The Psychosocial Aspects of Induced Abortion: Men in the Focus

Abstract

Although a man is as well concerned in each case of induced abortion as a woman is, the amount of existing studies that attempt to describe and gain insight into the psychological effects of induced abortion on men is extremely small, either when considering this number in itself or when comparing it to the number of related studies focusing on women. The present article gives an overview of the existing psychological knowledge of men’s perspective on induced abortion including their typical reactions; roles; participation in, and responsibility for, decision-making; and their impact on the female partner. Furthermore, a number of related but understudied issues are addressed.

Full text

Review
The Psychosocial Aspects
of Induced Abortion: Men
in the Focus
Bea
´ta Nagy
1,2
and Adrien Rigo
´
2
Abstract
Although a man is as well concerned in each case of induced abortion as a woman is,
the amount of existing studies that attempt to describe and gain insight into the
psychological effects of induced abortion on men is extremely small, either when
considering this number in itself or when comparing it to the number of related
studies focusing on women. The present article gives an overview of the existing
psychological knowledge of men’s perspective on induced abortion including their
typical reactions; roles; participation in, and responsibility for, decision-making; and
their impact on the female partner. Furthermore, a number of related but under-
studied issues are addressed.
Keywords
men, abortion, unintended pregnancy, psychological sequelae, social support,
decision-making
Although the global incidence of induced abortion has shown a decreasing trend
since the mid-1990s, the number of terminated pregnancies was still 55.9 million
each year between 2010 and 2014, of which 49.3 million were ended in developing
regions and 6.6 million in developed countries. The global incidence of induced
1
Doctoral School of Psychology, Eo
¨tvo
¨s Lora
´nd University, Budapest, Hungary
2
Institute of Psychology, Eo
¨tvo
¨s Lora
´nd University, Budapest, Hungary
Corresponding Author:
Bea
´ta Nagy, Institute of Psychology, Doctoral School of Psychology, Eo
¨tvo
¨s Lora
´nd University, Izabella
utca 46, Budapest 1064, Hungary.
Email: nagybeatamagda@imap.cc
Men and Masculinities
1-19
ªThe Author(s) 2019
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/1097184X19856399
journals.sagepub.com/home/jmm

abortion among women aged 15–44 years is 35/1,000 women. Incidence is the
highest in Latin America and in the Caribbean region (44/1,000) and lowest in North
America (17/1,000; Singh et al. 2018).
Any attempt at understanding why a woman or a couple chooses to terminate a
pregnancy requires comprehensive knowledge of the psychosocial factors underlying
such decisions. While empirical findings have been continuously published since the
1970s on women’s psychological responses to induced abortion; on the related coping
and adaptation processes; and on the impact of abortion on their self-esteem, mental
health, and childbearing plans (or on their relationship with the concerned male
partner in some cases; see, e.g., Major et al. 2008; Ring-Cassidy and Gentles 2003),
very little is known about the concerned men’s perspective on induced abortion.
1
In a review article, Coyle (2007) reported as few as twenty-eight studies addres-
sing the psychological, relationship-related, social, and sexual effects of induced
abortion on men, which were found in a pool of studies available in the MEDLINE,
CINAHL, PsycINFO, PsycARTICLES, and Academic Search Premier databases
with a publication date between 1973 and 2006. In all of the twenty-eight studies,
all the respondents were males. Moreover, some of these studies used partly or
entirely overlapping samples. The size of the twenty independent samples reported
by Coyle varied between 1 and 2,868. Most of the publications reported case studies,
clinical observations, and results obtained from qualitative interviews. Only four
studies were based on hypotheses tested by means of quantitative methodologies.
The issues addressed by the reported studies included men’s attitudes toward
induced abortion, demographic characteristics of the concerned men, their preferred
methods of contraception, men’s rights to participate in making the abortion deci-
sion, and its impact on their female partners.
The same trend continued between 2007 and 2017.
2
During this period, one meta-
analysis was published in the field, which focused on the effects of intimate partner
violence on induced abortion (Hall et al. 2014), while a large part of the studies
included in the analysis collected data from the concerned women only. As the
authors note, the concerned men’s individual characteristics (age, ethnicity, income,
education, substance use, etc.); their mental, physical, and sexual health indicators;
and the possible forms of intervention are equally scarcely addressed in the litera-
ture. Altshuler and colleagues (2016) published a systematic review of findings on
men’s role in abortion care, which will be discussed later. Another systematic review
analyzed studies of posttraumatic stress following reproductive losses (Daugirdait _
e,
van den Akker, and Purewal 2015), but there was only one study that focused on
posttraumatic stress symptoms related to non-therapeutic-induced abortion and also
involved the concerned men (Coyle, Coleman, and Rue 2010).
A large part of the studies in men and induced abortion published since 2007
focus on (primarily young) men’s knowledge of, and attitudes toward, induced
abortion, most of which used in-depth interviews, focus group discussions, or online
surveys (see, e.g., Ekstrand et al. 2009; Kavanaugh et al. 2013). There are seven
studies published between 2007 and 2018 addressing the decision on induced
2Men and Masculinities XX(X)

