The purpose of this study was to investigate women's experiences of pain, bleeding,to discover the fetus, hospitalization associated with medical abortion at home and toexplore differences in experiences between different groups of women, as age orprevious childbirth. The study was conducted at two gynecological clinics in Uppsalaand in Stockholm. A questionnaire was distributed and analyzed using a quantitativeanalysis method. The response rate was 30 %. Most women were satisfied with thepain relief given to them from the hospital. The group that had not given birth and theyounger women (18-28 years) experienced greater pain than the older women andthose women who had not given birth. Heat such as heating pad on the stomach wasthe most common non-pharmacological method of pain relief. A majority of thewomen in the study bled for six days, and many bled over 14 days. Many of theparticipants who felt that they noticed when the fetus descended described it as alump or a ball. Despite the low numbers of participation this study helps midwives inthe two clinics to provide better support and information to women seeking anabortion completed in the home.

No description available.

India introduced family planning in the ‘50s, legalized abortion in the ‘70s, and accomplished a remarkable drop in maternal mortality and fertility since 1990. Nevertheless, abortions account for a large proportion of maternal deaths, and sterilization is the most frequently used contraception. This thesis aims to identify the means to simplify and increase access to reproductive health in low-resource settings, focusing on abortion and contraception in Rajasthan. A randomized controlled trial compared simplified follow-up, where women assess their abortion outcome at home after early medical abortion, with in-clinic follow-up. Additionally, contraceptive use was compared between study groups post-abortion. In order to explore young women’s opportunities to access reproductive health services in the area, we conducted in-depth interviews with recently-married women. Women in the home-assessment group preferred home-assessment in the future to a greater extent than the women in the clinic follow-up group, who preferred in-clinic follow-up. Complete abortions were reported in 95% of women in the ‘home-assessment group’ and 93% in the ‘in-clinic group’, suggesting that efficacy of simplified follow-up is non-inferior to in-clinic follow-up. A majority (81%) of women carried out the pregnancy test and found it easy to use. Women (96%) were satisfied with their abortion. There were no differences in contraceptive use between study groups at three months; however, women in the ‘in-clinic group’ were most likely to initiate contraception at two weeks. A majority of women preferred the three-month injection, while only 4% preferred sterilization. The recently-married women considered reversible contraception to be unfeasible due to misconceptions and taboos, yet women wanted effective contraception because their current use of traditional methods resulted in unintended pregnancies. Abortions were common, and were procured from private or informal providers. Allowing women to take an active role in reproductive health services can enable simplification of, and access to, reproductive services in low-resource settings as well as in other settings. Simplifying medical abortion, providing contraception ‘intra-abortion’, and offering a context-appropriate and effective means of contraception, creates a great potential to increase access to reproductive health services and can result in a more equal society where women, and men, can attain their sexual and reproductive rights.

Abstract Each year approximately 11,000 induced abortions are performed in Finland, the majority of these women being younger than 25 years of age. Medical abortion with the antiprogestin mifepristone and the prostaglandin analogue misoprostol is increasingly being used instead of surgical method (dilatation of cervix and uterine evacuation with instruments). Similarly, miscarriages can be treated with medical or surgical management. Still, clinical outcomes of the medical treatment of miscarriage are not well established, and various different regimens exist. The aim of this study was to investigate the frequency and risk factors of repeat abortions and immediate post-abortal complications, focusing especially on the impact of the method of abortion. National health registries were used as a data source. Another part of the study was aimed at comparing the efficacy, acceptability and cost-effectiveness of the medical and surgical treatment of miscarriage. In national cohort, the risk of repeat abortion was associated with sociodemographic characteristics (parity, previous abortion, low socioeconomic status, being unmarried but cohabiting or single), but not with the method of abortion. The risk of repeat termination of pregnancy decreased with age, among women living in rural area, and when intrauterine devices or sterilization were planned for future contraception. The overall incidence of adverse events was 4-fold greater in the medical compared to the surgical abortion cohort. Hemorrhage and incomplete abortion were more common following medical abortion, but the incidence of infections did not differ. Medical and surgical treatment of miscarriage were compared in a randomized setting; the efficacy of the treatment did not differ. Medically treated patients were less satisfied with the treatment and had experienced more pain. In the cost analysis, the primary costs of the surgical treatment were higher, but more unexpected events and complications increased the secondary costs in the medical group. In summary, medical abortion offered a good alternative to surgical method without increasing the risk of repeat abortions, but with an increased risk of short-term adverse events. The medical method was efficient in treating miscarriages, and the majority of women were satisfied with the treatment. Neither of the methods was economically superior in treating miscarriage.

