( OS prefers reducing animation! )

Sharing abortion experiences online: how my research is being shaped by the global pandemic

I know that I am not the only researcher whose project has been impacted by the recent COVID-19 pandemic. But, in an unexpected twist, my research might become ultimately more relevant in the long run. You see, I am a PhD student looking into how women talk about their abortion experiences, and interact with the experiences of others, in online spaces. One in three women will have an abortion in their lifetime, making it the most common gynaecological procedure worldwide. And yet, many women choose not to talk publicly about their abortion experiences because it remains a stigmatised procedure, criminalised in many countries, and highly regulated in others. Whilst choosing to remain silent about their abortion may protect them from the stigmatising reactions of others, this also prevents women from accessing social support, and further perpetuates the silence and stigma around abortion more generally.

Why research online abortion disclosures?

My Masters research (conducted in 2018) looked at who women chose to talk to about their abortion with friends, family, and conception partners. But several women described sharing their abortion experiences online. For some, they looked online because they didn’t know of anyone in their life who had previously had an abortion, and were looking for some direct experience to comfort them. For others, posting about aspects of their experience was their way of fighting abortion stigma and normalising the procedure. However, little research to date has focused on how women use the Internet to share their abortion experience, despite the existence of many designated online spaces in which to do so (shoutyourabortion.com, womenonweb.org, etc).

We know that individuals with other healthcare needs and conditions have utilised online chat rooms, support groups, and message boards, and benefit from disclosing their experiences through computer-mediated communication. Online, people can connect with others without geographical boundaries, when it is convenient for them, and from the comfort of their own home. The anonymity provided by Internet communication has been demonstrated to encourage those living with stigmatised conditions, such as HIV to speak with others in a similar situation. The support provided in such contexts is sometimes perceived to be more valuable than that provided by those without that shared experience. These online spaces may foster empowerment by offering experiential knowledge of, for example, what a medical procedure will be like, knowledge that is often not provided by healthcare professionals.

Abortion online and COVID-19

My study explores how and why women use these online spaces in the context of their abortion experience, in the hopes that with this knowledge, I can contribute to better support for women and reducing abortion stigma. But with current government guidelines about social distancing and the importance of staying at home, these online resources might become even more vital for women in the UK (and globally). We all have to be more creative with communicating with those outside our household at the minute. But there is a particular question around how women can access abortion services safely, without exposing them to unnecessary risk by requiring them leaving their homes during this pandemic (for further information regarding this topic read Carrie Purcell and Nicola Boydell’s blog post here)

This unprecedented time could be a chance to utilise existing online resources for women during and after their abortion. For instance, womenonweb.org provides abortion pills and telemedicine for women where abortion is illegal. They have demonstrated the safety and utility of women accessing abortion services online. Initially the UK governments refused to embrace this option, however, they have since changed their guidance. Women in Scotland, England, Wales, and Northern Ireland (with the help of British Pregnancy Advisory Service) can now have the consultation using telephone or video calls, and can take both early medical abortion medications (mifepristone and misoprostol) at home during the first 10 weeks of pregnancy.

With these movements towards telemedicine abortion care, and in this time of heightened computer-mediated communication and uncertainty, it is crucial to understand how and why women are using online spaces to post about their abortions and interact with other women’s stories. Are they receiving the healthcare and social support they need? Are they experiencing abortion stigma either on or offline? This study seeks to answers these questions by interviewing women and speaking to them about their personal experiences with talking and reading about abortion online.

Want to contribute your story/experience?

I have recently requested an amendment to my study’s ethical approval, adapting my research methodology to allow for interviews via Zoom or telephone. I want to hear from women about why they have used online resources and spaces before, during, and after their abortion. If you would like to participate in this study or just find out more,
Check out my study’s Facebook page
Please follow me on Twitter for more updates: @Rwilsonlowe

Working together to understand condom and contraception use among young people in Scotland

We are now about half way through the CONUNDRUM project – a research study aiming to understand the social context shaping use and non-use of condoms and contraception for penetrative sex among young people in Scotland.

Rather than rush headfirst into “collecting” data, we’ve spent the past six months working with young people and a range of professionals involved in supporting young people’s sexual health to better understand what they think this study needs to focus on. At the midpoint of the project, now seems like a good time to pause and reflect on what we’ve been doing so far.