abortion and its impact on the concerned men; five of them only involved female
respondents. These studies typically focused on the causes (Chibber et al. 2014;
Kapadia, Finer, and Klukas 2011) and consequences of induced abortion related to
the intimate relationship (Mauldon, Foster, and Roberts 2015) or on the extent and
impact of support provided by male partners (Lipp 2008; Jones, Moore, and Froh-
wirth 2011). There are two studies conducted with male respondents, one of which
analyzed the intrapsychic and relationship-related factors underlying induced abor-
tion (Naziri 2007). The other one is a Finnish cohort study conducted with pregnant
women’s partners (N¼540), which found no significant differences in psycholo-
gical well-being according to whether or not the partner had had previous experience
of abortion (Holmlund et al. 2014).
Since the law confers on women the exclusive right to decide on terminating a
pregnancy, induced abortion is thematized as an issue concerning women only,
despite the fact that the majority of women discuss the options with their male
partner before making a decision (Vandamme et al. 2017; Costescu and Lamont
2013). In the same vein, psychological research on induced abortion mostly focuses
on women’s interpersonal characteristics, paying little or no attention to the male
perspective on abortion, which is questionable, among others, because if ending a
pregnancy is assumed to be women’s “concern” in the social discourse, then it
implies that any possible consequences concern women only. Such circumstances
pose difficulties to men in adequately recognizing and understanding their own
negative emotional states and in finding help with grieving losses if needed
(Altshuler et al. 2016).
Men’s perspective is likewise ignored in legislation, insofar as the legal condi-
tions of exercising a right to abortion are thematized as an issue involving two
parties, where a woman’s right to self-determination is in conflict with a fetus’ right
to life, whereas rights and interests of the father as the third party are completely
ignored (Strahan 1999). Any attempt to introduce a male perspective into the abor-
tion discourse immediately gives rise to the concern that allowing greater scope to
men’s participation in decision-making may in some way infringe women’s rights
(Papworth 2011; Myers and Nevill 2010).
While some reproductive-related issues that traditionally were mother oriented
now include men’s perspective, there is almost complete silence on the subject of
“lost fatherhood” due to induced abortion. As several authors note, there is no
commonly used term to describe men concerned in abortion, since the expression
father-to-be applied to cases of planned and/or completed pregnancies is not appli-
cable in such cases (Makenzius 2012; Kero and Lalos 2004).
Number of scientific studies about the male partner’s role is very limited, and it is
usually analyzed based on their effect on the female’s emotional, psychological
state, way of coping and experiences (e.g., whether it is beneficial for the woman
to have the male partner during the intervention or not; Papworth 2011). This is
regrettable particularly because ignoring men concerned in abortion may maintain
Nagy and Rigo
´3

and/or reinforce the view that unintended pregnancies are women’s exclusive con-
cern and responsibility (Makenzius 2012).
The structure, dominant religious views, and culture of a society may influence
the presence of and research on induced abortion. Providing the background for the
legal regulation of abortion in a specific society also limits the generalizability of
findings across countries and social groups. Such factors are, for example, male and
female roles, approval versus disapproval of extramarital sex, the relationship
between procreation and masculinity, responsibility for contraception, or the stig-
matization of abortion (Papworth 2011).
Moreover, scientific studies in men and induced abortion have to face methodo-
logical challenges as well. It is not by chance that most authors report case studies
and findings of semistructured interviews, whose validity is limited, however, due to
the small sample size and other methodological issues (e.g., the lack of a control
group).
Even sampling men concerned in abortion is not without difficulty, since they do
not form a clinical population, thus they are contacted in the hall of the institution
where the abortion is performed or at counseling sessions. This, however, results by
necessity in biased data collection, since men not seeing their partner to the inter-
vention are excluded from sampling, while those living in a permanent relationship
are overrepresented, and those who choose to terminate a pregnancy occurring in a
casual or less stable relationship are underrepresented. This strongly affects the
obtained findings on the responsibility taken and the support provided by male
partners and on their impact, for example (since men seeing their partner to the
intervention presumably are more responsible and supportive in the given situation).
Likewise, biased sampling hinders reconstruction of the decision-making process
(since data are only collected from those who choose to end the pregnancy and not
from those who eventually decide to keep the baby; Reich and Brindis 2006).
Another case of biased sampling is when respondents represent a special subpopula-
tion formed by those men who ask for help with their own problems following the
abortion. It may raise further difficulties that the identity of the father is only known
to the woman; therefore, male respondents may only be reached through female
respondents, and thus, as Kero and Lalos (2004) note, the sample is double selected,
first by female respondents and then by male respondents. Researchers often cope
with the poor availability of male respondents by asking the concerned women
themselves about their partners (e.g., about their attitudes, their approach to the
decision, etc.), this procedure, however, obviously distorts the obtained information
on the concerned men (Kero and Lalos 2004). Furthermore, men’s experience of the
abortion and the forms and intensity of their responses to the event are presumably
related to socialization patterns (e.g., regarding the disclosure vs. repression of
emotions), similarly to their responses to perinatal losses or infertility (Wischmann
and Thorn 2013; Kersting and Wagner 2012).
In abortion research, the characteristics of control group are also significant
because females and couples choose to have an abortion based on many different
4Men and Masculinities XX(X)

