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“I didn’t doubt my choice, but I felt bad”: A qualitative exploration of Canadian abortion patients’ experiences with protesters
Abstract
Objectives
Although a body of research has focused on violence, disruption, and harassment targeting abortion clinics and clinic staff, little research has explored Canadian abortion patients’ experiences with protesters. Through this national qualitative study we aimed to address this gap.
Methods
Between 2012 and 2016, we conducted in-depth interviews with 305 Canadian women who had an abortion in the previous five years. Thirty participants reported encountering protesters when seeking abortion care. We focused on this sub-set of interviews and analyzed these data for content and themes using inductive and deductive techniques.
Results
Across the country, participants reported encountering protesters holding signs, chanting slogans, and shouting insults. These interactions were concentrated at clinics in New Brunswick, Newfoundland and Labrador, and Ontario. Although no participants reported that these encounters made them reconsider their decision, they did report that seeing and interacting with protesters was at times unsettling, stigmatizing, and frustrating. Participants who struggled with the decision to have an abortion and those who made the decision in the context of health issues or violence found these encounters especially upsetting. Participants discussed how their interactions with protesters and the additional security measures put in place by clinics contrasted with their experiences accessing other kinds of health care and they wished that the protesters had not been there.
Conclusions
For some Canadian abortion patients, encountering protesters is upsetting and stigmatizing. Exploring ways to minimize interactions between protesters and those seeking abortion care, such as enacting and enforcing safe access zone legislation, appears warranted.
Implications
Although several Canadian provinces have enacted safe access zone laws, these do not currently exist across all jurisdictions. In addition to protecting clinics and clinic staff, implementation of these buffer zones have the potential to improve some patients’ experiences obtaining a medically necessary and essential service.
... Some recent research has reported that religiously motivated harassment is ineffective in preventing abortions (Fiala et al, 2020;Foster et al, 2020). While the evidence that protests deter people seeking abortions is weak (Fiala et al, 2020), activity may continue with other motivations -'witnessing' encouraged by church leaders (Swank, 2020), causing emotional distress and targeting health professionals to try to persuade them not to participate. ...
Reproductive justice is essential in the struggle to remove health inequalities. Currently escalating threats to reproductive rights are rarely discussed in contemporary social work literature. Discomfort in the profession about addressing challenges to abortion rights exposes a lack of courage to treat abortion as essential healthcare. A case study of several abortion focused articles and chapters reveals a strand of ambivalence about taking a progressive stance on abortion. Recent trends demonstrate that reproductive rights cannot be taken for granted. Even when law reform removes some of the barriers to safe legal abortion, abortion stigma and anti-choice harassment remain potent threats to reproductive autonomy. A case is made for reproductive justice to be central in our drive for health equality. This requires a feminist perspective, moving away from seeing women as merely the object of the social work gaze, too often the focus of scrutiny and judgment.
... Study participants reflected on their experiences with protestors at their visits. Although anti-abortion protestor activity is more common in the South, there has been limited study of patients' experiences in this context, particularly one in which protestors may feel emboldened by state policy makers' explicit efforts to curtail abortion access (Fitch et al., 2021;Pettus, 2019). This study also adds to the literature about the potential benefit of more extensive patient protection measures on people seeking abortion care. ...
IntroductionIn October 2019, the Jackson, Mississippi city council passed a buffer, bubble, and quiet zone ordinance to discourage protestor activity outside the state’s only licensed abortion facility. We sought to learn about patients’ encounters with protestors and how the ordinance would have affected their experiences obtaining care.Methods
Before the passage of the ordinance, patients seeking care at the Mississippi facility enrolled in a prospective study on access to abortion and contraception. We invited participants completing the six-month follow-up survey between November 2019 and January 2020 to participate in an in-depth interview over the phone about their experiences with protestors at their visits. We analyzed interview transcripts for content and themes using inductive and deductive approaches.ResultsOf 30 participants interviewed, the majority expected to see protesters at their visits but were surprised at the number present and how close they were able to get to patients, which made some feel unsafe. Participants also reported that protestors’ offers of adoption and financial support were unwanted and that they were able to withstand comments that promoted shame and stigma because of their strong sense of reproductive autonomy. Participants credited clinic escorts and security with helping mitigate negative protestor encounters. Nearly all felt the city ordinance would have improved their experience by making them feel safer and more at ease.Conclusions
Protestors created negative experiences for the majority of study participants, even though the facility adopted strategies to ameliorate protestors’ impacts.Policy ImplicationsAdditional protections are needed to ensure people can obtain abortion care with respect.
