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.

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 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 addressing 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 decision, 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 literature. 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 (Daugirdaitė, 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 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 Frohwirth 2011). There are two studies conducted with male respondents, one of which analyzed the intrapsychic and relationship-related factors underlying induced abortion (Naziri 2007). The other one is a Finnish cohort study conducted with pregnant women’s partners (N = 540), which found no significant differences in psychological 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 their options with their male partner before deciding (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 conditions 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 abortion 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 applicable in such cases (Makenzius 2012; Kero and Lalos 2004).

Number of scientific studies about the male partner’s role is very limited, and they are 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 and/or reinforce the view that unintended pregnancies are women’s exclusive concern 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 stigmatization of abortion (Papworth 2011).

Moreover, scientific studies in men and induced abortion have to face methodological 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 intervention 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 subpopulation 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 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 optimization 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 literature and the available research findings on the male perspective on induced abortion. 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 generalized because of either special sociocultural features or legal policies (e.g., the assistance 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 prevalence 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 relationship 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 (Kågesten 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 (Kågesten 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 (N = 250).³

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 (Kågesten et al. 2015), while an international 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 (N = 217) reported to have terminated their pregnancy against their partner’s wishes (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; N = 664), 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] = 2.3; 95 percent confidence interval [CI 1.5, 3.5]), nonreligious (IRR = 2.1; 95 percent CI [1.3, 3.5]), or born to a mother were more educated (IRR for college or more compared with no diploma = 2.8; 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 (Kågesten 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 problems 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; N = 954), 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.

− 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] = 1.55; 95 percent CI [1.12, 2.15]), among single women (showing the largest difference to those having got pregnant by their husband/fiancé: OR = 0.24; 95 percent CI [0.14, 0.40]), among those victimized in a physically abusive relationship (OR = 3.53; 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 = 0.61; 95 percent CI [0.41, 0.90]; Chibber et al. 2014).

Men may exert pressure on their female partners 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 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, sadness, or guilt after an abortion, especially when the decision raised ambivalent feelings in them. A typical male reaction is engaging in impulsive risk-taking behavior 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 (N = 89), 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 abandonment, 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 themselves 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 overwhelming 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 responsibility 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 abortion. One year after the intervention, no one reported mental problems nor did anyone regret 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 (N = 113) and three weeks after (N = 69), 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 significantly 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 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 significantly 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 highest 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 relationship (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 study that directly compared 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 (r = −.22, p < .05, N = 62; Moseley et al. 1981). A subsequent study established a positive relationship between support from the partner and women’s postabortion health (r = .411, p < .001, N = 143) and a negative relationship between the received support and the likelihood of engaging in self-harming behavior (r = −.323, p < .001; Gentile 2014). The negative relationship 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 perceived 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 (N = 20) and found that higher level of negative interactions in relationship associated with later termination (adjusted OR = 1.95; 95 percent CI [1.19, 3.20]), which also held true when controlling for sociodemographic variables (age, ethnicity, employment). Similar results were obtained by Foster and colleagues (2008), who found in a larger sample of women undergoing induced abortion (N = 398) 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 complications, which in turn increase the probability of abortion-related mental health problems (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).

− 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 already decided before sharing their intention with the partner (fifteen of thirty), and half of these women (eight of thirty) overtly confronted their 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 percent 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 decisions 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 primarily 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 (r = .42, p < .01), which relationship was even more pronounced among couples living together (r = .49, p < .01). Similarly, partners’ internal and external abortion motivation were each positively correlated (r = .30, p < .01 and r = .23, p < .05, respectively). Interestingly, even male partners who experienced stronger external pressure for abortion were primarily internally motivated (r = .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: r = .24, p < .01). By contrast, men’s certainty was significantly influenced by their general ability to achieve cognitive closure (r = .46, p < .001).

Even more pronounced partner effects were found when partners’ current relationship status (whether or not they lived together) was considered. 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 (r = .59, p < .01 and r = .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 (r = .24, p < .05), while men were more certain about their decision when their female partner referred to more personal and internal reasons (r = −.43, p < .01). Apparently, while women need a subjective sense of autonomy (high internal motivation) to be certain about their decision (r = −.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 decision 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. Studies on the subject suggest that men’s understanding 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 responsibility for an unintended pregnancy may equally be manifested in supporting abortion (either by arguing for the necessity of abortion during decision making or by managing 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

Deciding on induced abortion is a stressful life event challenging not only the concerned women but presumably the concerned men as well. However, very 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 longitudinal studies.

Research on women concerned in abortion has already adopted a research paradigm that separates the time frame from the last menstrual period to obtaining the abortion into different stages (from the last menstrual period to suspecting pregnancy, 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 adequate psychological support for couples considering the abortion decision. This requires vastly more studies conducted with samples of a statistically adequate size and based on a reliable methodology.

Footnotes

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.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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