reasons: they have different financial, social, cultural, and personal backgrounds,
and diverse gestational period, which leads to a great variability of psychological
consequences. On the other hand, it makes the choice of properly adjusted control
groups to be more difficult (Major et al. 2008).
As a result of these circumstances, men concerned in abortion were for long
excluded from or, following Kero and Lalos (2004), “invisible” to studies either
analyzing the psychological effects of induced abortion or targeted at the optimiza-
tion of abortion care, and although there is a growing amount of scientific findings in
this area, several questions are yet to be answered.
The subsequent sections provide an overview of the existing international liter-
ature and the available research findings on the male perspective on induced abor-
tion. The overview is focused on research reports published after 2000 and, within
this pool, on studies based on a quantitative approach, while case studies are not
discussed. Similarly, we do not review those studies which results cannot be general-
ized because of either special sociocultural features or legal policies (e.g., the assis-
tance of males in women’s use/access to safe abortion services) or special
circumstances (e.g., decision-making about abortion in a setting with a high pre-
valence of HIV).
The purpose of this article is to review men’s perspectives on the relationship
between unwanted pregnancies and induced abortion, the typical male reactions to
abortion, the importance of men’s supportive role, and characteristics of the abortion
decision, when it includes men. The limited scope of this article does not allow
inclusion of an analysis of the impact of induced abortion on the intimate relation-
ship and the issues of abortion care.
In Whose View Is a Pregnancy Unwanted?
Unwanted pregnancy includes cases when a woman does not want to have a child or
another child or when the time of conception is inconvenient (e.g., earlier than
planned). That is, the categories of intended and unwanted pregnancy are defined
with regard to women even though decisions on the related issues (e.g., engaging in
sexual activity, contraception) usually involve male partners as well (Ka
˚gesten et al.
2015). For this reason, little is known about men’s understanding of an unwanted
pregnancy.
A large part of unwanted pregnancies are terminated. In 2006, 49 percent of
pregnancies were unintended in the United States, 43 percent of which were ended
on the pregnant women’s request (Gentile 2014), while 45.8 percent of unintended
pregnancies were terminated in France (Ka
˚gesten et al. 2015). Since childbearing
frequently depends on the concerned parties’ financial situation, this is a crucial
factor influencing the prevalence of unwanted pregnancies. Zabin and colleagues
(2000), for example, found this prevalence to be 57 percent in a sample of women
having low income (N¼250).
3
Nagy and Rigo
´5

