Hesitant Steps: An Exploratory Qualitative Study of the Influential Factors on Women’s Attitudes Toward Elective Abortion
Abstract
Background: Abortion is one of the most complex and controversial issues in ethics, legislation, and health. Strict abortion restrictions and population growth policies have increased the complexity of abortion in Iran. Thus, this study aimed to explore women’s attitudes toward Elective Abortion (EA). Materials and Methods: This exploratory qualitative study was conducted between January and September 2024. Participants included 20 women (aged 15–49 years) with no previous history of abortion, purposively selected from eight healthcare centers in Hamadan, Iran. Data were gathered through in‑depth, semi‑structured interviews, and analyzed through Graneheim and Lundman’s conventional content analysis. Trustworthiness was ensured according to Guba and Lincoln’s criteria. Results: The five main themes regarding factors influencing women’s attitudes toward EA included moral and religious beliefs, violation of the right to live, sheer panic, modern rethinking, and an insecure future. The 10 categories of these themes were God’s will, respectability of life, EA as antisocial behavior, EA as murder, heavy penalty, physical, and mental consequences, changes in values, ambiguities in maternal roles, socioeconomic insecurity, and familial insecurity. Conclusions: Moral and religious beliefs, fears, and personal, socioeconomic, and value changes can influence women’s attitudes toward EA. Therefore, implementing multifaceted strategies in shaping reproductive health policies, emphasizing individual, economic, and social components, is essential for the assessment and management of EA.
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Fauser B, Adamson GD, Boivin J, Chambers GM, de Geyter C, Dyer S, et al. Declining global fertility rates and the implications for family planning and family building: An IFFS consensus document based on a narrative review of the literature. Hum Reprod Update 2024;30:153 73.
Dai YF, Lin LZ, Lin N, He DQ, Guo DH, Xue HL, et al. APA scoring system: A novel predictive model based on risk factors of pregnancy loss for recurrent spontaneous abortion patients. J Obstet Gynaecol 2022;42:2069 74.
Kortsmit K, Mandel MG, Reeves JA, Clark E, Pagano HP, Nguyen A, et al. Abortion surveillance United States, 2019. MMWR Surveill Summ 2021;70:1 29.
Rasch V, Muhammad H, Urassa E, Bergström S. The problem of illegally induced abortion: Results from a hospital‐based study conducted at district level in Dar es Salaam. Trop Med Int Health 2000;5:495 502.
Zhirova IA, Frolova OG, Astakhova TM, Ketting E. Abortion related maternal mortality in the Russian Federation. Stud Fam Plann 2004;35:178 88.
WHO. Abortion Care Guideline. World Health Organization; 2022.
Zendehdel M, Jahanfar S, Hamzehgardeshi Z. Frequency of self reported abortion and associated factors in Iran. J Family Med Prim Care 2024;13:2432 9.
Haseli A, Rahnejat N, Rasoal D. Reasons for unsafe abortion in Iran after pronatalist policy changes: A qualitative study. Reprod Health 2024;21:182.
Shirdel E, Asadisarvestani K, Kargar FH. The abortion trend after the pronatalist turn of population policies in Iran: A systematic review from 2005 to 2022. BMC Public Health 2024;24:1885.
Okonofua F. Abortion and maternal mortality in the developing world. J Obstet Gynaecol Can 2006;28:974 9.
Shahbazi S. The consequences of unsafe abortion: A qualitative study. J Adv Nurs 2012;68:1247 55.
Dolatabadi Z, Moridi M, Farnam F, Damghanian M. Developing a comprehensive abortion prevention program for couples based on I change model: Study protocol for a mixed method research. Reprod Health 2024;21:81.
Westfall JM, Kallail KJ, Walling AD. Abortion attitudes and practices of family and general practice physicians. J Fam Pract 1991;33:47 51.
Saeed S, Jain S, Emma N, Afzali H, Razaqi N, Ahmadi M, et al. Knowledge and attitude towards abortion among women in Afghanistan. Razi Int Med J 2022;2:52 62.
Anable J. ‘Complacent car addicts’ or ‘aspiring environmentalists’? Identifying travel behaviour segments using attitude theory. Transp Policy 2005;12:65 78.
Munakampe MN, Zulu JM, Michelo C. Contraception and abortion knowledge, attitudes and practices among adolescents from low and middle income countries: A systematic review. BMC Health Serv Res 2018;18:1 13.
Marván ML, Lagunes Córdoba R, Orihuela Cortés F. Design of a questionnaire on attitudes towards induced abortion. Salud Publica Me×2018;60:742 3.
