Amongst the 24 participants, the average age was 30 years old, ranging between 20 and 41 years old. A quarter of participants reported having an abortion after 12 weeks’ gestation. Half of all participants had a medication abortion (all recruited from the accompaniment model) and half had a Manual Vacuum Aspiration (MVA) (all recruited from the clinic). There were six participants who reported having a prior abortion and nine who already had children. None of the participants reported being married, however nearly half of participants reported being in a relationship, four of whom lived with their partners (Table 1).
Table 1
Participant characteristics
|
N = 24
n (%)
|
Age (years)
|
Mean
|
30
|
Range
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20–41
|
Abortion method
|
Medication abortion
|
12 (50.0%)
|
Manual vacuum aspiration (MVA)
|
12 (50.0%)
|
Gestational age
|
<=12 weeks
|
16 (66.6%)
|
> 12 weeks
|
6 (25.0%)
|
No data
|
2 (8.3%)
|
Previous abortion
|
Yes
|
6 (25.0%)
|
No
|
18 (75.0%)
|
Children
|
Yes
|
9 (37.5%)
|
No
|
15 (62.5%)
|
Marital Status
|
Married
|
0 (0.0%)
|
In a relationship
|
11 (45.8%)
|
Single
|
13 (54.2%)
|
Acompañamiento and Contención[1]
Universally, participants recruited from both the clinic and accompaniment models of care described high-quality abortion care as feeling acompañamiento and contención from their providers. These terms emerged over and over in the descriptions of positive interactions, and were highlighted across the sample as necessary for good care.. Interpersonal care provided with acompañamiento and contención helped participants trust their provider or accompanier, which, in turn, reassured their sense of safety throughout the abortion. When describing her experience with the hotline, a participant explained, “I always say that they provide you with a security that, out there, perhaps at another place, I do not know if...let’s see, they are not doctors, but the fact that they provide such contención is really important, you do not feel alone.” (Age 34, Accompaniment). Another participant, who did not experience any abortion symptoms after three medication abortion attempts, echoed the importance of knowing that they would not be left alone. With the support of their accompanier, the participant ultimately ended up receiving an MVA at a clinic.
“What I always felt was that sense of security, you are not going to come out of this alone, we are never going to abandon you, this is where we solve this. That kind of...gives you that sense of security, to say I failed once and now what do I do, maybe they will leave me on my own, no, they will not leave you alone, because they told me, ‘we already started to dance, we are going to continue dancing until the song is over’, and that is how it is.” (Age 33, Accompaniment)
Acompañamiento and contención also played a role in relieving participants’ anxieties. Participants described a sense of respite that was rooted in the realization that they would be able to end their pregnancies in a context of high-quality care. A participant described, “[...] I felt...how can I say it, very well attended to, I did not expect to get here, very emotionally contenida...” (Age 26, Clinic). Finally, a participant expressed that they felt “light” after meeting with the accompaniment group, since they knew that the accompaniers would help them terminate their pregnancy,
“I felt...I felt light, I felt supported, acompañada, and I knew that everything would be fine, so I felt calmer, much calmer, because I was very scared, I felt that my problem was solved, that is what I felt.” (Age 26, Accompaniment).
Below we present four key aspects of abortion care with acompañamiento and contención which help to define what participants in Argentina valued during interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management.
Attentive communication and interactions
Many participants in the study described feeling supported during interpersonal interactions when providers and accompaniers communicated continuously and were attentive to their needs throughout their abortion process, particularly during the abortion procedure itself. One participant at the clinic appreciated the fact that the provider explained every step of their MVA as it was taking place, and showed attentiveness to their comfort,
“Well, I can’t remember the name of the girl who was accompanying me, but well, she was sitting next to me, talking to me, as if we knew each other forever, the doctor too, who was there, was telling me everything she was doing. That everything was going well. Always asking me if it hurt, what I felt, if I felt something strange.”(Age 25, Clinic)
When providers and accompaniers showed concern about their physical and emotional wellbeing, participants felt safer, calmer and more trusting of the provider or accompanier. One participant highlighted the fact that their provider asked for permission to touch them before beginning the MVA procedure, which they did not anticipate. This helped them feel that they were receiving respectful care; they explain, “[…] they were very attentive because they told me, ‘I’m going to put this on you, I’m going to put that on you, I’ll touch you here.’ So these are things that you are not accustomed to happening either. No specialist is going to ask you for your permission” (Age 41, Clinic).