Of course, the two partners do not necessarily agree whether or not a pregnancy
has been intended. One in every five ongoing pregnancies (19.6 percent) in a French
sample was unintended by the male partner (Ka
˚gesten et al. 2015), while an inter-
national US survey (National Surveys of Family Growth) involving 10,000 male
respondents found that four in every ten children were born after a pregnancy not
intended by the male partner (Lindberg and Kost 2014). In another US survey, 14
percent of female respondents (N¼217) reported to have terminated their preg-
nancy against their partner’s will (Rue et al. 2004), and 39 percent of 345 Alabama
women reported a pregnancy they chose to terminate, while their partner would like
to have had a baby (Kroelinger and Oths 2000).
The prevalence of pregnancies not wanted by the male partner was highest among
those men who did not live with their partner (73.9 percent of those whose partner
had been pregnant in the five years preceding the study; p< .001; N¼664), who had
had at least ten female partners during their lifetime (33.2 percent; p< .001), and
those who had used five or more different methods of contraception (43.7 percent;
p< .001). Among those men whose partner was expecting a baby at the time of the
study, the pregnancy was most frequently reported to be unintended by those who
were aged twenty-five or under (incident rate ratio [IRR] ¼2.3; 95 percent confi-
dence interval [CI 1.5, 3.5]), nonreligious (IRR ¼2.1; 95 percent CI [1.3, 3.5]), or
born to a mother were more educated (IRR for college or more compared with no
diploma ¼2.8; 95 percent CI [1.7, 4.6]). Further influencing factors were a difficult
financial status, difficulties with reconciling ongoing studies or professional life
with childbearing, and instability of the intimate relationship.
Of pregnancies following a previous unintended pregnancy, 68 percent were also
unintended (Ka
˚gesten et al. 2015).
Whether a woman regard conception as a desirable event largely depends on her
partner’s attitude to pregnancy (Kroelinger and Oths 2000). Findings on pregnancies
unintended by women show that a frequently reported reason for choosing abortion
is the male partner (the lack of his support or responsibility, his incompetence,
aggressive behavior, etc.). Women applying for abortion refer to relationship prob-
lems in about one-third of the cases according to various sources (Biggs, Gould, and
Foster 2013; Chibber et al. 2014). In a large-scale prospective longitudinal study
conducted in the United States (Turnaway Study; N¼954), 31 percent of female
respondents applying for abortion explained their decision by referring to their
partner (Chibber et al. 2014). The related reasons mentioned by the respondents fell
into one of the following six categories:
– There is no relationship with the biological father or the relationship has been
unsatisfactory or was formed too recently—35 percent.
– The partner is unable or unwilling to support childbearing (unable to provide
financial support, not ready to be a father, not responsible enough, fulfilling a
prison sentence, fails to take care of his existing children, etc.)—26 percent.
6Men and Masculinities XX(X)

– The partner is a “bad guy” (not the one whom the respondent expected as a
lifelong partner, not the one with whom she wants to have a child, uses drugs,
etc.)—21 percent.
– The partner does not want to have a child—10 percent.
– The partner is abusive (physically or mentally; the respondent is worried that
the partner will continue to be aggressive after childbirth, and the child will be
raised under such circumstances)—8 percent.
– The respondent wants to get married before having a child or does not want to
be a single mother—27 percent.
The probability of referring to the male partner as the reason for abortion was
higher among women with tertiary education as compared to those with lower
education (odds ratio [OR]¼1.55; 95 percent CI [1.12, 2.15]), among single women
(showing the largest difference to those having got pregnant by their husband/fiance´:
OR ¼0.24; 95 percent CI [0.14, 0.40]), among those victimized in a physically
abusive relationship (OR ¼3.53; 95 percent CI [2.12, 5.88]), among those whose
partner did not want to have a child as opposed to those whose partner was uncertain
or left the decision to the woman (OR ¼0.61; 95 percent CI [0.41, 0.90]; Chibber
et al. 2014).
Men may exert pressure on their female partner to terminate a pregnancy they
consider unwanted. The prevalence of such cases is hard to estimate (primarily due
to the difficulty of measurement); certain studies suggest that the proportion of
women subjected to social pressure among those undergoing an abortion may be
as large as 64 percent (Rue et al. 2004). However, these findings are exclusively
based on the concerned women’s (subjective) responses nor are the form and extent
of pressure defined adequately. Of those women who were discontent with their
abortion decision after terminating a pregnancy, 73 percent reported to have been
subjected to their partner’s pressure, and 39 percent of these women experienced
intense pressure (Reardon 1987, cited by Shuping 2011)—it is a question, due to the
abovementioned methodological issues, to what extent these responses reflect male
partners’ actual pressure and to what extent respondents’ shifting responsibility or
cognitive dissonance reduction. Some studies found that women choosing abortion
due to perceived social pressure showed more negative psychological outcomes and
poorer adaptation (Rue et al. 2004; Kimport, Foster, and Weitz 2011), but the
underlying intrapsychic processes and/or interpersonal factors or relationship
dynamics are yet to be clarified.
Male Partners’ Psychological Responses to Abortion
Research rarely focuses on the short- and long-term effects of an induced abortion on
the concerned men including the distress or negative emotional states they may
experience. In fact, it is frequently questioned whether abortion-related experiences
even have any impact on them. The dichotomous approach inherent in this
Nagy and Rigo
´7