Background The majority of all abortions performed in Sweden are medical and performed at home, despite this there is a lack of research on women's experience. Since the abortion law came, it has looked different. Today, the abortion law is better developed and places demands on the healthcare staff who must have a positive attitude to the woman's decision, as well as show respect and empathy. The aim was to describe women's experience of doing a medical abortion at home. Method A general literature study with an inductive approach was used. Both quantitative and qualitative articles, as well as a mixed method constitute the result, a total of nine result articles. Results show that women experience contact with care staff as deficient during the performance of the abortion at home. Adequate information was also lacking. The safe home environment contributed to a strengthened integrity and closeness to the partner and the family. The analysis resulted in three categories:Women's experiences of having an abortion without the presence of healthcare staff, Women's experiences of the safe home environment in connection with medical abortion at home and Women's experiences of being prepared for medical abortion at home. Conclusion In order for women to feel safe in the event of a medical abortion at home, it is necessary that healthcare staff are available throughout the process. The information women receive before abortion at home can be decisive for how the experience will be. / Bakgrund Majoriteten av alla aborter som utförs i Sverige är medicinska och utförs i hemmet, trots detta saknas det forskning kring kvinnors upplevelse. Sedan abortlagen kom har den sett olika ut. Idag är abortlagen bättre utvecklad och ställer krav på sjukvårdspersonalen som ska ha en positiv inställning till kvinnans beslut, samt visa respekt och empati. Syftet var att beskriva kvinnors upplevelse av att genomgå en medicinsk abort i hemmet. Metod En allmän litteraturstudie med en induktiv ansats användes. Både kvantitativa och kvalitativa artiklar, samt en mixad metod utgör resultatet, totalt nio resultatartiklar. Resultat visar att kvinnor upplever kontakten med vårdpersonalen som bristfällig under utförandet av aborten i hemmet. Även adekvat information saknades. Den trygga hemmiljön bidrog till en stärkt integritet och närhet till partnern och familjen. Analysen resulterade i tre kategorier: Kvinnors upplevelser av att genomgå abort utan närvaro av vårdpersonal, Kvinnors upplevelser av den trygga hemmiljön i samband med medicinsk abort i hemmet och Kvinnors upplevelser av att vara förberedd inför medicinsk abort i hemmet. Konklusion För att kvinnorna ska känna trygghet vid medicinsk abort i hemmet krävs det att vårdpersonal finns tillgängliga under hela processen. Informationen kvinnorna får inför abort i hemmet kan vara avgörande för hur upplevelsen kommer bli.

Uppsatsens syfte är att undersöka hur läkarvetenskapen uttrycker sig om medicinska fosterfördrivningar under tidsperioden 1870–1900 samt studera om det har skett ett medikaliserande av fosterfördrivning. Till uppsatsens syfte hör även att studera hur förhållningssättet till de medicinska fosterfördrivningarna förändrades under den aktuella tidsperioden samt undersöka om det förekom ett motstånd mot utförandet av medicinska fosterfördrivningar inom den medicinska diskursen. Frågor som ställs för undersökningen är vilka föreställningar om medicinsk fosterfördrivning som uttrycks i samtida medicinska skrifter, om det i dessa går att utläsa ett motstånd inom den medicinska vetenskapen beträffande utförandet av de medicinska fosterfördrivningarna, vilken medicinsk fosterfördrivningstradition beträffande medicinska metoder och regelverk som kännetecknar de olika nedslagsperioderna 1870–1875; 1885–1890; 1895–1900 samt hur förhållningssättet till de medicinska fosterfördrivningarna har förändrats över tid.Med en utgångspunkt i Foucaults diskursanalys samt begreppen föreställning, tradition, förändring och medikalisering studeras det hur läkarvetenskapen under perioden 1870–1900 har förhållit sig till utförandet av medicinska fosterfördrivningar samt vad som har varit möjligt att uttrycka inom den medicinska diskursen beträffande dessa.Resultatet visar att början av tidsperioden innehåller en medicinsk fosterfördrivning som inte utfördes under resten av tidsperioden. Det rör sig om en fosterfördrivning i ett tidigt skede av graviditeten. Generellt sett så sker oftast en medicinsk fosterfördrivning annars i samband med en komplicerad förlossning. Utöver ett direkt förgörande av fostret inuti livmodern så problematiseras även igångsättningar av en tidig förlossning då dessa av lagstiftningen klassade som en sådan vid tidpunkten. Undersökningen visar att utförandet av medicinska fosterfördrivningar till stor del var allmänt accepterade av läkarvetenskapen även om det sker ett visst motstånd inifrån det egna medicinska ledet. Tydligt är även att läkarvetenskapen vid tidpunkten ser kvinnan som huvudpatient och inte fostret.