Background
Disrespect and abuse during facility-based abortion and postabortion care (PAC) manifests in various forms, including disrespect, abuse (physical, verbal, and sexual), stigma, discrimination, failure to meet standards of care, neglect, breaches in privacy and confidentiality, misinformation or a lack of information, mistreatment or undignified care, and protests. The objective of this mixed methods systematic review was to describe the various forms of disrespect and abuse that women face during abortion or PAC.
Methods
We conducted a comprehensive literature search in Embase, Medline, and PubMed using Medical Subject Headings (MeSH) and text-based terms targeting disrespect and abuse in facility-based abortion care. The initial search was conducted in 2019, followed by an updated search in 2023. Thirty-eight articles conducted in 20 countries met inclusion criteria and were included in this review.
Results
The most frequently observed form of disrespect and abuse, identified in 31 studies, was the failure to meet care standards in providing quality abortion care or PAC, particularly in terms of offering adequate and accurate information to women before, during and after the procedures. Additionally, stigma was reported in 20 studies, disrespect in 19 studies, discrimination in 10 studies, and both verbal and physical abuse, as well as humiliation and condescension, each in 8 studies. The presence of abortion protestors was also noted in 8 studies.
Conclusions
Our results indicate the need for multi-level strategies to transform healthcare providers' perceptions and attitudes towards women seeking abortion care, and other actions at the individual, institutional, and policy levels to provide quality, respectful abortion care. We found that providers sometimes highlighted caste or other markers of vulnerability as part of disrespectful care. The systematic measurement of disrespect and abuse in abortion care and PAC could help understand the distribution of experiences across different groups.
New Brunswick has been an outlier concerning abortion access for decades. In 2015, the Liberal government under Premier Brian Gallant made significant legislative changes to regulation 84–20 to make abortions more easily accessible in the province. Despite these changes, the Liberal government fell short of publicly funding community-based abortions outside hospitals. This qualitative study aimed to examine the political dynamic and pressures explaining why New Brunswick remains behind on abortion access compared to other Canadian provinces. From September until November 2020, we conducted semi-structured in-depth interviews with 22 participants. Participants were a mix of past and present politicians, health care leaders, and high-ranking public officials identified as key stakeholders in the abortion debate in New Brunswick. Some participants shared their challenges separating their personal views on abortions and admitted wanting to limit access to make it difficult for people to get an abortion. At the same time, other participants described concern for the most vulnerable segments of the New Brunswick population who may struggle with accessing abortions, leading to undue stress and anxiety levels. Ultimately, this article describes the challenges politicians face with power dynamics within their parties and the balance between managing political risks to maintain popularity within the New Brunswick electorate without infringing on people’s right to medical care.
Objective:
To analyze the association between number of anti-abortion protesters and patients' and their companions' experiences accessing abortion clinics in North Carolina.
Study design:
In this concurrent mixed-methods study conducted in 2018-2019 at two independent abortion clinics in NC, the author triangulated the methods of participant observation, descriptive statistical analysis of survey data, and thematic content analysis of open-ended responses to compare experiences of respondents who observed larger (>10) versus smaller (1-10) numbers of protesters at their clinic visit. The analytic sample contained experiences of patients and companions who saw protesters during the study period.
