‘It's good to be able to talk’: An exploration of the complexities of participant and researcher relationships when conducting sensitive research

Drawing on qualitative data from a project on young women’s experiences of abortion, this paper considers the dual exchange of the research interview. It considers the view that researcher and participant ‘collude’ in the research process to meet their individual and differing needs. The paper explores the researcher’s active role in stimulating participants to talk about and disclose highly personal, and potentially stigmatising, experiences and interrogates the ways in which participants may use, or re-frame, research in a quasi-therapeutic capacity as a process of catharsis. This raises questions around whether the participant and researcher share common research goals, and the implications of this for informed consent. The paper concludes with a discussion of the problems of balancing the need of the researcher to ‘get the job done’ and to generate meaningful rich data, and the need to prioritise participant and researcher wellbeing throughout the research, suggesting that further consideration needs to be given to the post-consent process

Young women's experiences of unintended pregnancy and abortion: key findings

This document reports on the key findings of a mixed methods study to investigate different aspects of young women’s (aged 16-24) pregnancy experiences of one or more unintended pregnancies ending in abortion. Following an abortion at one of Marie Stopes’ main centres, a total of 430 women completed a quantitative telephone survey between June 2012 and May 2013. In addition, thirty six young women were interviewed qualitatively following their abortion. These interviews took place between February 2013 and April 2014. Seventeen of these participants were then interviewed for a second time approximately five to eight months later. Women were asked about their contraceptive use at the time of pregnancy, their experience of the abortion consultation and service, their post abortion contraception decision making, their attitudes towards pregnancy and abortion, and their perception of contraceptive risk taking. The women who had experienced a previous abortion were also asked about their contraceptive use between their two most recent abortions

"I thought i was protected" Abortion, contraceptive uptake and use among young women: a quantitative survey

In 2012, when this research study began, the total number of abortions in England and Wales was 185,122. This was 2.5% fewer than in 2011 (189,931) [1]. The latest government abortion statistics show that there was a total of 185,331 abortions in 2013 which is 0.1% more than in 2012 [1]. The percentage of women undergoing an abortion who have had one or more previous abortions is increasing, with more than one in three abortions in the UK (37%) being a subsequent episode, an increase from 34% in 2010 and 31% in 2002. Among women under 25 years, 27% had a previous abortion in 2012, a slight increase since the previous year (26%). This proportion was also the same for under-25 year old women in 2013. This increase may indicate a gap between provision of abortion care and effective post abortion contraception use among this population. Reasons for unintended pregnancy are well documented, and include non-use of contraception, failure of a contraceptive method, poor knowledge of methods, cultural or religious barriers, fear or misconceptions of side effects, and relationship changes [2-6]. Factors associated with why some women who have an abortion go on to have a subsequent abortion are less evidence based. It has been acknowledged that increasing access to contraceptive information and services is too simplistic a solution [7]. There are no known UK studies that provide quantitative data about post abortion contraceptive practices among young women. While post-abortion contraceptive services for young women have become a government policy priority, more needs to be understood about why some young women struggle to exercise reproductive control, and do not use contraception effectively; as well as about service provider and other factors that may influence its initiation and continuation. Marie Stopes International (MSI) is one of the UK’s leading reproductive health agencies and is the largest provider of abortion services. Given the lack of understanding regarding the complex interplay of factors that influence the incidence of successive episodes of abortion, MSI commissioned a mixed method study to investigate different aspects of young women's experiences of one or more unintended pregnancy ending in abortion. This paper reports on the second component of the study: a quantitative survey. It draws on the survey results to identify ways in which local sexual health strategies and services can support young women after abortion, helping them to improve their reproductive control and avoid further unintended pregnancies

Hormonal contraception and regulation of menstruation: a study of young women's attitudes towards ‘having a period’

Background Irregular bleeding is one of the most common side effects of hormonal contraception and a key reason for the discontinuation of hormonal methods. Study design A qualitative study in which 12 young women volunteered to be interviewed in depth, along with six focus group discussions (23 participants). The study had two main research objectives: to document and investigate what young women think and feel about menstruation and contraception, and to explore young women's preferences regarding the intersection of contraceptives and bleeding patterns. Results Although participants held a broad view that menstruation can be an inconvenience, they did ascribe positive values to having a regular bleed. Bleeding was seen as a signifier of non-pregnancy and also an innate part of being a woman. A preference for a ‘natural’ menstruating body was a strong theme, and the idea of selecting a hormonal contraceptive that might stop the bleeding was not overly popular, unless the young woman suffered with painful natural menstruation. Contraceptives that mimicked the menstrual cycle were acceptable to most, suggesting that cyclic bleeding still holds a symbolic function for women. Conclusions When counselling young women about the effect of different contraceptive modalities on their bleeding, practitioners should explore how the women feel about their bleeding, including how they might feel if their bleeding stopped or if they experienced erratic bleeding patterns. Practitioners also need to recognise the subjective understanding of the ‘natural body’ as held by some women, and in these cases to support them in their seeking out of non-hormonal methods of contraception

‘Repeat abortion’, a phrase to be avoided? Qualitative insights into labelling and stigma

Background In recent years there has been growing international interest in identifying risk factors associated with ‘repeat abortion’, and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives. Study design Mixed-methods research study: a quantitative survey of 430 women aged 16–24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15). Results The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame. Conclusions This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion

Unanticipated bleeding with the etonogestrel implant: advice and therapeutic interventions.

A common problem with etonogestrel contraceptive implants is irregular bleeding, for which women are often unprepared despite adequate pre-insertion advice. Dickson et al.’s commentary is a useful summary of management options. It will refresh readers’ ability to deal with this problem and it's a reminder to avoid ‘watchful waiting’, which risks women losing confidence in this highly effective contraceptive method

Call volume, triage outcomes and protocols during the first wave of the COVID-19 pandemic in the UK : results of a national survey

Objectives During the first wave of the COVID-19 pandemic in the United Kingdom (UK), to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance was dispatched, proportion conveyed to hospital, and features of triage used. Methods Semistructured electronic survey of all UK ambulance services (n = 13) and a request for routine service data on weekly call volumes for 22 weeks (February 1–July 3, 2020). Questionnaires and data request were emailed to chief executives and research leads followed by email and telephone reminders. The routine data were analyzed using descriptive statistics, and questionnaire data using thematic analysis. Results Completed questionnaires were received from 12 services. Call volume varied widely between services, with a UK peak at week 7 at 13.1% above baseline (service range -0.5% to +31.4%). All services ended the study period with a lower call volume than at baseline (service range -3.7% to -25.5%). Suspected COVID-19 calls across the UK totaled 604,146 (13.5% of all calls), with wide variation between services (service range 3.7% to 25.7%), and in service peaks of 11.4% to 44.5%. Ambulances were dispatched to 478,638 (79.2%) of these calls (service range 59.0% to 100.0%), with 262,547 (43.5%) resulting in conveyance to hospital (service range 32.0% to 53.9%). Triage models varied between services and over time. Two primary call triage systems were in use across the UK. There were a large number of products and arrangements used for secondary triage, with services using paramedics, nurses, and doctors to support decision making in the call center and on scene. Frequent changes to triage processes took place. Conclusions Call volumes were highly variable. Case mix and workload changed significantly as COVID-19 calls displaced other calls. Triage models and prehospital outcomes varied between services. We urgently need to understand safety and effectiveness of triage models to inform care during further waves and pandemics