Authors: Midiam Moreno López, Karla Flores Celis, Catalina González-Forteza, María Teresa Saltijeral,1 Raffaela Schiavon, María Elena Collado, Olivia Ortiz, Luciana Ramos Lira
Source: https://www.medigraphic.com/
INTRODUCTION
Voluntary interruption of pregnancy is a practice rejected by certain social sectors and health professionals, which cites
both ethical and moral reasons and the possible effects on the physical and mental health of women who carry it out
(Lerner, Guillaume, & Melgar 2016). However, the results of systematic reviews show that there is no direct association between induced abortion in safe and legal conditions and the presence of health problems, specifically those involving mental health (Vignetta et al., 2008; Major et al.,2009; Robinson et al., 2009; National Collaborating Center for Mental Health, 2011; Russo, 2014). In fact, evidence has shown that the negative consequences on mental health appear to be more related to other factors, such as abortion stigma (Steinberg et al., 2016).
stigma as a “negative attribute ascribed to women seeking to terminate a pregnancy [that] marks them internally or externally as inferior to ideals of womanhood.” They argue that this stigma is extremely powerful because women who abort challenge three basic cultural beliefs held by broad social groups about the “nature” of being a woman: 1. a woman only has sex to procreate; 2. otherhood is inevitable; 3.a woman is naturally vulnerable. Cockrill & Hessini (2014) posit that this stigma comprises at least two dimensions: the internalized and the perceived social dimension. The first refers to the negative point of view women who abort have about themselves, which creates feelings of guilt and shame and other emotions that produce distress and concealment. The second refers to the individual perceptions women have about the attitudes of others and therefore about the perceived risk of being judged, rejected, or discriminated against for having an abortion.
According to O’Donnell et al. (2018), by interrupting a pregnancy, women access a socially constructed, stigmatized identity, which can lead them to experience effects on their emotional well-being. Their results also show that self-stigmatization due to abortion predicts anxious and depressive distress, including internalized shame and deliberate isolation from other people. It should be
mentioned that induced abortion is the result of a decision made after days or weeks of consideration. Since this process can be difficult, its psychological consequences would therefore appear to be more related to the social, moral, and psychological context in which it occurs than to the medical procedure itself (Broen, Moum, Bødtker, & Ekeberg, 2005). Feelings of guilt and shame may be
exacerbated because they are related to beliefs such as considering abortion a sin (LeTourneu & Tyson, 2016). This can lead women to have a more negative view of the event (Rocca et al., 2015) and accordingly may increase their emotional distress if they do in fact have an abortion (Kimport, Foster, & Weitz, 2011).
There are also variations in the way this stigma is expressed in various social groups. For example, Hispanic women in the United States perceive increased stigma on the part of friends and relatives and often conceal abortion more frequently than other racial and ethnic groups (Shellenberg & Tsui, 2012). It has also been reported that Protestant and Catholic women who described themselves as less religious or spiritual perceived less stigma for abortion than those who considered themselves more religious or spiritual (Cockrill et al., 2013).
However, most of the research on the subject has been undertaken in Western developed countries (Biggs et al., 2017; Fergusson et al., 2008; Rees & Sabia, 2007; Pedersen, 2008; Taft & Watson, 2008; National Collaborating Center for Mental Health, 2011; Munk-Olsen et al., 2011; Huang et al., 2012). These countries report the lowest number of abortions in the world (11.8%), of which only 12.5% are
unsafe, and abortion has been legal for decades. Conversely, in developing countries, 50% of all abortions performed are
unsafe. In Latin America, six and a half million abortions are performed annually, 76.4% of which are unsafe (Ganatra, 2017). In Latin America, voluntary interruption of pregnancy has only been decriminalized in five countries: Cuba, Puerto Rico, Guyana, Uruguay, and French Guiana (Center for Reproductive Rights, 2018).
In Mexico, 30 out of 32 states punish women with prison sentences ranging from 15 days to six years for voluntarily interrupting a pregnancy. Some penal codes also consider sanctions such as psychiatric treatment and/or community work (GIRE, 2018). The only place in the country where the voluntary termination of pregnancy during the first trimester is legal is Mexico City. Since 2007, following changes to the legislation, the Secretaría de Salud has implemented this procedure safely and at no cost for women (Mondragón y Kalb et al., 2011). It is therefore a space of possibility for conducting studies on the subject, particularly since despite the success of the Legal Interruption of Pregnancy (LIP) program, a social context continues to prevail in which motherhood is one
of the most important values and women are stigmatized for having abortions (McMutrie et al., 2012; Sorhaindo et al., 2014). On the other hand, most studies on the issue in Mexico were conducted before abortion was decriminalized in Mexico City (Lafaurie et al., 2005; Erviti, Castro, & Sánchez, 2006), or have been carried out at health service providers (Lamas, 2014) or on women who have not necessarily had an abortion (Sorhaindo et al., 2016).
ily had an abortion (Sorhaindo et al., 2016). For example, Sorhaindo et al. (2014) conducted a qualitative study on women who had interrupted their pregnancies in several Mexican cities and their partners to explore the sources, experiences, and consequences of abortion stigma. Respondents reported having felt pain, shame, sadness, and guilt related to abortion. They also admitted fearing divine punishment associated with the prohibition of abortion by the Catholic Church –such as becoming infertile–, which produced feelings of anxiety and exacerbated the guilt and shame of having had an abortion, especially if the family held these beliefs. In fact, they and their partners had chosen to conceal the experience for fear of being judged by their family and friends. However, younger women were proud of their ability to make decisions and to have successfully resolved a difficult situation, which made them feel
privileged for having prioritized their health and personal well-being.
In view of the above, this study seeks to determine stigma levels in women who underwent a Legal Interruption of Pregnancy (LIP) at a clinic in Mexico City, and explore whether these levels are associated with any sociodemographic characteristic and whether there are any differences between those with and without high depressive symptomatology. As far as we know, this is the first effort in Mexico to address the issue from a perspective that includes mental health and within a public health paradigm that makes it possible to compare our findings with international results.
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