Results:
Of 1530 people approached for the survey, 886 (58%) completed the questionnaire. Overall, 655 respondents were included in the analysis. Most respondents (n=546, 83%) saw 1-10 protesters, versus those who saw >10 protesters (n=109, 17%). Respondents who saw 1-10 protesters had their cars stopped at higher rates (53%) than those who saw >10 protesters (40%) but reported being physically approached at similar rates (22% v. 23%). Respondents who saw >10 protesters indicated that it was more dangerous to drive into the clinic (44% v. 23%) and more difficult to access the clinic (65% v. 39%), when compared with people who saw 1-10 protesters. Respondents who saw >10 protesters also reported that they thought about leaving more frequently (21% v. 12%), that the protesters made them feel unsafe (44% v. 23%), made their visit more stressful (71% v. 59%), and protesters negatively impacted their clinic experience at higher rates (47% v. 31%).
Conclusion:
Respondents experienced logistical barriers to clinic access regardless of the number of protesters, though these worsened with larger numbers of protesters. Respondents perceived larger numbers of protesters as more intimidating and felt less safe navigating into the clinic. While all respondents made it to their appointments, these perceptions about larger numbers shows how clinic protesting is an intimidating force that interferes with clinic access.
Implications:
Showing the ways that the number of protesters relates to logistical and emotional barriers can help clinics in planning mitigation measures to address issues of clinic access for their patients and their companions.
Objective:
To explore violence and disruption events reported by Canadian facilities providing abortion care in 2017, when only three provinces had passed safe access zone legislation.
Methods:
We reviewed self-reported data from 16 of 38 Canadian members of the National Abortion Federation.
Results:
Twelve facilities in seven provinces reported 571 instances of picketing (97%), trespassing (>1%), threats of harm (>2%), and harassing calls/mail/emails (2%); four facilities reported no incidents. Freestanding clinics reported more picketing than hospital-based facilities.
Discussion:
Abortion providing facilities in Canada experienced picketing and other kinds of violence and disruption in 2017. These data serve as a baseline for future studies.
In 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction (n = 20) and after mifepristone–misoprostol became available (n = 20) to explore their experiences obtaining care. We audio-recorded and transcribed all interviews and analyzed these data for content and themes using deductive and inductive techniques. Prior to the introduction of mifepristone, our participants reported obtaining abortion care at two facilities and many faced long wait times. Those who had an abortion after mifepristone became available reported obtaining care from a wider array of providers and few waited more than two weeks. However, several mifepristone–misoprostol users reported having to go through a process that involved as many as 10 health service encounters. Both groups reflected positively on their abortion experiences, but some patients who obtained mifepristone–misoprostol outside of an abortion clinic did not feel as well informed as they would have liked. The introduction of mifepristone appears to have expanded the number of service delivery points and reduced wait times for those seeking abortion care in Ottawa. Identifying ways to expand access to medication abortion information and streamline services appears warranted.
Background: Abortion has been available without criminal restriction in Canada since 1988, and approximately 33 000 terminations take place in Ontario each year.
Objectives: This study aimed to explore women’s expressed desire for post-abortion support services, document the priorities expressed by women in seeking post-abortion support, and identify actionable strategies to improve post-abortion support services in Ontario.
Methods: Between 2012 and 2014 we conducted in-depth, open-ended interviews with 60 Anglophone women from across Ontario who had recently had an abortion. We aimed to rigorously explore the compounding issues of age and geography on women’s abortion experiences. We analyzed our data for content and themes and reported on the findings related to post-abortion support.
Results: One third of our participants expressed a desire for post-abortion support, yet few were able to access a timely, affordable, non-directive service. Women were uncertain about how to find services; most contacted a provider recommended by the clinic or searched online. Women were enthusiastic about a talkline format citing anonymity and convenience as the main advantages.
Conclusion: Our results suggest that exploring ways to expand post-abortion support services in Ontario is warranted. A talkline format could provide an anonymous, convenient, non-judgmental, and non-directive way to address this unmet need.
Objective To determine the location of Canadian abortion services relative to where reproductive-age women reside, and the characteristics of abortion facilities and providers.
Design An international survey was adapted for Canadian relevance. Public sources and professional networks were used to identify facilities. The bilingual survey was distributed by mail and e-mail from July to November 2013.
Setting Canada.
Participants A total of 94 abortion facilities were identified.
Main outcome measures The number and location of services were compared with the distribution of reproductive-age women by location of residence.
