The male partner involved in legal abortion

A. Kero1, A. Lalos1,3, U. Högberg1 and L. Jacobsson2

1 Department of Obstetrics and Gynaecology and 2 Department of Psychiatry, University Hospital, SE-901 85 Umeå, Sweden


    Abstract
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
This study comprises 75 men who have been involved in legal abortion. The men answered a questionnaire concerning living conditions and attitudes about pregnancy and abortion. Most men were found to be in stable relationships with good finances. More than half clearly stated that they wanted the woman to have an abortion while 20 stressed that they submitted themselves to their partner's decision. Only one man wanted the woman to complete the pregnancy. Apart from wanting children within functioning family units, the motivation for abortion revealed that the desire to have children depended on the ability to provide qualitatively good parenting. More than half the men had discussed with their partner what to do in event of pregnancy and half had decided to have an abortion if a pregnancy occurred. More than half expressed ambivalent feelings about the coming abortion, using words such as anxiety, responsibility, guilt, relief and grief. In spite of these contradictory feelings, prevailing expectations concerning lifestyle make abortion an acceptable form of birth control. A deeper understanding of the complexity of legal abortion makes it necessary to accept the role of paradox, which the ambivalence reflects. Obviously, men must constitute a target group in efforts to prevent abortions.

Key words: ambivalence/attitudes/legal abortion/male/motives


    Introduction
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Studies investigating men in abortion situations are extremely rare. Most studies of legal abortion are focused on the women and when abortion and contraception are discussed, attention is mostly centred on the role and responsibility of the woman. Hospital staff often meet only the woman and not the man in cases of legal abortion, which can result in the risk of abortion being regarded solely as a female issue. Thus, the participation of the man remains largely invisible. However, many women have stated that they are influenced in their decision about abortion by the man and one of the most frequently stated reasons for terminating a pregnancy is related to the partner (Torres and Darroch Forrest, 1988Go; Törnbom et al., 1994Go; Skjeldestad, 1994Go; Holmgren, 1994Go; Söderberg et al., 1997Go; Johansson et al., 1998Go).

Many of the legal abortions carried out occur in established relationships (Swedish Ministry of Health and Social Affairs, 1983Go; Holmgren, 1988Go; Törnbom et al., 1994Go). One of very few studies carried out in Western countries that included both women and men showed that the majority of those who had legal abortion had good socio-economic positions and were in relatively established relationships. Many couples had no children but the majority planned to have children in the future. Nevertheless, many women felt alone when making the decision to have an abortion and they also had to take responsibility for contraception (Jacobsson et al., 1980Go). Other studies including only women also show that many women make the decision to have a legal abortion more or less on their own (Trost, 1982Go; Holmgren, 1988Go). In contrast, another study of both women and men concluded that few women seemed to be alone in their decision (Graff-Iversen and Kristoffersen, 1990Go). Furthermore, a study on 60 men who accompanied their partners to the hospital showed that the men considered themselves responsible, along with the partners, for preventing unwanted pregnancies and choosing abortion (Rothstein, 1977Go). However, abortion studies usually ignore the involvement of the man or examine it only indirectly, i.e. the women are asked about how they regard their partners' attitude and participation and how they are influenced by them. Therefore, roles and reactions of men in connection with unwanted pregnancy and legal abortion remain a virtually unexplored and neglected field.

Ambivalence during the early stages of pregnancy and towards parenthood is a known phenomenon among expectant mothers (Uddenberg, 1974Go; Holmberg and Uddenberg, 1993Go). A study of prospective parents showed that the ambivalence among both men and women appeared in conflicting views regarding children as constituting the meaning of life or the loss of freedom. The view that children represent loss of freedom was more obvious among men (Wikman et al., 1993Go). Ambivalence also existed among women applying for abortion (Trost, 1982Go; Allanson and Astbury, 1995; Hamark et al., 1995Go; Törnbom et al., 1996Go). For example, one study showed that 44% of the women were in doubt about the abortion decision when the pregnancy was initially confirmed and 30% when the abortion was due (Husfeldt et al., 1995Go). Another study found that the most common thought for abortion among women was that continuing the pregnancy would jeopardize their future and the most common theme against abortion was that they really wanted to have children some day (Allanson and Astbury, 1995).

