The interplay of risk and protective factors for psychosocial outcome in women after induced abortion – an interview study from Germany

BACKGROUND: Abortions are one of the most common gynecological treatments worldwide. Although many studies investigate risk factors (RF) for a negative abortion-related psychosocial outcome (APO), less is known about protective factors (PF) and the interplay of RFs and PFs. METHODS: From May to August 2022, we conducted a semi-structured interview study in Germany and interviewed 23 women (21-43 years) who had undergone an elective abortion within the last 12 months, asking them about their experiences, perceived RF, PF and APO. The data was analyzed using qualitative content analysis. RESULTS: We found three different patterns: The first group of women found the process, especially the legal requirements, stressful but reported a mostly positive outcome with sufficient social support as PF. Women who reported neuroticism-related personality factors as RF sought less social support and more frequently used emotion-focused coping strategies such as self-care and distraction and often showed a mixed outcome. A third group of women experienced intimate partner violence (IPV) and also reported distraction as PF. Regardless, all women who survived IPV reported a negative APO. CONCLUSIONS: The majority of women find the legal requirements (e.g., mandatory counseling, waiting periods) burdensome. At the same time, they offer no benefit to women who find themselves in critical situations such as coercion and domestic violence, which was a major RF. The protection of women who survived IPV should therefore be improved and the access to abortion improved. Further research is needed to include effects on more vulnerable groups such as migrants or queer individuals.