National Partnership for Women & Families

Monthly Women's Health Research Review

Research review finds beneficial association between male partner involvement, women's abortion experience

Summary of "Male partners' involvement in abortion care: A mixed-methods systematic review," Anna Altshuler et al., Perspectives on Sexual and Reproductive Health, Oct. 11, 2016.

Research has found "favorable outcomes ... when men have been active partners of women rather than passive bystanders in both pregnancy prevention and prenatal care," but "male partner involvement in the context of abortion services remains understudied and generally overlooked," according to Anna Altshuler, an OB-GYN at the California Pacific Medical Center Research Institute, and colleagues.

Altshuler and colleagues explained that male partner involvement in the abortion experience could provide women with emotional support and potentially help "improve women's access to safe abortion care more broadly" by affecting how men "treat women and how abortion is perceived in society." Nonetheless, the researchers cautioned that male partner involvement "should be considered only when women desire it," as those experiencing intimate partner violence, reproductive coercion or relationship problems require access to "safe services that are free of undue influence."

To provide guidance for clinics aiming to incorporate male partners into patients' abortion experiences, the researchers "reviewed the published literature to learn how male partners are involved in the abortion process under non-coercive circumstances and the relationship between male involvement and women's experiences with abortion."

Methods

For the study, researchers focused on "the experiences of women who received abortion care at medical facilities that permitted male accompaniment." The researchers "defined 'male accompaniment' as a male partner's presence during some part of the abortion process, starting with the presentation to the medical facility and ending with postabortion care provided at the facility."

Because of the limited number of studies on the topic, the researchers assumed accompanying males to be involved in the pregnancy and in a romantic relationship with the woman seeking care. The researchers excluded studies involving illicitly obtained abortion care, as well as abortion care provided in instances of fetal anomalies.

The researchers between July 2, 2015, and Sept. 23, 2015, reviewed published literature on the topic and ranked the quality of the results as "low," "medium" or "high." According to the researchers, "Articles were eligible for inclusion if they were published in a peer-reviewed journal; analyzed primary data (qualitative or quantitative); examined induced abortion experiences at medical facilities; discussed how male partners were involved in the abortion process; assessed how partners' involvement was related to women's abortion experiences, from the women's perspectives; and were published in English, Spanish, Portuguese or French."

Findings

The researchers had a final sample of "15 articles, encompassing 13 unique studies published between 1985 and 2012," all of which were categorized as low or medium quality. The countries represented in the literature included Canada, Egypt, India, Sweden, the United Kingdom and the United States.

The research included seven cross-sectional studies and five qualitative or mixed-methods studies. Study participants were usually younger than 25, although the Swedish studies focused on medication abortion taken at home and tended to involve women older than 30. All of the randomized controlled studies except for one had control groups that were similar to the test groups.

Regarding abortion method, eight articles examined only abortion procedures, five examined only medication abortion, and two assessed both abortion procedures and medication abortion. Ten of the articles focused on abortion care provided in the first trimester, while five examined abortion care provided in the second trimester. Overall, six articles had as their primary focus the relationship between the male partner's accompaniment and the woman's abortion experience.

According to the researchers, the review found four types of male accompaniment: "presence in the medical facility; participation in the preabortion counseling; presence where the abortion was occurring ...; and participation in postabortion care." Overall, the researchers found that the "most common phenomenon explored was accompaniment during misoprostol administration for medication abortion."

Presence in medical facility

The researchers identified four studies examining "male partners' presence in medical facilities," two of which focused on "its associations with women's postabortion coping" and two that focused on its associations with "access to abortion care."

The two studies that examined the relationship between male partners' presence in medical facilities and women's postabortion coping occurred at a U.S. abortion clinic seven years apart. The first one found that "accompanied women were significantly more likely than unaccompanied women to have difficulty with coping 30 minutes after their abortions." However, the study found "[n]o difference ... at a three-week follow-up visit, although only 40 percent of women returned." The second study examined whether the partner's presence contributed to women's difficulty coping and found that "[p]ostabortion depression scores were low for all women, and accompaniment was not found to be associated with coping 30 minutes or three weeks after the abortion." Further, the study found that "accompaniment was positively associated with women's reports of their degree of relationship commitment, their partner's supportiveness of the decision to have an abortion, and their feeling that their partner had been supportive since learning of the pregnancy and could be relied on for support in the future." However, the researchers said the study did not examine whether "women's perceptions of support from their partners during the abortion process meant that the women actually received support; nor did they describe the various forms of support that the women received."

The two other studies examining male partners' presence in the medical facility and abortion access focused on "the abortion experiences of young unmarried women in freestanding abortion clinics in northern India." The first study found that women rarely presented at the clinic alone and that their accompaniment by a male partner "was associated with increased access." Specifically, women accompanied by their male partner accessed abortion care earlier in pregnancy than women who brought other companions. Further, although the study did not examine whether women brought male accompaniment for emotional support or to facilitate abortion access, it did find that "a significantly larger proportion of women in the first trimester than of women in the second trimester reported receiving emotional support from the partner (91 percent vs. 70 percent)." Meanwhile, the second study, conducted at the same clinic, "found that many women needed their partner to facilitate accessing abortion care, but some also valued his presence on an emotional level." In addition, the study found that "emotional support was often linked to financial support."