How did the CONUNDRUM project come about?

CONUNDRUM emerged from conversations between people involved in the design and delivery of services providing free condoms and contraception. They perceived changes in uptake among young people over recent years and wanted to find out what was going on. While condoms remain a commonly used form of protection against sexually transmitted infections and (where relevant) unintended conceptions, over the last five years, there have been strong indications in some areas of Scotland that fewer young people than before are accessing free condom services, such as c:card schemes. National data also suggest a decline in use of some forms of Long Acting Reversible Contraception (LARC), such as the implant, IUD and IUS, among women under 20.

Among those working to improve young people’s sexual health, these changes raise important questions – have young people’s attitudes towards using condoms and contraception changed in recent years? What matters most for young people in accessing free condoms and contraception, and are these priorities being met? And how do young people navigate the complex array of information and messages about sexual health in general, and condoms and contraception in particular?

To investigate this situation, three NHS health boards (Greater Glasgow and Clyde, Lanarkshire, Lothian) in partnership with Scottish Government, asked us (a team of researchers at University of Glasgow) to explore the multi-level and complex factors shaping young people’s use and non-use of condoms and contraception for penetrative sex in Scotland. In particular, the study commissioners wished to understand the contemporary social context in which young people are making decisions about condoms and contraception. Our aim is to work with young people to shape the study throughout, including to co-produce recommendations for future sexual health policy and service provision. We were asked to provide a broad picture of the social context, and to ensure multiple experiences and perspectives are represented in the research. This includes working with young people living in a range of locations and circumstances, and with a range of gender and sexual identities.

What have we been doing so far?

The first phase of CONUNDRUM involved 7 interactive workshops – six with young people (38 total), and one with 22 professionals involved in supporting young people’s health and wellbeing (e.g. health promotion workers, youth workers, school and family nurses, pharmacists).

We designed these sessions to help us understand young people’s and professionals’ views on what topic areas to explore with young people in the next phase of the study, which will involve small group discussions and an online survey. We used systems thinking tools, including a technique called rich picture, to open up conversations about the numerous factors shaping young people’s use and non-use of condoms and contraception.

images from workshops with young people, including rich pictures and study priority setting activities

These discussions underlined a basic, yet crucial point: no one factor ‘causes’ young people to use or not use condoms or contraception. Rather, young people’s experiences in relation to condoms and contraception are dynamically shaped through their interactions with many different actors and contexts within a complex system that involves sexual partners, friends, families, education systems, health services, community and faith groups, mainstream and social media, porn, and so on. Not only does this complex social system have many interrelated parts, it is also continuously evolving – whether that be due to social changes (e.g. changing norms regarding roles and responsibilities for sexual health), technological changes (e.g. development of new prevention technologies, growth of digital health services, proliferation of apps offering new ways to sexually connect with others), political changes (e.g. cuts to funding for sexual health), and so on.

Building cross-sector partnerships and ways of working that allow us to engage with this complexity matter because “solutions” to improving sexual health are unlikely to be simple or located just in one part of the system. Improving sex education in schools, or innovating sexual health services, would – on their own – not be enough. Rather, assessing and rethinking the system in a way that better protects and promotes young people’s sexual health requires the action and collaboration of many different partners, and young people must be at the heart of these efforts.

images from workshop with multi-sector stakeholders

What’s next for CONUNDRUM?

Building from the discussions we’ve had with young people and multisector stakeholders, our next steps are to further explore the priority topics identified in our first phase. As with everyone, we have had to adapt our plans in the context of the COVID-19 pandemic, meaning all of the remaining study activities will now be conducted virtually. This includes:

    • Small group discussions with young people living in three health boards (Greater Glasgow and Clyde, Lanarkshire, and Lothian);
    • An online survey which will go live in June 2020 and will be open to any young person aged 16-24 who lives in Scotland;
    • Collaboration with young people to co-develop policy and practice recommendations for the NHS and Scottish Government.

Thanks to everyone who has participated in CONUNDRUM so far! If you would like to get involved, be added to the mailing list for the final report, or if you have any comments or feedback, please get in touch with us at sphsu-conundrum@glasgow.ac.uk

You can also find project updates on twitter at #ProjectCONUNDRUM.