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Abortion service in Amsterdam: deciding and coping in a liberal system
1Department of Obstetrics and Gynecology, University of Amsterdam, The Netherlands.
Objectives:
The Netherlands have liberal abortion laws and contraceptives are easily available. In the AMC, a service protocol is designed to facilitate decision-making. In this context, the following questions arise: Do our abortion clients know what went wrong with their contraceptive behavior? Did they decide for more effective contraception afterwards? How did they feel about their own decision and about our services, which include obligatory counselling?
Study Design:
A questionnaire was sent to 23 consecutive clients, who were willing to cooperate. The questionnaire consisted of a scale with 26 items and two open-ended essay-questions.
Results:
The response rate was 45% (11 complete questionnaires). Seven women had used contraceptives, six knew what had gone wrong, five had decided to improve their contraception, four women had not used contraceptives, out of which two decided to start, seven women found the abortion decision difficult, seven women (not the same) were content with their decision, and one of them felt bereaved. The four who were not, on the whole, content with their decision felt bereaved. Eight appreciated our services, ten had used the essay-questions to tell their own story. One woman explicitly regretted her decision and would have liked more intensive counselling.
Conclusions:
Our system does not yet function as it should. The reasons may be psychological (unexplored ambivalence), sociocultural (difficulties in using effective contraception) and cognitive (some women were very young and not adequately informed). On a methodological level, we conclude that open-ended questions on these subjects generate more accurate and subtle information.