proposition and the associated attitude homogenizing men’s experiences are well
reflected in the following question posed in a handbook on women’s health after
abortion: “Do men walk away unscathed from the experience, or do they suffer as
women do following the abortion decision?” (Ring-Cassidy and Gentles 2003, 238).
Very few empirical findings are available on men’s typical reactions to induced
abortion. Although a relatively large number of publications address the subject, the
vast majority of them presents case studies or summarize the authors’ clinical
observations mostly made in a psychodynamic approach. These latter generally
point out that men, similarly to women, frequently experience anger, shame, sad-
ness, or guilt after an abortion, especially when the decision raised ambivalent
feelings in them. A typical male reaction is engaging in impulsive risk-taking beha-
vior in order to avoid a sense of failure and the awareness that they abandoned their
partner and unborn child. Those men who pressed their partner for abortion mainly
felt ashamed and sad, while those who were not involved in the decision-making
process more frequently experienced anger and frustration (e.g., Ring-Cassidy and
Gentles 2003; Stern 1999).
In an online qualitative study involving men concerned in abortion (N¼89),
Coyle and Rue (2015) revealed the following three major themes in the collected
responses:
–loss and grief including loss of the child and fatherhood, loss or deterioration
of the intimate relationship, loss of trust in the partner and feelings of aban-
donment, loss of self-esteem resulting from personal failure, and sadness
accompanying guilt or regret.
–feelings of helplessness and/or victimhood due to the lack of control over the
outcome of pregnancy: helplessness entails a sense of vulnerability and
incompetence, while victimhood entails weakness and humiliation, and these
negative attributes undermine the positive experience of masculinity.
–spiritual healing experience associated with forgiving the partner and them-
selves or with being forgiven by a higher power.
Kero and Lalos (2004) conducted a longitudinal study of male reactions to
induced abortion, in which they interviewed twenty-six Swedish men three times,
first before their partner’s abortion and then in the fourth and twelfth months
following the intervention. Four months after terminating the pregnancy, the over-
whelming majority of the respondents were satisfied with the decision (twenty-four
of twenty-six), responsible (twenty-one of twenty-six), and thought it had been the
best choice regarding their intimate relationship, the unborn child, and the existing
children (where relevant). Seventeen men felt relieved. Twelve reported feelings of
guilt in part because of neglecting contraception and in part because of their respon-
sibility for their partner’s difficult situation. Six felt powerless because they had no
choice. Nine reported feelings of sadness and/or emptiness in relation to the abor-
tion. One year after the intervention, no one reported mental problems nor did
8Men and Masculinities XX(X)

anyone feel regret for their abortion decision. Half of the respondents (thirteen of
twenty-six) never or almost never thought of the events taking place one year before.
Few experienced only negative emotions (guilt, sadness, shame, emptiness, anger,
etc.) in relation to the abortion (two of twenty-six after four months and one of
twenty-six after twelve months). The number of those experiencing only positive
emotions (relief, responsibility and maturity) increased between the fourth and
twelfth months (eight of twenty-six after four months and fourteen of twenty-six
after twelve months); the majority (sixteen of twenty-six) reported mixed feelings
including both positive and negative emotions four months after the event.
Lauzon and colleagues (2000) assessed the level of distress in men concerned in
abortion directly before the intervention (N¼113) and three weeks after (N¼69),
and the results were compared to data of a control group (not concerned in abortion)
involved in a health assessment (Lauzon et al. 2000). The authors found that 39.6
percent of the men concerned in abortion showed a high level of distress, which
frequency was significantly higher as compared to the matched control group
(p< .05), while their proportion was 30.9 percent three weeks after the intervention
(the difference to the control group was nonsignificant in this case). The following
factors were found to predict high distress in the concerned men: fear of negative
impact of the abortion on the intimate relationship, starting the relationship less than
one year before, being worried about the abortion, fear of pain, negative perception
of own health, suicidal ideation in past year, and suicidal gesture in whole life.
A special case for men in terms of coping is when their female partner chooses to
terminate a pregnancy against their will. Findings reported by Coyle and colleagues
(2010) suggest that in cases when the partners disagree on the abortion decision,
postabortion relationship and sexual problems are more likely to be accompanied by
posttraumatic stress symptoms in men such as hyperarousal and intrusive thoughts.
4
The Male Partner as a Source of Social Support
Findings obtained in different countries and at different times are highly consistent
in that a large part of induced abortions are known to the male partner prior to the
intervention. Major et al. (1997) found that 85 percent of women applying for
abortion had informed their partner of the pregnancy. A study conducted by the
Guttmacher Institute in 2010 likewise found that 82 percent of 4,769 US women
undergoing induced abortion reported their male partner to have been aware of the
planned intervention (Jones, Moore, and Frohwirth 2011). The study revealed three
major factors influencing women’s decision on informing their male partner: the
type and duration of the intimate relationship and the female partner’s exposure to
physical abuse in the relationship. Women living in marriage or partnership signif-
icantly more frequently informed their partner of the planned abortion (87.1 percent
and 87.8 percent, p< .001, respectively) than those who had never been married
(79.4 percent) or had divorced or widowed (71.8 percent; p< .05). However, the
majority (60.6 percent; p< .001) of those women who did not in a permanent
Nagy and Rigo
´9

