Pregnancy engagement and mementos in person-centered abortion care: A mixed methods analysis

Clinicians, researchers, and policy-makers have limited understanding of how people seeking induced abortion think and feel about opportunities to engage with their pregnancies, including mementos. We sought to characterize why people desire or decline specific mementos for induced abortion and relate these decisions to grief or decisional uncertainty.

We conducted a mixed methods study of people seeking induced abortion, using purposive sampling to enroll patients in the first and second trimesters, and with and without diagnosed fetal anomalies. Enrollment dates were from 8/2019 to 4/2020. We report on mementos and opportunities to engage with the pregnancy including: viewing the ultrasound exam, receiving ultrasound photos or fetal footprints, learning if multiple gestations are present, learning the presumed sex of the pregnancy, viewing the pregnancy tissue after the abortion, and arranging for private burial or cremation of the pregnancy tissue. We completed individual semi-structured interviews to explore each participant's memento choices and the reasons for those choices. We derived themes and subthemes from the transcripts using the constant comparative method. Participants completed validated surveys to measure feelings of grief and loss relating to their pregnancy, and their decisional certainty about their abortion.

Memento choices and the reasons for those choices varied widely among the 39 participants who completed interviews. Choices were not predictable by gestational duration, level of grief, decisional certainty, or the presence of fetal anomalies. Reasons participants desired mementos included closure and to cope with loss, curiosity or disbelief about their pregnancy, and to maintain a memory. Others declined mementos because they did not want the reminder of the experience, they would raise difficult emotions, or they disagreed with the suggestion of the fetus's humanity.

Pregnant people seeking abortion make individualized, unpredictable choices regarding pregnancy mementos, but generally appreciate the offer. Best practice for holistic abortion care should include offering pregnancy mementos in a person-centered way that avoids assumptions.

We found that patients seeking induced abortion defy preconceived notions of who may want pregnancy mementos like ultrasound printouts or fetal footprints, and accept or decline those mementos for varied and nuanced reasons. These results suggest that pregnancy mementos should be universally offered, where feasible, but not mandated.