The primary aim of this study was to increase knowledge and understanding of the abortion situation by making the men/impregnators' views visible. Therefore, psychosocial background and current living conditions of the men and their attitudes and feelings about pregnancy and legal abortion were studied. A further aim was to investigate whether there are any differences between men with previous experience of legal abortion and those without.


    Materials and methods
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
This study on men is part of a larger project which included a questionnaire completed by women and an interview study involving both men and women. The entire study was carried out at the University Hospital, Umeå, Sweden which has a catchment area with about 160 000 inhabitants. The questionnaire study was performed at the Department of Obstetrics and Gynaecology between February and November 1995. Two experienced social workers asked 250 consecutive Swedish-speaking women applying for legal abortion if they would be willing to participate in the study. Seventeen of the women came with their partners to the clinic and those men were personally asked about participation in the study. Women who came without a partner were asked to give a questionnaire to the men by whom they had become pregnant. Information about the study and a prepaid envelope were enclosed with the questionnaire. In all, 51 of the participating women (n = 221) and 28 of those who dropped out (n = 29) did not want to give a questionnaire to the man involved so the maximum number of men who might have participated was 171. However, it is impossible to know how many women actually gave the questionnaire to the man. Seventy-eight men actually answered the questionnaire, which is 46% of the maximum number possible. As it was impossible to identify the men, they could not be sent a reminder to complete the questionnaire. Two of the men answering questionnaires had partners who chose to continue their pregnancies to full term and another one's partner turned out not to be pregnant. These three questionnaires were excluded from the analyses, which therefore finally included 75 men. In only six cases the pregnancy had passed the 12th week.

The questionnaires covered the men's own judgement about psychosocial background, current living conditions, partner relationship, use of contraceptives, decision-making process, motives for abortion and questions about emotions in connection with the pregnancy, the current abortion and possible previous abortions. The questionnaire was semistructured, self-administered and contained 49 questions, mainly with given response options.

Questions about emotions in connection with the pregnancy, the current abortion and previous abortion/s gave the respondent the possibility to choose more than one response option, allowing the possible occurrence of contradictory feelings to be expressed. Answers other than the given response alternatives could also be supplied. In order to avoid the dichotomy and the valuation which are built into expression of positive and negative feelings, feelings in this study were classified as positive or painful. The answers were divided into three categories: those containing only positively charged words, those containing only words expressing pain and those containing both positively charged words and words expressing pain. The question about motives for having an abortion was open-ended in order to allow the respondents to express themselves freely. In a follow-up question the respondents were subsequently asked to state the most important motive and in the analyses the answers were divided into categories. Analyses of data and choice of categories were (triangulated) made by the two social workers together with the supervisor.

Non-participants
This study relied on the assistance of pregnant women applying for legal abortion. This resulted in answers from 78 men, constituting 46% of the maximum number of men who were possible participants. However, the corresponding drop-out of 54% cannot be considered real since some women probably did not give the questionnaire to their partners, meaning that many men never got a chance to decide whether or not they wanted to participate in the study. Since the men were not patients, it was impossible to identify them, and consequently to ask or remind them to send in the completed questionnaire.