Participants accompanied by the feminist accompaniment group described feeling contención and acompañamiento while interacting with their accompanier from the beginning to the end of their experience. This participant explained the importance of knowing the accompanier would be there for them if something happened,
“From the day you are going to do it, they are already accompanying you, that is, it is not that they are just going to show you how to do it […] there is a before, during and after, and everything is with acompañamiento, and that is really good, because you know that in the moment if something happens to you it is not that you go to a hospital or something, you have someone to consult, who can help you.” (Age 30, Accompaniment)
In some cases, participants were surprised by how supported they felt by the interactions they had with accompaniers over phone calls and text, such as this participant,
“[…] but it was like… it was very relieving and I felt the contención beyond the kilometers and beyond the non-contact face to face, I felt the contención and I knew they were there, it was not the only time they called me, […], they explained everything to me, they called me before, after the process, and during the process too […]” (Age 30, Accompaniment)
The attentiveness that both accompaniers and providers showed towards participants helped them feel that they could rely on the providers or accompanier, which helped participants feel that they were very well cared for and supported during their abortions.
Comprehensive, clear information provision
Almost all the participants described the importance of receiving clear and comprehensive information from their providers or accompaniers. At both recruitment sites, comprehensive information, which included details on each step of the abortion process, was provided during an initial group information session, as this participant explains,
“They explained everything step by step, and it was all like, ‘yes, let’s go, I want to end [my pregnancy] here’, and nothing, in terms of contención here I found it 100%, that is, contención that I did not find in him [my partner], that I did not find in my friend, in the psychologist.” (Age 20, Clinic)
For the participant, the detailed information they received on the procedure helped them make the choice to have their abortion at the clinic. Additionally, this participant linked information provision to feeling contención at the clinic, highlighting how providing transparency on the abortion procedure may have facilitated a sense of trust between the participants and the providers.
Participants also appreciated the opportunity to ask questions and discuss their circumstances with providers and accompaniers, as well as with other people who were there to have an abortion. One participant mentioned that they were given the opportunity to interact with the MVA instruments prior to the procedure in the clinical model. Additionally, the group workshops that both models used, offered a space for participants to hear what questions other people had and instilled in them a sense of community and safety. As one participant explained,
“This thing of it being in a group makes you feel a little more relaxed, because you know that you are not alone and that there others are going to ask questions that do not occur to you and that could happen to you, so, then you are like more sure of what you are doing […]” (Age 30, Accompaniment).
Various participants also highlighted the importance of receiving information that was easily accessible and understandable, as this participant explains, “It was like they spoke to you in a way that you could understand everything, you understand? And I came without knowing anything...the truth is that they inspired so much confidence in me, so much security, they explained everything, absolutely everything[...]” (Age 32, Clinic). Receiving thorough information helped participants to feel safe, helped them trust their providers and helped them feel well-prepared for their abortion experiences.
Empathetic and non-judgmental listening
Participants often mentioned the importance of feeling heard by their providers or accompaniers. This made them feel respected and understood by their providers and accompaniers. One participant explains, “[…] they provide contención emotionally, they listen to you, they know how to listen, they know how to understand the situation you are going through and professionally they are very delicate, respectful, attentive […]” (Age 26, Clinic). Another participant described how it felt to be able to share their motives for wanting an abortion with a provider who helped them feel that their experience was important,
“[…] I know that a lot of girls pass through here, but they like made you feel, I don't know, not special, but like it mattered what you were feeling, and that your decision was fine, whatever it was, that the reason why you didn’t want to have it [the pregnancy] mattered […]” (Age 20, Clinic)
Perceiving that providers and accompaniers did not cast judgement or stigmatize their decision, and instead listened empathetically, helped participants feel that they were receiving care with acompañamiento and contención.