Hoffmann JP, Johnson SM. Attitudes toward abortion among religious traditions in the United States: Change or continuity? Sociol Relig 2005;66:161 82.
Snegroff S. The development of instruments to measure attitudes toward abortion and knowledge of abortion. J Sch Health 1976;46:273 7.
Adamczyk A, Kim C, Dillon L. Examining public opinion about abortion: A mixed‐methods systematic review of research over the last 15 years. Soc Inq 2020;90:920 54.
Farash Kheialo N, Ramzi N, Sadeghi R. Social and cultural determinants of students’ attitudes toward abortion. Women Strateg Stud 2020;22:109 30.
Faria G, Barrett E, Goodman LM. Women and abortion: Attitudes, social networks, decision making. Soc Work Health Care 1985;11:85 99.
Abdoljabbari M, Karamkhani M, Saharkhiz N, Pourhosseingholi M, Khoubestani MS. Study of the effective factors in women’s decision to make abortion and their belief and religious views in this regard. J Res Religion Health 2016;2:44 54.
Friedman SB, Phillips S. Psychosocial risk to mother and child as a consequence of adolescent pregnancy. Semin Perinatol 1981;5:33 7.
Allen RH, Fortin J, Bartz D, Goldberg AB, Clark MA. Women’s preferences for pain control during first trimester surgical abortion: A qualitative study. Contraception 2012;85:413 8.
Pérez Sánchez B, Burgos Padilla JJ, Alveal Álamos C, Concha Salgado A, Jara Sepúlveda L, Rodríguez Díaz FJ. Design and study of psychometric properties of the community attitude to abortion scale (CAAS) with the Chilean population: Autonomy and stigma. Front Psychol 2022;13:1008492.
WHO. Studying Unsafe Abortion: A Practical Guide. World Health Organization; 1996.
Islamic SH. Ethical approaches to abortion: A case study. J Reprod Infertility 2006;6:321 42.
Kaczor C. The Ethics of Abortion: Women’s Rights, Human Life, and the Question of Justice. Routledge; 2022. 30. Ekmekci PE. Abortion in Islamic ethics, and how it is perceived in Turkey: A secular, Muslim country. J Relig health 2017;56:884 95.
White JE. Contemporary Moral Problems. Wadsworth Publishing Company; 2000.
Manninen BA. Rethinking Roe v. Wade: Defending the abortion right in the face of contemporary opposition. Am J Bioeth 2010;10:33 46.
Manninen BA. Revisiting the argument from fetal potential. Philos Ethics Humanit Med 2007;2:7.
Pogorilenko A. Legal regulation of the right to life of unborn human protection in international and national legislations. Соціологія права 2018;1 2:80 6.
Fleming L. The moral status of the foetus: A reappraisal. Bioethics 1987;1:15 34.
Rachels J. The Right Thing to do: Basic Readings in Moral Philosophy. McGraw Hill Education; 2015.
Warnock M. Existentialist Ethics. Macmillan; 1967.
Moshirzadeh H. From Movement to Social Theory: The History of Two Centuries of Feminism. Tehran: Nashr Pazhuhesh Shirazeh; 2010.
Rabani Esfahani H, Yazdekhasti B. Qualitative study of radical feminism effect on woman role in family institute and comparing it with Islam Maneuvers (Case Study: Women of Isfahan). J Appl Soc 2015;26:125 40.
Arisi E. Changing attitudes towards abortion in Europe. Eur J Contracept Reprod Health Care 2003;8:109 21.
Erfani A. Induced abortion in Tehran, Iran: Estimated rates and correlates. Int Perspect Sex Reprod Health 2011;37:134 42.
Gholami Z. Investigating the relationship between religious beliefs and induced abortion in unwanted pregnancies. Nurs Midwifery J 2021;19:378 86.
Shellenberg KM, Hessini L, Levandowski BA. Developing a scale to measure stigmatizing attitudes and beliefs about women who have abortions: Results from Ghana and Zambia. Women Health 2014;54:599 616.
Rahimi M, Yadollahpour M, Jorsaraie G, Khafri S. Evaluation of the Effect of religious beliefs on the attitude toward abortion among the students and healthcare personnel of Babol university of medical sciences. J Babol Univ Med Sci 2016;18:70 6.
Carrà E. The Consequences of Modernity. JSTOR; 1992.
Razaghi Nasrabad H. How women’s education affects delinquency in childbearing? The results of a qualitative study among university students of Tehran. J Sociocultural Strateg 2016;5:167 90.