Bakgrund: Avbrytande av graviditet innebär att fostret utförskaffas ur livmodern innan graviditetsvecka 22, spontant eller genom induktion. En inducerad abort kan ske medicinskt eller kirurgiskt. Cirka 56 miljoner aborter sker årligen i ett globalt perspektiv. Barnmorskan ska stödja kvinnan i abortvården samt verka för att ge jämställd och rättvis vård baserad på vetenskap och beprövad erfarenhet utifrån ett socialt-, ekonomiskt- och kulturellt perspektiv. Barnmorskan utvecklas i sin yrkesroll genom kunskap och erfarenhet. Syfte: Syftet med studien är att belysa kvinnors erfarenheter av medicinsk- eller kirurgisk abort i ett globalt perspektiv. Metod: Studien genomfördes som en metasyntes med kvalitativ ansats. Femton (15) vetenskapliga artiklar utgör resultatet. Resultat: Fyra huvudkategorier identifierades otillgänglighet och konsekvenser för kvinnan, ekonomiska faktorer, stigma samt autonomi. Resultatet visar att kvinnorna upplever att restriktiv lagstiftning skapar en stor oro och kan ge desperation. Detta kan innebära att många kvinnor söker sig till osäkra alternativ om tillgången på säker abortvård inte finns tillgänglig. Aborten hade negativa ekonomiska konsekvenser för kvinnorna. Att få bestämma över sin egen kropp och känslan av kontroll var en viktig del i abortbeslutet för kvinnan. Slutsats: Brist på ekonomiska tillgångar och stigma gör att många kvinnor söker sig till osäkra abortalternativ. Den enskilda kvinnan bör få ta beslut som rör hennes egen kropp och själv besluta om när hon önskar skaffa barn vilket innebär att tillgängligheten på säker abortvård måste öka. Klinisk tillämpbarhet: Studien kan användas för att ge ökad kunskap om kvinnors upplevelser och erfarenheter vilket kan leda till en mer tillgänglig abortvård för kvinnor i ett globalt perspektiv. / Background: Termination of pregnancy is when a fetus is removed from the uterus before pregnancy week 22, spontaneously or through induction. An induced abortion can be performed either medical or surgical. In a global perspective, each year around 56 million abortions are performed. The role of the Midwife in abortion care is to support the woman aiming to offer equal and equitable care based on proven experience and with a social-, economical- and cultural perspective. The professional skills of the midwife is developing through knowledge and experience. Objective: The aim of the study was to identify womens experiences of medical- or surgical abortion in a global perspective. Method: The study was conducted as a qualitative metasynthesis. Fifteen (15) scientific articles were included in the result. Result: Four main categories were identified inaccessibility and consequences for the woman, economical factors, stigma and autonomy. The result shows that the women experience that restrictive legislations makes women anxious and instill feelings of desperation. Many women are considering unsafe alternatives when safe abortion care isn’t accessible. The abortion had negative financial consequences for the women. To decide about their own body and having a feeling of control was an important part in the decision of abortion for the woman. Conclusion: Lack of financial assets and stigma means that many women seek unsafe abortion options. The individual woman should be able to make decisions concerning her own body and decide for herself when she wants to have children, which means that access to safe abortion care must increase. Clinical applicability: The study can be used to provide increased knowledge about womens experiences which can lead to a more accessible abortion care for women in a global perspective.