Thus, a traditional analysis of the non-participants was not possible to do. However, it was possible to analyse whether there were any significant differences between the female partners of responding and non-responding men. The group of women whose partners answered the questionnaire (n = 74) was compared with the group of women who clearly stated that they did not want to give a questionnaire to their partner (n = 47 since four out of these 51 women had been excluded because they were not pregnant or had decided to continue the pregnancy), and the group of women who took a questionnaire for their partner but where the partner did not respond (n = 90). The groups were compared for a large number of variables such as age, civil status, education, personal finances, children, partner relationship, attitudes and feelings in connection with pregnancy and abortion, the partner's attitude to the current abortion and experiences of previous abortion/s. The results of these analyses show that the groups of women exhibited more similarities than differences. Some differences were found between the group of women whose partners answered the questionnaire and the group of women who did not take a questionnaire for their partner. The latter more frequently stated that they did not have a firm relationship with the man they were pregnant by or that they were more dissatisfied with the relationship (P < 0.001). These women also had a lower educational level (P < 0.05). There were fewer differences between the group of women whose partners participated in the study and the group of women who took a questionnaire for their partner, who failed to reply. The group whose partners did not reply had a lower educational level (P < 0.05) and more often thought that most men consider that it is the woman's responsibility to prevent unwanted pregnancy (P < 0.01). The results of these analyses show that there are no essential differences between the women whose men participated in the study and the women whose men did not participate. However, it was uncertain whether these similarities among the women could be extended to the men.

Statistics
Statistical analyses were performed using the SSPS statistical package. Discrete variables were compared with the {chi}2 (exact test). A P value of < 0.05 was considered as statistically significant.

The study was approved by the Ethics Committee of the University of Umeå.


    Results
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Psychosocial characterization
The median and mean age for the men was 29 years, range 18–50 (one missing). The corresponding figures for the pregnant women were a median age of 25 years (mean = 27), range 15–47 years. Men with previous experience of abortion had a median age of 35 years, range 19–50 (mean = 36) and the median and mean age for the others were 27 years, range 18–46 (P < 0.001). Table IGo shows the living conditions of the men. The majority were married or co-habiting in relatively long-lasting relationships with the pregnant woman. Most of them were employed and slightly more than a quarter was studying. A total of 84% were pleased with their occupation and more than 70% regarded their financial situation as good; 11% were very worried about it (data not shown). Half the men already had children, and 34% had children with the pregnant women. Three quarters of the married and co-habiting men and a quarter of the single men had children (P < 0.001). All except five had grown up in Sweden and one third of all men adhered to some religious belief.


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Table I. Psychosocial characterization of the men responding to the questionnaire (n = 75; values are percentages)
 
A total of 89% of the men had a partner relationship and all except two were pleased with their relationship (Table IGo); 67% of these men said that the pregnancy had not had any influence on the relationship, 21% said that the relationship had been influenced positively while 12% felt it had had a negative influence. One man was unsure whether he was the prospective father. All men except six considered their sexual life in positive terms. Sixty-three per cent of the men declared that the couple had not used any contraceptive methods at the time of conception and four men did not know if contraceptives were used.

A total of 75% of the men were involved in legal abortion for the first time while 25% had had a previous experience. There were more similarities than differences concerning psychosocial factors between those who had and those who had not experienced abortion previously (Table IGo). Significant differences were found between the groups concerning age (see above), duration of the relationship, evaluation of sexual life and whether or not they had children. Men with previous experience of abortion were older compared with men involved in abortion for the first time (P < 0.001) and more often lived in long-term relationships (P < 0.05) than those involved for the first time (Table IGo). Men with previous experience of abortion more often had children with the pregnant women (P < 0.001) and had children more than twice as often as the men in the other group (P < 0.001). However, men involved in their first abortion were more satisfied with their sexual life than men with previous experience of abortion (P < 0.05).

Men accompanying the women to the hospital
Seventeen men accompanied their partners to the hospital and could therefore be asked in person to participate in the study. One of them refused to participate and two were excluded because the partner of one decided to continue the pregnancy to full term and the partner of the other was found not to be pregnant. Thus, 14 of the men who accompanied their partners to the hospital were included in the study. These men differed from the rest of the men concerning employment, attitudes to abortion and use of contraceptives. They were more often at home, i.e. not in paid employment, were students or unemployed (P < 0.01), they more often used only positively charged words in relation to the current abortion (P < 0.05) and none had used contraceptives during the relevant intercourse/s (P < 0.01) compared with men not accompanying the woman to the hospital.