relationship with the biological father also reported that their partner had been aware
of the abortion. Violence committed by the male partner was found to be a negative
predictor, which was reported by 7 percent of the respondents, and which signifi-
cantly decreased the male partner’s chance to be informed of the abortion (p< .001).
The proportion of those informing their male partner of the pregnancy and the
abortion decision increased with the duration of the relationship: it was 81.1 percent
in relationships beginning less than a year before (p< .001), 85.0 percent in those
beginning one to two years before (p< .05), and 88.5 percent in those beginning two
to five years before. As the authors point out in relation to the above findings,
besides the fact that keeping a pregnancy secret is more difficult in a committed
partnership, women living in such a relationship are more motivated to, and feel
more responsible for, discussing the situation with their husband or partner, and
committed partners’ strategies to deal with an unintended pregnancy are presumably
easier to reconcile (Jones, Moore, and Frohwirth 2011).
When the male partner knows about the pregnancy, the next question is the extent
to which women perceive men to be supportive of their abortion decisions, and how
it depends on the characteristics of the relationship.
The respondents rated the perceived support provided by the partner on a five-
point Likert scale. Two-thirds (67.8 percent) of the respondents judged their partner
supportive (55 percent rated them as “very supportive”), while 8 percent perceived
their partner to be completely unsupportive. Of course, perceived support was high-
est among those living in marriage or partnership (87.0 percent and 81.5 percent; p<
.001, respectively), and it significantly increased with the duration of the relation-
ship (76.4 percent in relationships beginning less than a year before and 84.9 percent
in those beginning more than five years before). Nearly half (49.1 percent; p< .001)
of those physically abused by their partner perceived the partner as supportive and
about a quarter of them (24.8 percent; p< .001) as completely unsupportive (Jones,
Moore, and Frohwirth 2011).
Besides individual and relational characteristics, complex sociocultural factors
are influencing a woman’s decision on whether or not she informs her partner about
abortion and also the amount of support received from the male partner. We found
only one research that compared directly the impact of two different cultures
on women’s psychological responses to abortion. A comparative study involving
Russian and American women found that the proportion of those perceiving their
partner to be supportive was twice as high in the American sample as in the Russian
sample (50.7 percent and 23.8 percent, respectively; Rue et al. 2004).
The amount of support provided by the partner has essential consequences for the
period following the abortion. It was revealed as early as in the first studies in the
field that indicators of women’s postabortion psychological adaptation significantly
correlated with the amount of support received from the partner but not with that
provided by parents and friends (Bracken, Hachamovitch, and Grossman 1974;
Shusterman 1979) and that perceived support received from the partner negatively
correlated with preabortion anxiety (r¼.22, p< .05, N¼62; Moseley et al. 1981).
10 Men and Masculinities XX(X)

A subsequent study established a positive relationship between support from the
partner and women’s postabortion health (r¼.411, p<.001,N¼143) and a
negative relationship between the received support and the likelihood of engaging
in self-harming behavior (r¼.323, p< .001; Gentile 2014). The negative rela-
tionship between the experience of a supportive partner and postabortion distress
was subsequently corroborated in qualitative studies (Kimport, Foster, and Weitz
2011). Major and colleagues (1990) found a positive relationship between the per-
ceived amount of support and women’s self-efficacy in coping with abortion,
whereas both low-level social support and a lack of adequate coping strategies are
explanatory variables of negative psychological responses to abortion (Major et al.
2008).
The partner’s supportive attitude also influences the amount of time needed for
making the abortion decision and eventually the timing of the intervention. Kapadia,
Finer, and Klukas (2011) compared women applying for abortion either before or
after the ninth week of gestation (N¼20) and found that higher level of negative
interactions in relationship associated with later termination (adjusted OR ¼1.95; 95
percent CI [1.19, 3.20]), which also held true when controlling for sociodemo-
graphic variables (age, ethnicity, employment). Similar results were obtained by
Foster and colleagues (2008) who found in a larger sample of women undergoing
induced abortion (N¼398) that having an unsupportive partner was associated with
a delayed application for abortion. This finding is particularly important because
performing the abortion at a later gestational age exposes women to greater physical
risk due to the increased probability of infections, hemorrhage, and other complica-
tions, which in turn increase the probability of abortion-related mental health prob-
lems (Bartlett et al. 2004). It has to be noted, however, that all presented findings
were obtained in cross-sectional studies, which did not enable establishment of
causes and effects (e.g., it is possible that procrastinating over the abortion decision
results in an increased frequency of negative interactions in the intimate relationship
and not vice versa; Kapadia, Finer, and Klukas 2011).
Who Makes the Abortion Decision? The Male Partner’s Role
in Choosing Abortion
The way and extent of the male partner’s participation in making the decision on
whether or not to terminate a pregnancy may follow several patterns as follows
(Reich and Brindis 2006):
He is completely uninvolved in the decision-making process because he feels
excluded or does not even know about the pregnancy.
He is partly involved but leaves the final decision to his partner (possibly by
not giving voice to his own preferences).
Nagy and Rigo
´11