De två läkemedel som administreras vid medicinsk abort i Sverige idag består av de aktiva substanserna mifepriston respektive misoprostol. Behandlingskuren bygger på effekter hos de endogena ämnena progesteron och prostaglandiner. I denna studie beskrivs fysiologiska processer under graviditeten med avseende på progesteron och prostaglandiner samt vid medicinsk abort med avseende på mifepriston och misoprostol. Valet av fokus på fysiologiska processer speglar biologilärarens didaktiska uppgift i att undervisa om hur människokroppen fungerar och dess interaktion med läkemedel. Slutligen presenteras och diskuteras även möjligheter och svårigheter med undervisning om abort inom ramen för högstadie- och gymnasieskolans biologiundervisning. / The drugs administrated to cause medical abortion consist of one tablet with the active substance mifepristone and one with the active substance misoprostol. The regime is based on effects of the endogenic substances progesterone and prostaglandins. In this study, physiological processes in pregnancy regarding progesterone and prostaglandins are described, as well as the physiological processes in medical abortion with respect to mifepristone and misoprostol. The focus on physiological processes relates to the mission of the biology teacher to explain how the human body works and interacts with medical drugs. Finally, opportunities and difficulties with instructions on abortion in secondary and upper secondary school biology are presented and discussed.

Einleitung: Nach einer kontrovers diskutierten Einführung von Mifepriston im Jahre 1999 in Deutschland weisen die niedrigen Anwendungszahlen auf eine zögerliche Etablierung hin. Aufgrund der aktiven Einbeziehung der Frau in die Durchführung des Schwangerschaftsabbruches wird oft eine erschwerte emotionale Verarbeitung vermutet. Wir untersuchten die psychische Belastung vor und nach medikamentösem und chirurgischem Abbruch. Methoden: 147 Frauen mit gewähltem medikamentösen und 72 Frauen mit chirurgischem Abbruch wurden vor und vier Wochen nach dem Eingriff befragt. Neben demographischen Aspekten, Beweggründen, Kriterien der Methodenauswahl und medizinischen Details wurden die deutsche Fassung der Hospital Anxiety and Depression Scale (HADS) und der Impact of Event Scale (IES) verwendet. Ergebnisse: Die demographischen Angaben zeigten keine Unterschiede zwischen den Anwenderinnen beider Methoden. Bei einem Vergleich der Ergebnisse der HADS vor und vier Wochen nach dem Abbruch zeigte sich ein signifikanter Abfall der Werte für Angst und Depression bei beiden Methoden. Die Anwenderinnen von Mifepriston wiesen jedoch deutlich seltener erhöhte Angstwerte vor dem Schwangerschaftsabbruch auf. Vier Wochen später zeigten die Werte für Angst und Depression keine signifikanten Unterschiede zwischen beiden Verfahren mehr. Auf den Skalen der IES wurde ein geringeres Ausmaß von erlebter Intrusion und Vermeidungshaltung bei den Frauen der medikamentösen Methode gefunden. Im Vergleich deutlich stärker waren die erlebten Blutungen, Schmerzen und Nebenwirkungen bei der Anwendung von Mifepriston. Dieses hatte jedoch weder einen negativen Einfluss auf die psychische Verarbeitung des Ereignisses noch auf die hohe Akzeptanz der Methode. Eine überwältigende Mehrheit der Frauen beider Methoden schätzte es als außerordentlich wichtig ein, zwischen verschiedenen Methoden wählen zu können. In einer hypothetischen Zukunftssituation würden sich 80,3 % der Frauen nach medikamentöser Methode und 62,9 % der Frauen nach chirurgischer Methode wieder für die gleiche Methode entscheiden. Schlussfolgerung: Unsere Untersuchung belegt die in anderen Studien allgemein geteilte Auffassung, dass die Beendigung einer ungewollten Schwangerschaft unabhängig von der durch die Frau gewählten Methode eine positive erste Konfliktlösung bedeutet. Die positiven Ergebnisse der psychischen Verarbeitung und die hohe Zufriedenheit der Anwenderinnen unterstreicht die Notwendigkeit einer Aufrechterhaltung der Auswahlmöglichkeit zwischen verschiedenen Methoden zur Schwangerschaftsbeendigung und einer verbesserten Zugänglichkeit zur medikamentösen Methode mit Mifepriston in Deutschland. / Introduction: After a controversial introduction of medical abortion with mifepristone in 1999 this method is still not widely available in Germany. Because of the active participatory role of the women many doctors fear a higher rate of psychological sequelae after an abortion with mifepristone. In our study we compared the coping process of women who chose the medical procedure to terminate an unwanted pregnancy with others who opted for surgical abortion. Methodology: Women were asked before and four weeks after the procedure to complete a questionnaire covering demographic data, motivation, medical details and social support. Additionally, the women completed the German Version of the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). The following evaluation compares the data of 147 women who chose medical abortion with the results of 72 women who preferred a surgical abortion. Results: No significant differences were found for the demographic background of the women using the two different methods. Comparing data before and a month after the abortion, our study shows a significant decline of both anxiety and depression for both methods. Women using the abortion with mifepristone showed significantly lower entrance levels on the anxiety subscale than the surgical group. There were no significant differences in post-abortion anxiety and depression levels. For the IES, women choosing medical abortion scored significantly lower on the intrusion and avoidance subscales than the women opting for surgical abortion. Women using mifepristone experienced significantly more bleeding, pain and other side effects. However, these side effects did neither show a negative influence on the psychological coping nor on the high acceptability of mifepristone. An overwhelming majority of women in both groups evaluated choosing between different abortion methods as being highly important to them. 80,3 % of the women after medical abortion with mifepristone and 62,9 % of the women after surgical abortion would chose the same method again. Conclusions: Our study supports the consensus view that termination of an unwanted pregnancy is a positive first solution to the conflict, regardless of the chosen method. The positive outcome and high satisfaction levels among the participants illustrate the importance of an ongoing and improved accessibility of medical abortion for women in Germany.

