Factors influencing abortion decision-making of adolescents and young women: A narrative scoping review

Abstract

Abstract Introduction: Globally, about half of all induced abortions have been estimated to be unsafe, and have resulted in maternal death. Of these, 41% unsafe abortions have been reported in young women who are dependent on their parents for livelihood. They are often left in a vulnerable position and may have difficulty in making a decision regarding abortion. This study aimed to (a) characterize and map factors that influence abortion decision-making of adolescents and young women, and (b) identify the care and support they need in their decision-making process. Methods: We conducted a scoping review following the JBI method and PRISMA-ScR checklist. We comprehensively searched MEDLINE (PubMed), EMBASE, Cochrane Library, CINAHL, and PsycINFO, and hand searched publications in Google Scholar database between November 2021 and December 2021. The search included all English language qualitative and mixed-methods research articles published from 1976 to November 2021, and included participants aged 10-24 years. The CASP checklist was used as guide for the qualitative analysis. Nvivo was used to synthesize the findings. Results: There were 14 studies from 10 countries (N = 334 young women) that met the inclusion criteria. Three domains and 11 categories were included: Personal (Desire for self-realization and Unwanted pregnancy), Interpersonal (Parental impact, Reaction of partner, Roles of peers and friends, Existence of own child, and Lack of support), and Social circumstances (Sexual crime, Financial problem, Limitation of choice, and Underutilized healthcare services). Decision-making factors regarding abortions were also found across all three domains. Conclusion: The abortion decision-making of young women is influenced by various external factors regardless of country. Parents are especially influential and tend to force their daughters to make a decision. Young women experienced suffering, frustration, and lack of autonomy in making decisions based on their preference. This emphasizes the importance of autonomous decision-making. In this regard, healthcare services should be used. However, there are barriers to access these services. To improve such access, the following are required: staff training to provide women-centered care, counseling based on women’s needs, counseling including parents or guardians that is confidential and ethical, promotion of decision aids, and affordable accessible care.