Motives for legal abortion
Every second man (56%) stated that they had talked to the woman before she became pregnant about what they should do in the event of pregnancy. Twenty-six of these men (60%) said that they had decided with their partner to have an abortion. No differences were found in this case between men with and without experiences of previous abortions.

Among all men, 64% stated in clear terms that they wanted the woman to have an abortion and 27% said that they did not take any specific standpoint but left it to the woman to decide. Five men said that they had not at the time of the questionnaire study decided whether to support an abortion or not. In total, 48 men who thought that the women should have an abortion were asked about the motives behind their standpoint. However, 11 of the 25 men who had answered either that they left the decision to the woman or that they had not taken any standpoint answered this question. Thus, 59 men declared motives for having legal abortion.

The primary motive for being in favour of an abortion was given by 30% as family planning; either they already had all the children they wanted or it was not the right time to have children. Half of these men had children. The other half, consisting mainly of students without children, provided more background to their standpoint, and said that they gave priority to other things, principally their studies, or that they were unable to offer a child a caring environment in their current circumstances; 19% gave reasons related to insecure relationships with the woman while 12% gave socio-economic motives. Next in order came motives related to age (12%), mainly a feeling of being too young; 10% stated as the first reason for the abortion that they had no time for an extra child: their work and existing children already took all their time. Four men stated motives concerning health.

Analysis of psychosocial factors and the stated primary motives for abortion revealed very few links. All those who gave planning as their motive enjoyed economic prosperity while none of those living under more strained economic circumstances stated that as a motive (P < 0.01). Half of the 19 men who were studying declared that they gave priority to their studies and 25% believed they were too young. Among the 41 employed men the motives were more varied. A quarter of them stated planning reasons and another quarter stated reasons related to insecure relationships. Men without children gave motives related to the relationship nearly twice as often as men who already had children. All men under 20 years of age gave age or socio-economic motives. At ages between 20–30 years, planning and reasons related to the relationship were predominant, while the predominant motive for the over 30 year olds was the planning. An obvious trend was found with increasing age. The older men less often gave socio-economic reasons, fewer reasons related to the relationship and more motives related to problems of combining professional work/housework with existing children. No man with previous experience of abortion gave motives relating to the relationship as a reason for having the abortion, while 11 in the other group stated this as their primary motive (P < 0.05). Apart from this, no differences between motives given for abortion could be found among men with and without previous experience of abortion.

Feelings connected with pregnancy and abortion
Figure 1Go gives the words the men could choose from, that would best reflect their initial feelings towards the current pregnancy. The most frequent words were unrealistic, wonder, joy, guilt and pride. Contradictory feelings appeared among 41% who chose both positively charged words and words expressing pain. A third of them (32%) chose words which only characterized pain such as unrealistic, despair, guilt, panic and dread while 27% chose only positively charged words such as joy, pride and happiness.



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Figure 1. Words expressing the men's initial feelings about the current pregnancy (n = 74). Information missing for one man (see Table IIGo).

 
Figure 2Go gives the words the men could choose from, that would best correspond to their feelings about the coming abortion. The most frequent words were anxiety, responsibility, guilt, relief and grief. Fifty seven per cent chose both words that were positively charged such as responsibility, relief and release and those that reflected pain such as anxiety, guilt, grief, anguish and powerlessness; 29% chose only words charged with pain and the remaining 13% chose only positively charged words. No differences in feelings regarding the pregnancy and the abortion were recorded between men who had children and men who did not. Furthermore, no differences could be found concerning feelings and attitudes to pregnancy and abortion between men who had and who did not have previous experience of legal abortion.



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Figure 2. Words expressing the men's feelings about the expected abortion (n = 75).