Participants also recounted that in both models of care, they felt that providers and accompaniers took efforts to normalize abortion. One participant explains of the accompaniment model, “[…] since here [abortion] is normalized, what we do is not judged in any way” (Age 33, Accompaniment). The group workshops were also instrumental in normalizing abortion. One participant who was initially skeptical about the group workshop recounts how they later understood it as a way of legitimizing abortion,
“‘Why do I have to go to a collective interview?’ At first I didn’t like that one bit and after, I understood why it was collective, or at least I explained it to myself through the experience we had, and I liked that...it’s like half because it’s good thinking from the perspective of taking it [abortion] out of the dark or the clandestine or illegal practice or secret practice, the fact that it is collective [...]” (Age 36, Clinic)
Another participant accompanied by the hotline model further explained how the group workshops helped to create a friendly rapport between participants and accompaniers, “[…] the girls made it more enjoyable, it seemed like a chat with friends. Yes, it was really good. Yes, I felt very good, I felt contenida, it was good” (Age 30, Accompaniment). The non-judgmental space that providers and accompaniers helped to facilitate during group workshop, as well as the empathetic listening that participants recounted receiving from their providers and accompaniers, helped them feel heard, validated and supported and was an important aspect of receiving care with acompañamiento and contención.
Choice in pain management
Participants reported feeling that providers and accompaniers took their needs into account and offered innovative techniques for pain management during their abortions. For instance, participants who received care at the clinic were given a number of options for pain management including hot water bottles to place on their abdomens and the opportunity to play the music of their choice during their MVAs. One participant described how the music and the conversation with the people in the room helped distract them from the pain,
“They put music on for me, Los Redondos [a band], and the truth is that if I’m honest with you, I didn’t feel any pain, […] the girls talked to me and we chatted, and I had the hot water bottle, for like in case you feel pain.” (Age 32, Clinic)
When reflecting in the interviews, participants often highlighted these moments as representative of supportive interpersonal interactions during their abortion care. Another participant who received care at the clinic described being surprised at how much effort her providers made to meet her individual comfort needs,
“They told me something that really surprised me, they said ‘if you want, we can play music’, which surprised me in the best sense...at what level they are, I don’t know how to say it, as if they are really thinking about the comfort of the patient, in a moment like that, I had the best time possible...” (Age 21, Clinic)
As this participant points out, the ability for many participants to have choice in their pain management helped them feel as though they had the best possible healthcare experience. In the feminist accompaniment group, accompaniers suggested that participants try different pain management options at home, for example using a hot compress, or setting up the space in which they were going to take the medications so that it would feel unique and comfortable. For instance, one participant mentioned watching their favorite TV show and preparing some of their favorite snacks, as their accompanier had suggested,
“She [the accompanier] told me to stay calm, that the calmer I was, the faster and easier it would be, she told me to create a nice ambiance, that the person who is with you transmits good things to you, if you like incense, light an incense stick, prepare whatever you like to eat […] I made myself a cake of dulce de leche [caramel], walnuts and chocolate…she told me watch whatever you want, so I did it watching Ru Paul...[television show]” (Age 30, Accompaniment)
The empathic and compassionate way through which providers and accompaniers centered the needs and choices of participants in relation to pain management helped them feel as though their individual needs were being taken into account and helped them feel that they were in a safe and comfortable environment during their abortions.
Footnote:
[1] These are two key terms in Spanish that participants used frequently to describe the way that providers/accompaniers interacted with them. In an effort to capture the essence of these words, we will continue to refer to the two terms in Spanish throughout this paper. “Contención”, and its adjective “contenida” literally translate to “containment” in English. However, in use, the word suggests a type of kind, caring, compassionate emotional support, a support that contains the individuals feeling of fear or anxiety. “Acompañamiento”, and its adjective “acompañada” literally translate to “accompaniment” in English. But in practice, it too suggests kind, caring, and supportive care that accompanies one throughout their healthcare experience.