He makes a joint decision with his partner (usually after discussing the
options).
He makes the decision (e.g., because the woman is procrastinating over the
decision or because his individual interest is in abortion).
Costescu and Lamont (2013) collected questionnaire data on the decision-making
process from thirty couples applying for abortion. Half of the women had made a
decision already before sharing their intention with the partner (fifteen of thirty), and
half of these women (eight of thirty) overtly confronted the partner with their
decision. Nevertheless, twenty-nine women asked the partner for advice on the
decision including fourteen of those making an individual decision previously. All
respondents were asked to individually rate their own and the partner’s contribution
to the decision on a visual analogue scale ranging from 100 percent respondent’s
decision to 100 percent partner’s decision. Of the sixty respondents, forty-one (68.3
percent) reported to have made equal contributions (i.e., a joint decision) with the
partner, sixteen (26.7 percent) attributed greater importance to themselves (60 per-
cent or higher), and three (5 percent) to the partner (60 percent or higher) in the
decision-making process. Matching responses were given by 77 percent of the
couples. (As the authors note, one-third of the couples were married or engaged,
which might contribute to the high proportion of joint decisions.)
Vandamme and colleagues (2017) point out that any analysis of abortion deci-
sions should take account of interpersonal or dyadic processes beyond intrapersonal
factors. The cited study involved 106 Flemish couples applying for abortion and
focused on the relationship between their decision-making ability and subjective
feeling of autonomy (high internal and low external abortion motivation), on their
uncertainty about the decision, and on partners’ mutual influence on each other’s
uncertainty. The authors found that both women and their male partners were pri-
marily internally and less externally motivated, but women showed higher internal
motivation for abortion, which indicated that they generally had a stronger feeling of
autonomy than their male partners in terms of the abortion decision. Males and
females showed equally moderate uncertainty about the decision (both gender
groups scored twelve on a scale ranging from five to twenty-five), and partners’
uncertainty scores showed a positive relationship: the more uncertain a woman was
about the decision, the more uncertain her male partner was as well (r¼.42, p< .01),
which relationship was even more pronounced among couples living together (r¼
.49, p< .01). Similarly, partners’ internal and external abortion motivation were each
positively correlated (r¼.30, p< .01 and r¼.23, p< .05, respectively). Interest-
ingly, even male partners who experienced stronger external pressure for abortion
were primarily internally motivated (r¼.31, p< .001). Men’s certainty about their
decision was not related to either their own or their partner’s external/internal
motivation (women’s certainty positively correlated with their internal motivation:
r¼.24, p< .01). By contrast, men’s certainty was significantly influenced by their
general ability to achieve cognitive closure (r¼.46, p< .001).
12 Men and Masculinities XX(X)

Even more pronounced partner effects were found when partners’ current rela-
tionship status (whether or not they lived together) was taken into account. Among
those living separately, women’s higher external motivation (i.e., lower subjective
level of autonomy) was associated with both their own and their partner’s higher
uncertainty (r¼.59, p< .01 and r¼.34, p< .05, respectively). Among couples
living together, women’s uncertainty about their decision was positively associated
with their partner’s tendency to focus on external circumstances (r¼.24, p< .05),
while men were more certain about their decision when their female partner referred
to more personal and internal reasons (r¼.43, p< .01). Apparently, while women
need a subjective sense of autonomy (high internal motivation) to be certain about
their decision (r¼.27, p< .05), men’s certainty depends on their female partner’s
motivation for abortion rather than on their own (Vandamme et al. 2017).
Kimport, Foster, and Weitz (2011) also revealed the distress-reducing effect of
decision-making autonomy in semistructured interviews conducted with twenty-one
American women undergoing abortion. The authors pointed out that the abortion
decision more frequently led to negative outcomes (e.g., regret) in cases when the
concerned women felt they had little impact on the decision, even if they themselves
would also have chosen abortion in the absence of external influence.
Of course, participation in the abortion decision is inseparable from the question of
responsibility. The extent to which the male partner participates in making the deci-
sion on completing or terminating a pregnancy presumably depends, among others, on
how much responsibility he takes for conception (or for the failure of contraception): if
contraception is a responsibility shared by the partners, then unintended pregnancy
will presumably be a shared responsibility as well (Costescu and Lamont 2013),
although this hypothetical relationship is yet to be confirmed by further empirical
evidence. Findings of qualitative studies on the subject suggest that men’s understand-
ing of an unintended pregnancy varies widely from sharing responsibility (regarding
conception as a punishment for extramarital sex or as the price for sexual activity, etc.)
to emphasizing women’s exclusive responsibility (assuming that the female partner
was neglectful or irresponsible or that she got pregnant deliberately; Reich and Brindis
2006). It is not yet known, however, how such views influence men’s participation in
making the abortion decision. Moreover, researchers point out that taking responsi-
bility for an unintended pregnancy may equally be manifested in supporting abortion
(eitherbyarguingforthenecessityofabortionduringdecisionmakingorbymanaging
practical issues such as meeting abortion-related expenses, arranging a date for the
intervention, or seeing the partner to the surgery) and in supporting completion of the
pregnancy and taking parental responsibility for the child to be born (Kero and Lalos
2000; Reich and Brindis 2006).
Summary and Conclusions
Making a decision on induced abortion is a stressful life event challenging not only
the concerned women but presumably the concerned men as well. However, very
Nagy and Rigo
´13