 
Table IIGo shows the men's initial feelings related to the pregnancy in relationship to feelings related to the abortion. More than a quarter (28%) had experienced both positive and painful feelings related to both the pregnancy and the abortion. A quarter of the men (25%) who chose only positively charged words to describe their initial feelings related to the pregnancy also chose only such words to describe their emotions related to the abortion. On the other hand, the same situation could be described in that half of those with only positive feelings towards the abortion initially had only positive feelings related to the pregnancy (Table IIGo). Another separate analysis revealing the complexity of the abortion situation shows that 45% of the men who only expressed positive initial feelings towards the pregnancy also stated clearly that they wanted the woman to have an abortion (data not shown). Furthermore it was found that 64% of the men who expressed only painful feelings related to the abortion nevertheless wanted the woman to have an abortion (data not shown).


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Table II. Initial feelings related to the pregnancy in relationship to feelings related to the abortion (n = 74)a. Values are numbers of men
 
Among the 19 men who had experience of previous abortions, eight had been involved in at least two abortions. Those men were asked about their feelings related to the previous abortion/s. The words the men could choose from were almost the same as those in Figure 2Go. The words anxiety and anguish were excluded and the words depression and regret were added. About half the men chose such words as relief, guilt and grief when describing their emotions regarding previous abortions. About 30% chose words such as powerlessness, responsibility and emptiness while about 20% chose words such as shame, release, regret, and exclusion. Many of these words were the same as the words the men used about their feelings with reference to the current abortion (Figure 2Go). When confronted with either the current or a previous abortion no man used the word `crisis'. Eleven of the men with experience of previous abortions described these experiences with both positively and painfully charged words. Four expressed only positive feelings and three chose words that only characterize pain.


    Discussion
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Men are usually invisible in abortion studies and hardly ever considered as a target group in the effort to prevent legal abortions in Western countries. To increase the understanding of the complexity of an abortion situation, it is of great importance that men involved in abortion should also become visible. However, it is ethically difficult to contact these men, as they are not patients. Thus, it is impossible to know how many men actually received the enquiry to participate in the study. In the present study women applying for abortion were asked to answer a questionnaire and thereafter to decide whether they wanted to participate in a prospective interview study. The women were also asked to give a questionnaire to the man they had become pregnant by. This procedure may have increased the stress on several women which in turn could mean negative influence acting on the possibility of the men participating in the study. In addition, we do not have any information about the men's proficiency with Swedish language. Furthermore, an American study has found an over-representation of domestic violence among women applying for abortion who did not want to involve their partner (Glander et al., 1998Go). Taking into account the delicacy of the issue per se, the participation frequency of about one in two is understandable. Whilst the participating men are not a statistically representative group for all men involved in abortion, they nevertheless represent a group that is of great interest, since they make visible 75 Western men involved in legal abortion.

The majority of the men were married/co-habiting and lived in functioning and relatively long-lasting relationships. Three quarters of them had children. More than half were employed, about a third were students and the remaining men were mainly unemployed. The majority were financially in a good position. Thus, the abortion situation for the vast majority did not equate to poor psychosocial conditions. On the whole, these results correspond with the results from a similar study conducted at the same department 20 years ago (Jacobsson et al., 1980Go). More similarities than differences were found between those who had and those who had not experienced legal abortion previously. Characteristic of the 19 men with previous experience of abortion was that they were older than the others and that they more often lived in long-term relationships and more often had children.

The majority of the men clearly stated that they wanted the woman to have an abortion. The predominant motives behind the men's standpoint regarding abortion involved various aspects of planning. Either they wanted to postpone parenthood until they had achieved an acceptable socio-economic standard or they already had the number of children they wanted. For some men the difficulty of combining employment with housework and satisfactory parenthood was a reason for wanting to limit the number of children. Unreliable relationships, i.e. problematic or newly established relationships constituted the second most common reason for abortion. This corresponds to results in other studies among women (Holmgren, 1994Go; Törnbom et al., 1994Go; Söderberg et al., 1997Go) and in one study among both women and men (Jacobsson et al., 1980Go). Furthermore, it has been shown that the intention to have children is dependent on the fulfilment of certain prerequisites and that the desire to have a child tends to decrease as a function of the number of children and the duration of the relationship (Willén and Montgomery, 1996Go).