Results We identified 94 Canadian facilities providing abortion in 2012, with 48.9% in Quebec. The response rate was 83.0% (78 of 94). Facilities in every jurisdiction with services responded. In Quebec and British Columbia abortion services are nearly equally present in large urban centres and rural locations throughout the provinces; in other Canadian provinces services are chiefly located in large urban areas. No abortion services were identified in Prince Edward Island. Respondents reported provision of 75 650 abortions in 2012 (including 4.0% by medical abortion). Canadian facilities reported minimal or no harassment, in stark contrast to American facilities that responded to the same survey.
Conclusion Access to abortion services varies by region across Canada. Services are not equitably distributed in relation to the regions where reproductive-age women reside. British Columbia and Quebec have demonstrated effective strategies to address disparities. Health policy and service improvements have the potential to address current abortion access inequity in Canada. These measures include improved access to mifepristone for medical abortion; provincial policies to support abortion services; routine abortion training within family medicine residency programs; and increasing the scope of practice for nurses and midwives to include abortion provision.
This paper explores memoing in the context of qualitative research methodologies. The functions of memos in the research process are discussed and a number of techniques for employing memo writing to enhance the research experience and outcomes are examined. Memoing is often discussed in the literature as a technique employed in grounded theory research, yet there is limited exploration of the value of memo writing in qualitative methodologies generally. Memoing serves to assist the researcher in making conceptual leaps from raw data to those abstractions that explain research phenomena in the context in which it is examined. Memos can be effectively employed by both the novice and experienced researcher as a procedural and analytical strategy throughout the research process. Data exploration is enhanced, continuity of conception and contemplation is enabled and communication is facilitated through the use of memoing. While guidelines exist to aid in the production and use of memos, memoing remains a flexible strategy wherein the process of construction and nature of content is determined by the preferences and abilities of the researcher and the aims and focus of the specific research study.
Objective
We analyzed trends in medication abortion provision before and after the 2017 introduction of mifepristone in Canada.
Methods
We reviewed 2016-2018 abortion services data from Canadian members of the National Abortion Federation (NAF) to determine the overall proportion of medication abortions in each calendar year as well as temporal and geographic trends in provision.
Results
In 2016, NAF’s Canadian members reported on 33,857 abortions of which 2,844 (8.4%) were with medications and used a methotrexate/misoprostol regimen. In 2018, 8,534 (25.6%) of the 33,320 reported abortions were with mifepristone/misoprostol.
Discussion
Mifepristone/misoprostol has been rapidly incorporated into abortion services in Canada.
Background:
Roughly one-third of all abortions in Canada are subsequent abortions. However, few published reports showcase women's voices or explore women's experiences on this topic. Our study aimed to understand better the ways that women who have had multiple abortions talk about and view those experiences.
Methods:
Between 2012 and 2016, we conducted in-depth interviews with 41 Canadian women who had a total of 87 abortions in the 5 years preceding the interviews. We audio-recorded and transcribed all English- and French-language interviews and analyzed our data for content and themes using a multiphased iterative approach and inductive and deductive techniques.
Results:
Women described their abortion experiences as unique life events, even in cases when the overarching circumstances surrounding the pregnancies were similar. Participants recalled multiple factors that influenced their decisions to terminate, including their relationship status; level of support from family and friends; financial situation; health status; previous reproductive health, pregnancy, and abortion experiences; and desire to parent. In general, a previous abortion demystified the abortion process but did not play a significant role in decision making. Women described intensified feelings of shame and both internalized and externalized stigma surrounding their decision to have more than one abortion. However, the overwhelming majority were confident in their decisions.
Conclusions:
The often-used phase "repeat abortion" fails to capture women's experiences and the complex decision making surrounding each pregnancy. Efforts to reframe the narrative of multiple abortions, including among health care providers, could help reduce the amplified stigma associated with having more than one lifetime abortion.