little is known about what proportion of the male population is concerned, and how
intensely and for how long they experience distress related to the abortion. Although
the subject may not be considered novel in research (related studies were published
in the United States as early as in the second half of the 1970s; see Coyle 2007), only
few findings have been reported on the impact of the psychosocial aspects of
induced abortion on men, and even the available data raise methodological issues
in many cases. There are a number of variables that proved to be factors influencing
women’s decision on abortion and their postabortion adaptation, yet no study has so
far examined these effects in a male sample. These factors include demographic
variables such as age and the number of existing children, individual characteristics
such as one’s preferred coping strategies, for example, and cultural factors such as
religion, and so on (see, e.g., Rue et al. 2004; Fine-Davis 2007). The available
findings on preabortion mental health are similarly deficient, primarily due to the
cross-sectional design of the related studies. Further methodological issues are
raised by selecting and reaching an adequate control group, especially in longitu-
dinal studies.
Research on women concerned in abortion has already adopted a research para-
digm that separates the time frame from the last menstrual period to obtaining the
abortion into different stages (from the last menstrual period to suspecting preg-
nancy, from suspecting pregnancy to confirming the pregnancy, from confirming the
pregnancy to deciding to have an abortion, from deciding to have an abortion to first
attempting to obtain abortion services, and from first attempting to obtain abortion
services to obtaining the abortion) and supposes that the different stages require
different time intervals according to the individual and relational characteristics
(Finer et al. 2006). The direction of further research can be that different stages
pose different psychological challenges to both women and men; they face different
difficulties and need different information, and different protective and risk factors
influence their adaptation to, and facing the consequences of, the abortion decision.
This review of psychosocial aspects of induced abortion from a men’s perspective
underlines the importance of designating a separate research field for studying the
decision making process leading to induced abortion, the psychological impact of
abortion, and the methods efficiently supporting coping and grieving losses, rather
than treating the related issues as subjects of a special line of research on women.
Taking account of the characteristics, needs and expectations of men concerned in
abortion has vital importance in developing efficient interventions that ensure ade-
quate psychological support for couples considering the abortion decision. This
requires a vast amount of further studies conducted with samples of a statistically
adequate size and based on a reliable methodology.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
14 Men and Masculinities XX(X)

Funding
The author(s) received no financial support for the research, authorship, and/or
publication of this article.
Notes
1. Here and later on concerned man is the one implicated in the pregnancy (it is the father if
the pregnancy does not end up in abortion)
2. The studies were retrieved from the databases searched, and by means of the search
expressions used, by Coyle (2007; “men and abortion or elective abortion,” “fathers and
abortion,” “fatherhood and abortion,” “male sexuality and abortion,” “homosexuality and
abortion,” “relationships and abortion”).
3. The well-known relationship between financial status and contraception is discussed else-
where in detail (see, e.g., Molloy et al. 2015).
4. A special subpopulation in the research on male reactions is formed by minor male partners
(see, e.g., Hallde´n and Christensson 2010; Holmberg and Wahlberg 2000).
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Author Biographies
Bea
´ta Nagy is a PhD candidate at the Department of Personality and Health Psychology of
Eo¨ tvo¨ s Lora´nd University in Budapest, Hungary. She is a clinical psychologist and sociolo-
gist. Her main research area is reproductive psychology with a special focus on male health
psychology.
18 Men and Masculinities XX(X)

Adrien Rigo
´is an associate professor at the Department of Personality and Health Psychol-
ogy of Eo¨tvo¨s Lora´nd University in Budapest. Her main research topic is clinical health
psychology. In this field she is dominantly interested in reproductive psychology, the different
psychosocial correlates of chronic somatic disorders/symptoms and the effects of medical
treatments, and the association between morningness-eveningness and the vulnerability for
mental and somatic health.
Nagy and Rigo
´19