Family planning and motives for abortion reflect living conditions and expectations about lifestyle, which in our post-modern society implies that most women and men adapt so that they can combine professional careers and housework with quality good partnership and parenthood. In Sweden divorces are common and men and women are expected to be economically independent. The Swedish parental insurance system is based on previous income from employment, which leads to a lifestyle where having a job necessarily comes before parenthood. In this study, men's thinking in the abortion situation was dominated by the idea that apart from wanting to have children in functioning family units, children should be desired and entitled to good care. Naturally, putting these opinions into practice requires careful family planning; thus the decision to have an abortion can be regarded as a rational choice. The fact that more than half the men had talked with their partner before she became pregnant concerning what to do in the event of pregnancy, and more than 50% had decided to have an abortion if a pregnancy should occur, must be interpreted to mean that legal abortion is regarded by many people as an acceptable form of birth control. This is in accordance with the conclusions from another Scandinavian study (Knudsen, 1997Go). In the work to prevent induced abortions, it is not sufficient only to give information about contraceptives and sexuality. The conditions for bearing and bringing up children in a modern society must be focused on since a good living standard and stable relationship do not ensure that a pregnancy will be accepted or wanted.

The fact that the majority of the men in this study regarded legal abortion as a possible solution to an unplanned pregnancy does not imply that they experienced their standpoint regarding abortion as easily conceived and uncomplicated. The decision process involves a large number of factors that concern the desire for a child, the partner, living conditions and the `right time'. The decision to have a legal abortion also involves considerations at an existential and ethical level. It is well known that these circumstances can evoke ambivalence in women. In the present study it is clearly shown that ambivalence in connection with pregnancy and abortion also exists among men. One example of this complexity is that initially more than a quarter experienced only positive feelings when they became aware of the pregnancy. Among these men, nearly half wanted the woman to have an abortion. Obviously, strongly positive feelings can be experienced about pregnancy/fertilization even if one is mentally prepared for abortion.

More than half the men chose both positively and painfully charged words to describe their feelings in connection with abortion. More than half the men with previous experience of abortion expressed these experiences in the same way. It is interesting to note that no man chose the word crisis to describe his experiences in connection with either the current or previous abortions, though more than half had contradictory feelings. Abortion as a solution to the problem of an unwanted pregnancy was expressed in such words as relief, release and responsibility but simultaneously the consequences of the choice were expressed in such words as anxiety, anguish, grief and guilt. This gives a picture of a person as one who can contain and live with paradoxes. In order to comprehend the complexity of the abortion situation, it is necessary to be open to the idea of paradoxes. We know about the ambivalence that arises in connection with pregnancy and legal abortion but the openness to paradoxes, which that ambivalence reflects, is often lacking as our thinking to a great extent is based on dichotomization. This dichotomization becomes obvious when ambivalence, for example, is shown as the occurrence of both positive and negative feelings (Törnbom et al., 1996Go) or when emotional pain is described as negative feelings (Lazarus, 1985Go; Adler et al., 1990Go; Dagg, 1991Go). The consequence of designating some feelings as negative is that important aspects in the abortion situation are not given a positive value and risk being regarded solely as something problematic or threatening. If the paradoxes in connection with abortion become visible, men and women have a better chance of recognizing themselves, which is an important prerequisite if the work to prevent undesired pregnancies is to succeed. In this context, it is of great importance that further studies include long-term experience and psychological integration of legal abortion among both men and women.


    Acknowledgments
 
The authors would like to thank social worker Katarina Bergström for professional assistance in conducting the study. The project has been supported by The Swedish Council for Social Research (project 94–0178) and the Swedish National Institute of Public Health.


    Notes
 
3 To whom correspondence should be addressed Back


    References
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
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Submitted on April 12, 1999; accepted on July 6, 1999.