When journalists, academics, and politicians describe the North American anti-abortion movement, they often describe a campaign that is male-dominated, aggressive, and even violent in its tactics, religious in motivation, anti-women in tone, and fetal-centric in arguments and rhetoric. Are they correct? In The Changing Voice of the Anti-Abortion Movement, Paul Saurette and Kelly Gordon suggest that the reality is far more complicated, particularly in Canada. Today, anti-abortion activism increasingly presents itself as “pro-women”: using female spokespersons, adopting medical and scientific language to claim that abortion harms women, and employing a wide range of more subtle framing and narrative rhetorical tactics that use traditionally progressive themes to present the anti-abortion position as more feminist than pro-choice feminism. Following a succinct but comprehensive overview of the two-hundred year history of North American debate and legislation on abortion, Saurette and Gordon present the results of their systematic, five-year quantitative and qualitative discourse analysis, supplemented by extensive first-person observations, and outline the implications that flow from these findings. Their discoveries are a challenge to our current assumptions about the abortion debate today, and their conclusions will be compelling for both scholars and activists alike.
Background:
Abortion has been legal without restriction in Canada since 1988 and is recognized as a medically necessary service. However, research indicates that women still face numerous barriers to accessing care, challenges that are amplified for women living in rural, remote and northern regions in Canada.
Objectives:
This qualitative study aimed to document women's experiences seeking and obtaining abortion services while residing in Yukon Territory, identify financial and personal costs and explore avenues through which services could be improved.
Methods:
We conducted 16 in-depth semi-structured phone interviews with women who accessed abortion services on/after January 1, 2005, while residing in the Yukon. We employed an iterative multiphase analytic approach centering on content and themes, using both inductive and deductive techniques.
Results:
With the Yukon's sole facility offering first trimester abortions twice a month, women experienced difficulty navigating a fragmented process and long wait times. Women found the process of attending multiple pre-procedure appointments at multiple locations with multiple health care providers, all while enduring pregnancy symptoms and handling other life commitments, physically, financially and emotionally taxing.
Conclusion:
Efforts to streamline the process of obtaining an abortion and providing women with more information at the first point of contact would improve service access and quality. Mifepristone has the potential to improve access for rural and remote populations, reduce wait times and alleviate privacy concerns, but only if the medication abortion regimen is affordable and available at a range of service delivery points and provision requirements are aligned with the global evidence.
Implications:
By documenting women's experiences, the identified barriers and outlined suggestions for improvement offer realistic avenues through which current abortion services in Yukon Territory can be modified in order to increase access. This study highlights future reproductive health care initiatives that warrant prioritization in Canada's North.
Introduction:
Although Canada decriminalized abortion in 1988, significant disparities in access to services and an uneven geographic distribution of providers persists. Health Canada registered mifepristone, the gold standard of medication abortion, in July 2015. Our study explored Canadian women's knowledge of, interest in, and perspectives on mifepristone prior to registration.
Methods:
From November 2012 through July 2015 we conducted in-depth interviews with 174 Anglophone and Francophone women from Alberta, Manitoba, New Brunswick, Ontario, and Quebec about their abortion experiences and their opinions about medication abortion. We purposively recruited participants from different age cohorts and different regions within each study province to explore a range of perspectives. We analyzed these interviews for content and themes related to mifepristone using both deductive and inductive analytic techniques.
Results:
The overwhelming majority of participants had no knowledge of mifepristone at the time of the interview. However, after providing a brief description of an evidence-based mifepristone/misoprostol regimen, more than half of the participants reported that they would have considered this method had it been available at the time of their abortion and most would have been comfortable receiving medication abortion care from a family physician or nurse practitioner. Most women supported the approval of mifepristone and felt Canadian women would benefit from having more options for early pregnancy termination.
Conclusion:
Although knowledge of mifepristone among recent abortion patients was low, considerable interest in medication abortion exists. Expanding awareness-raising efforts and supporting the approval of evidence-based regimens and provision of appears warranted.
Implications:
The approval and introduction of mifepristone for early abortion in Canada promises to increase options and access. Creating tailored and culturally and contextually resonant messages about mifepristone is of high priority. Promoting evidence-based protocols and the inclusion of a full range of qualified professionals in service provision is also warranted.