Khormpour Y, Dehghan A, Dehghan F, Behjatiasl SF. The relationship between globalization and rethinking among the youth in Yazd city. Q J Soc Dev 2017;12:127 50.
Yogi A, Prakash KC, Neupane S. Prevalence and factors associated with abortion and unsafe abortion in Nepal: A nationwide cross sectional study. BMC Pregnancy Childbirth 2018;18:376.
Sadeghi Fasaei S, Isari M. The sociological study of divorce patterns. J Soc Probl Iran 2015;6:131 56.
Mahmudian H, Rezaei M. Women and low childbearing action: The case study of Kurdish women. Women Strateg Stud 2012;14:173 225.
Zaidi B, Morgan SP. The second demographic transition theory: A review and appraisal. Annu Rev Sociol 2017;43:473 92.
Van de Kaa DJ. Postmodern fertility preferences: From changing value orientation to new behavior. Popul Dev Rev 2001;27:290 331.
Kato M, Sleeboom Faulkner M. Dichotomies of collectivism and individualism in bioethics: Selective abortion debates and issues of self determination in Japan and ‘the West’. Soc Sci Med 2011;73:507 14.
Eyetsemitan FE. Culture, abortion, and bereavement. Cultural Influences in Coping with Grief: Impact of Social and Psychological Factors. Springer; 2025. p. 63 76.
Nourizadeh R. The status of induced abortion in Iran: The rights of fertilization and the challenges of a safe induced abortion. Med Law J 2009;3:101 30.
Shields JA, Serna S. The demise of feminist communitarianism. Perspect Political Sci 2011;40:9 15.
Lerner R, Nagai AK, Rothman S. Abortion and social change in America. Society 1990;27:8 15.
Bellah RN, Madsen R, Sullivan WM, Swidler A, Tipton SM. Habits of the Heart, with a New Preface: Individualism and Commitment in American Life. Univ of California Press; 2007.
Sartre J. Existentialism and Humanism. Methuen Publishing Ltd; 2007.
Erdman JN, Jelinska K, Yanow S. Understandings of self managed abortion as health inequity, harm reduction and social change. Reprod Health Matters 2018;26:13 9.
Potts M. Abortion perspectives. Eur J Contracept Reprod Health Care 2010;15:157 9.
Inglehart R. Culture Shift in Advanced Industrial Society. Princeton University Press; 2018.
Torabi Farsani S. Iranian Women in Transition from Tradition to Modernity. 2019. p. 168.
Chervona L, Bulvinska O. Social and cultural determinants of university social responsibility. Cont Prof Educ Theory Pract 2021;2:25 31.
Sarai H, Roshan Shomal P. Measuring the social factors affecting pregnant women’s attitudes toward intentional abortion. Women Dev Politics 2012;10:5 23.
Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons U.S. women have abortions: Quantitative and qualitative perspectives. Perspect Sex Reprod Health 2005;37:110 8.
Eghdampour F, Haseli A. The role of religion and spirituality in Iranian youth sexual behaviors: A systematic review. J Mazandaran Univ Med Sci 2018;28:175 86.
Motavalli R, Alizadeh L, Shahbazzadegan S. Evaluation of the prevalence, reasons and consequences of induced abortion in women of Ardabil in 2011. J Ardabil Univ Med Sci 2012;12:384 91.
Erfani A. Fertility in Iran and Tehran: Rates, trends, and differences. Iran Popul Stud J 2013;1:87 107.
Hosseini H. An introduction to economic and social demography and family planning. Hamadan: Bu Ali Sina University Press; 2002.
Krieger N. Who and what is a “population”? Historical debates, current controversies, and implications for understanding “population health” and rectifying health inequities. Milbank Q 2012;90:634 81.
Bankole A, Singh S, Haas T. Reasons why women have induced abortions: Evidence from 27 countries. Int Fam Plan Perspect 1998;24:117 52.
Makenzius M, Tydén T, Darj E, Larsson M. Repeat induced abortion A matter of individual behaviour or societal factors? A cross sectional study among Swedish women. Eur J Contracept Reprod Health Care 2011;16:369 77.
Kanstrup C, Mäkelä M, Hauskov Graungaard A. Women’s reasons for choosing abortion method: A systematic literature review. Scand J Public Health 2018;46:835 45.
Kirkman M, Rowe H, Hardiman A, Mallett S, Rosenthal D. Reasons women give for abortion: A review of the literature. Arch Womens Ment Health 2009;12:365 78.
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