the central 'problem'. It is implied that too many abortions are being had and that a key purpose of post-abortion contraception is to address this issue. Abortion was often framed as an individual's failure to use (effective) contraception (correctly). This places the burden on individuals, further exacerbates abortion stigma and obscures structural constraints. Several conceptual slippages were identified, including using 'unplanned', 'unintended' and 'unwanted' pregnancy synonymously. Such practices risk collapsing and misrepresenting different kinds of lived experiences, creating barriers to the provision of person-centred abortion and contraceptive care. We recommend greater critical reflection on the language and assumptions within post-abortion contraception discourse to ensure research, policy and practice remain person-centred, evidence-informed and committed to principles of reproductive justice.