Participation in preabortion counseling

According to the researchers, only one study, conducted at a U.S. clinic, "explored the inclusion of male partners in preabortion counseling." In that study, among women who completed surveys following voluntary couples counseling prior to an abortion, some said they "expected their partners to be involved at various parts of the abortion process." Specifically, the study found that "12 out of 22 [women] expected partner participation in the preabortion counseling, five expected it during the abortion procedure and four expected it during contraceptive counseling." The study also found that 19 of the 22 women were satisfied with couples counseling, and a qualitative analysis of the data showed that "including male partners in preabortion counseling made women feel emotionally supported."

Presence where the abortion was occurring

The researchers found eight studies assessing "the relationship between male partner accompaniment in the physical space where the abortion was occurring and women's abortion experiences," including five studies focused on medication abortion.

One study, conducted at a U.K. hospital, "found that a partner's emotional support during the abortion process was associated with the acceptability of the abortion method."

Meanwhile, four studies assessing medication abortion "examined the administration of misoprostol at home and also found, in general, positive relationships between partner's presence and women's experiences." For instance, one Swedish study "found that having a support person present at home was positively associated with acceptability" of first-trimester home abortion, while data from two other studies "showed that women valued the presence of the partner during medication abortion for emotional support; for enabling them to share an intimate experience; and for practical support, such as attending to child-care needs." Of those two studies, one "found that some women selected medication abortion because it allowed them to involve their partner in the process and that women had a positive assessment of their partner's involvement after the abortion."

The researchers also cited another two studies, conducted at clinics in Canada and Sweden, that "found that either having a support person present or being given the option to have one present" during abortion procedures "was associated with satisfaction with care." Another study, conducted in community clinics in Canada, found that 85 percent of women "described having a male partner present during the abortion procedure as helpful and would advise other men to accompany their partner during an abortion."

According to the researchers, "Three of these studies also investigated whether the presence of a partner (or other support person) during the abortion was associated with women's perceptions of less pain; none showed such a relationship."

Participation in postabortion care

The researchers found two studies that examined "the role of partner accompaniment in postabortion care by measuring outcomes related to women's emotional recovery, physical recovery or both."

One of the studies, conducted at six hospitals in Egypt, assessed whether "counseling patients' husbands before discharge led to greater instrumental and emotional support at home, which would thereby improve patients' physical and psychological recovery one month later." The study found that women in the control group were more likely to seek abortion care later in pregnancy, but otherwise were similar to women whose husbands were counseled. In addition, the study found that women who said their husbands provided a high level of emotional support were "significantly more likely to also report good physical and psychological recovery."

The second study, conducted in a hospital-based family planning clinic in Canada, examined whether "inviting support people to the recovery room" after an abortion procedure "decreased patients' anxiety and made them feel supported." The study compared women's experiences with services before and after implementation of a policy to allow male partners and other support people in the recovery room. The study did not determine whether women prior to the policy's implementation wanted to be accompanied, but it found that women after the policy's implementation who wanted to be accompanied "reported a significantly greater decrease in anxiety levels after the procedure than those in the earlier phase; they also were significantly more likely to report that they received all the support they needed and that they found their support people helpful."

Discussion

"Although the evidence is not high-quality, findings suggest that the inclusion of male partners in abortion care under noncoercive circumstances has a positive relationship with women's abortion experiences," the researchers wrote. They noted that most of the studies found that a partner's involvement "was positively associated with women's emotional comfort and assessment of the experience," while no studies found "any negative associations." In addition, the researchers said the inclusion of a male partner or other support person "created opportunities for partners to offer financial and practical support."

The researchers wrote that while they focused on the relationship between a male partner's involvement and a woman's abortion experience, the studies provided insights on other aspects of accompaniment. For instance, one study found that clinic staff felt skeptical about the benefits of male partner involvement and that some women who were unaccompanied found the presence of male partners problematic in the recovery area. Separately, other studies found that some men experienced distress during their partner's abortion experience, especially if their partner experienced pain, and another study found that a woman's abortion experience could be affected by the quality of their partner's experience, particularly if the partner had a negative experience.

According to the researchers, the review "also brought out some of the limitations of the existing evidence," including small sample sizes, a lack of specificity in some studies about the type of partner who accompanied the woman and the failure in certain studies to ascertain whether women wanted to be accompanied.

The researchers concluded that the overall "body of literature on male involvement in abortion care, and especially on how women perceive male involvement, is rather limited." They encouraged further research into the topic, noting that "[i]f inclusion enables men to better comprehend the experiences of their partners, it may not only strengthen couples' relationships, but also help men become stronger advocates for women in general." According to the researchers, "This potential advocacy is particularly important because men are key actors in determining social norms and policies in many regions of the world." They wrote, "Understanding the roles of male partners in abortion care is the first step to pursuing these broader aims."