This article analyzes the nature of contemporary anti-abortion discourse in Canada. Based on a rigorous qualitative and quantitative analysis of the public discourse of a wide variety of influential actors, this study shows that contemporary anti-abortion discourse in Canada is quite different than the portrait offered by traditional accounts. Specifically, our analysis demonstrates that the new anti-abortion discourse aims at changing cultural values more than legislation; is explicitly framed as 'pro-woman'; largely avoids appealing to religious grounds; and relies on a new 'abortion-harms- women' argument that has supplanted and transformed traditional fetal personhood arguments. The article argues that these findings are important as they provide a more accurate account of the political discourse surrounding one of the most contentious issues in politics today and because they illustrate broader ideological patterns that are increasingly characteristic of Canadian political discourse.
This study examines responses to antiabortion picketing among women who encountered picketers as they entered 1 of 3 abortion clinics to have an abortion. The goals of this study are to describe women's experiences with, emotional reactions to, and attitudes toward antiabortion picketers; examine predictors of women's emotional responses to picketers; and examine the relations among exposure to picketers and emotional responses to picketers and postabortion mental health. Results indicated that most women encountered antiabortion picketers on clinic entry and experienced negative emotions in response. Women were more likely to feel angry than guilty in response to seeing picketers. Reports of positive emotions were rare. Women whose entry was blocked by picketers were more likely to experience both anger and guilt in response to picketers. Women who were personally conflicted about abortion were more likely to experience guilt, but not anger, in response to picketers. Feeling guilty in response to seeing picketers and being high in personal conflict about abortion were significant predictors of depression immediately postabortion. Feeling angry in response to picketers was unrelated to postabortion mental health. In general, women seemed to find encounters with picketers unpleasant and to be negatively affected by them in the short term but not to suffer serious, long-term, negative psychological effects as a result of these encounters.
Background:
Little is known about women's experiences with and reactions to protesters and how protesters affect women's emotional responses to abortion.
Study design:
We interviewed 956 women seeking abortion between 2008 and 2010 at 30 U.S. abortion care facilities and informants from 27 of these facilities.
Results:
Most facilities reported a regular protester presence; one third identified protesters as aggressive towards patients. Nearly half (46%) of women interviewed saw protesters; of those, 25% reported being "a little" upset, and 16% reported being "quite a lot" or "extremely" upset. Women who had difficulty deciding to abort had higher odds of reporting being upset by protesters. In multivariable models, exposure to protesters was not associated with differences in emotions 1 week after the abortion.
Conclusion:
Protesters do upset some women seeking abortion services. However, exposure to protesters does not seem to have an effect on women's emotions about the abortion 1 week later.
Canadian women currently entering menopause are the first generation with access to legal induced abortion throughout their reproductive years.
Statistics Canada data from 1974 to 2005 on age-specific abortion and first-abortion rates were analyzed to determine the proportion of the cohort hypothetically and actually undergoing at least one induced abortion, as well as the age-specific trends.
Among Canadian women who turned 45 years old in 2005, 31% had at least one abortion, with a median age at first abortion of 24 years. Since 1997, age-specific induced abortion rates overall and among teenagers have declined significantly, while rates among older women show less decline as age increases. Annually from 1974 to 2005, women aged 20-29 years account for 52% (SD 1.8%) of all abortions in Canada.
Induced abortion is a common procedure experienced by nearly a third of Canadian women during their reproductive years. Consistently, half of all women accessing abortion are in their twenties. These findings suggest that Canadian women, particularly those in their twenties, experience a significant unmet need for effective contraception.
This article defends the public funding of abortion in the Canadian health care system in light of objections by opponents of abortion that the procedure should be denied public funding. Abortion opponents point out that women terminate their pregnancies most often for social reasons, that the Canadian health care system only requires funding for medically necessary procedures, and that abortion for social reasons is not medically necessary care. I offer two lines of response. First, I briefly present an argument that characterizes abortion sought for social reasons as medically necessary care, directly contesting the anti-abortion position. Second, and more substantially, I present a justice argument that shows that even if abortion is not regarded as medically necessary care, the reasons that typically motivate women to seek abortion are sufficiently weighty from the moral perspective that it would be unjust to deny them public funding. I finish by drawing the more general conclusion that health care funding decisions should be guided by a broader concept of necessary care, rather than by a narrow concept of specifically medical necessity. A broad concept of necessary care has been debated in health care policy in the Netherlands, and I suggest that such a concept would be a more just and defensible guide for funding decisions than the concept of medical necessity.