Improving the quality of abortion care can reduce stigma, increase access, and enhance knowledge about pregnancy prevention and reproductive health. Midwifery-led medication abortion is considered effective, efficient, accessible, person-centred, equitable, and safe in alignment with the World Health Organization’s framework on quality abortion care. As research on client-centred access to healthcare recommends, Ontario’s expanded midwifery care models are improving the ease with which people can find and use sexual and reproductive services most appropriate to their unique needs. The expanded midwifery care presented in this study demonstrates how midwifery-led medication abortion provides high-quality services, decreases stigma, and improves access to safe, acceptable, and client-centred abortion care, particularly for commonly underserved populations deserving of health equity and Reproductive Justice. / The World Health Organization, the International Confederation of Midwives, and the Canadian Association of Midwives advocate for the inclusion of comprehensive abortion care within midwifery practice. International evidence shows positive outcomes in terms of efficacy, safety, acceptability, and post-abortion contraception uptake when midwives provide abortion services. In Canada, midwifery services are available across various populations, including urban, rural, remote, and Northern areas, suggesting a potential to enhance access and quality of abortion care, particularly for underserved people. Expanding the role of Canadian midwives to include comprehensive abortion care could improve accessibility, address gaps in service provision, support community needs, ensure professional sustainability, foster interprofessional collaboration, and offer continuity of care. Since 2017, the Ontario Ministry of Health has funded Expanded Midwifery Care Models to support midwifery integration, interprofessional collaboration, and delivery of midwifery-led sexual and reproductive care that is not funded under the current payment model. This research explores the individual and shared experiences of midwifery-led medication abortion delivered through Expanded Midwifery Care Models across three distinct regions in Ontario. The study employs interpretive description methodology to understand how midwifery influences the experiences of medication abortion for midwives, collaborating healthcare professionals, and clients. The methodology focuses on exploring how integrating a midwifery model of abortion care supports medication abortion services and promotes Reproductive Justice within primary care settings. By gathering insights from multiple perspectives, the findings hope to inform clinical practice, interest policymakers, and identify outcomes valued by midwives, clients, and healthcare professionals for future research on midwifery-led abortion care. / Thesis / Master of Science (MSc) / Quality abortion care improves the lives, health, and wellness of reproductive-aged people. Abortion is time-sensitive and people face barriers to this care. Reproductive-aged people benefit from healthcare systems that make abortion simple, safe, and effective. Internationally, midwives play a significant role in abortion care by delivering comprehensive services within sexual and reproductive healthcare. In Canada, however, the potential of midwifery in providing abortion care has not been fully realized. As an exception, Ontario’s Expanded Midwifery Care Models (EMCMs) - innovative sexual and reproductive healthcare delivery programs - have made it possible for midwives to provide abortion services. Midwifery-led abortion care in EMCMs includes providing early abortion care in ways that make it easier for people who find it difficult to access care. This research explores and compares the personal and professional experiences of medication abortion care delivered by midwives across three regions in Ontario.