The November shooting of a Vancouver physician has caused increased fear among doctors who perform abortions in British Columbia. There is also concern within the Society of Obstetricians and Gynaecologists that the recent violence and ongoing harassment will drive doctors from the abortion field. Some anti-abortion advocates support violence against those who perform abortions but spokespersons for the movement say they represent "fringe" views. One BC anti-abortion coalition now requires people to sign a pledge of nonviolence before participating in its conferences or other events.
Although Canadian women have had the right to obtain legal induced abortions for the past decade, access to the procedure is still limited and controversial in many areas.
Chiefs of obstetrics and gynecology, chiefs of staff, directors of nursing and other health professionals at 163 general hospitals in Ontario, Canada, were asked to provide information on issues concerning the availability of abortion services of their facility. The hospital participation rate was 97% and the individual response rate was 75%.
Nearly one-half (48%) of hospitals perform abortions. Approximately 36% of these hospitals do so up to a maximum gestational age of 12 weeks, 23% to a maximum of 13-16 weeks, 37% to a maximum of 17-20 weeks and 4% at greater than 20 weeks. Hospital factors, including resources and policies, did not significantly influence whether abortions are provided. However, these factors did affect the number performed, whether there were gestational limitations and the choice of procedure. About 13% of provider hospitals indicated that staff training contributes to the existence of gestational age limits, and 24% said that it directly influences procedure choice. Only 18% of hospitals reported that their physicians have received additional training outside of their medical school or medical residency education to learn abortion techniques or to gain new skills. Forty-five percent of hospitals that provide abortions had experienced harassment within the past two years, and 15% reported that this harassment has directly affected their staff members' willingness to provide abortions.
Based upon the provision of obstetric care, many hospitals in Ontario that are capable of offering abortion services do not. Some of the reasons for this failure are related to the procedure itself, while others may be related to resource issues that affect the delivery of other medical services as well. Variation in the availability of abortions is due to a shortage of clinicians performing the procedure, and training directly influences gestational limits and procedural choices.
A Vancouver gynaecologist, Dr Garson Romalis, who performs abortions and who was shot six years ago as he ate breakfast in his home (BMJ 1994;309:1322), has been stabbed by a young man in the lobby of his office at a medical clinic.
Since this latest attack, Dr Ellen Wiebe, another Vancouver gynaecologist who had during the previous week announced she had begun clinical trials with the abortion pill mifepristone (RU-486), has received what police called “a threatening message through her answering service.”
Dr Romalis, who was put under armed guard while in hospital after the attack, is reported to be doing well. Dr Wiebe said that the stabbing would not deter her.
Vancouver police urged all abortion providers to be on high alert, and British Columbia's premier, Ujjal Dosanjh, called for tougher penalties for those attacking doctors doing their jobs. The federal justice minister said that she was willing to look at tougher sanctions but that the Criminal Code already dealt with such actions.
Police are trying to determine whether the latest attack on Dr Romalis and the threat against Dr Wiebe are linked to the previous shooting of Dr Romalis and perhaps several other similar incidents. The weapon was different and the attack occurred in summer, whereas the other incidents happened during the autumn.
A warrant was issued earlier this year for American antiabortionist James Kopp, who is a suspect in the shooting of Dr Romalis in 1994 and of two other abortion providers in Canada. Mr Kopp, believed to be in hiding in Mexico, has also been indicted for the 1998 murder of Dr Barnett Slepian of Amherst, New York.
:Several people who were in the Seymour Medical Clinic, where Dr Romalis has his office, said that the assailant, a white man in his 20s or 30s dressed in a hooded dark grey or black tracksuit, waited for some time for Dr Romalis to appear. He watched as the doctor left his car with a valet for parking, then returned outside for his forgotten briefcase, and when Dr Romalis re-entered he stabbed him in the left rib cage from behind and escaped.
This paper is a description of inductive and deductive content analysis.
Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method.
When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge.
Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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