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The consequences of unsafe abortion: A qualitative study

August 2011
Journal of Advanced Nursing 68(6):1247-55

August 2011
68(6):1247-55

DOI:10.1111/j.1365-2648.2011.05826.x

Source
PubMed

Authors:

Shirin Shahbazi

TEHRAN UNIVERSTY OF MEDICAL SCIENCES

This paper is a report of a study of the consequences of illegal abortions experienced by Iranian women. Despite the increase in effective and safe methods of contraception and the distribution of information about these methods, unwanted pregnancy is still a problem in some societies. Induced abortion is a common procedure throughout the world and at least half of more than 45 million induced abortions which happen in a year are performed under unsafe circumstances. Unsafe abortions carry a high risk of maternal mortality and morbidity, accounting for more than 80,000 maternal deaths per year. In this qualitative study, 27 participants were interviewed in 2006. Some participants were women who had illegal abortions and others were people who had contact with those women. Content analysis was used to identify and categorize participants' responses to the interview questions. Four consequences of women's experiences of illegal abortion were identified: physical, psychological, socio-political and judicial. Conclusion: In Iran, as in some other developing countries intentional abortion, except for some special cases, is illegal because of social and religious beliefs. In these countries, offering services and support to women with unwanted pregnancies seems to be the best solution for reducing or preventing illegal abortion.

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ORIGINAL RESEARCH

Illegal abortions in Iran: a qualitative study

Shirin Shahbazi, Nahid Fathizadeh & Fariba Taleghani

Accepted for publication 20 November 2009

Correspondence to S. Shahbazi:

e-mail: shahbazishirin@yahoo.com

Shirin Shahbazi MS RN

Lecturer

Faculty of Nursing and Midwifery, Azad

Islamic University-Varamin Pishva Branch,

Varamin, Iran

Nahid Fathizadeh MS RN

Lecturer

College of Nursing and Midwifery, Isfahan

University of Medical Sciences, Iran

Fariba Taleghani PhD RN

Assistant Professor

Faculty of Nursing and Midwifery, Isfahan

University of Medical Sciences, Iran

SHAHBAZI S., FATHIZADEH N. & TALEGHANI F. (2009)SHAHBAZI S., FATHIZADEH N. & TALEGHANI F. (2009)

Illegal abortions in

Iran: a qualitative study. Journal of Advanced Nursing

doi: 10.1111/j.1365-2648.2009.05246.x

Abstract

Title. Illegal abortions in Iran: a qualitative study.

Aim. This paper is a report of a study of the consequences of illegal abortions

experienced by Iranian women.

Background. Despite the increase in effective and safe methods of contraception

and the distribution of information about these methods, unwanted pregnancy is

still a problem in some societies. Induced abortion is a common procedure

throughout the world and at least half of more than 45 million induced abortions

which happen in a year are performed under unsafe circumstances. Unsafe abortions

carry a high risk of maternal mortality and morbidity, accounting for more than

80,000 maternal deaths per year.

Method. In this qualitative study, 27 participants were interviewed in 2006. Some

participants were women who had illegal abortions and others were people who had

contact with those women. Content analysis was used to identify and categorize

participants’ responses to the interview questions.

Findings. Four consequences of women’s experiences of illegal abortion were

identiﬁed: physical, psychological, socio-political and judicial.

Conclusion. In Iran like some developing countries intentional abortion, except for

some special cases, is illegal because of social and religious beliefs. In these coun-

tries, offering services and support to women with unwanted pregnancies seems to

be the best solution for reducing or preventing illegal abortion.

Keywords: abortion, consequences, illegal abortion, judicial, psychological, quali-

tative research, socio-political

Introduction

Despite the increase in effective and safe methods of

contraception and the distribution of information about

these methods, unwanted pregnancy is still a problem in some

societies (Abdullahi & Mohammadpour Tahamtan 2003)

Women facing unwanted pregnancy, whether in developed or

developing countries, decide to terminate their pregnancy

based on the same reasons (Cohen 2003). Induced abortion is

a common procedure throughout the world and at least half

of more than 45 million induced abortions which happen in a

year are performed under unsafe circumstances. Unsafe

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abortions carry a high risk of maternal mortality and

morbidity, accounting for more than 80,000 maternal deaths

per year (Milsom 2006).

Background

Legal abortion is one of the safest medical procedures for

women, and is twice as safe as natural delivery (Bruce &

Bentar 2003). However, unsanitary abortion, which is an

important and neglected health problem in developing

countries, is one of the main issues in women’s lives during

the reproductive period. This kind of abortion is usually

performed outside the legal system by a person who does not

have enough knowledge and skill and in places with the

lowest medical standards. Based on the conditions in which

abortion is conducted and the methods used, the occurrence

of severe complications is a possibility. This makes illegal

abortion one of the main reasons for deaths in pregnant

women (Rasch et al. 2000). Zhirova et al. (2004), in their

study of the causes of maternal deaths after abortion in

Russia, reported that abortions which lead to death are

mostly performed by unskilled and unqualiﬁed doctors,

outside medical centres. Their results also showed that most

women who used this kind of abortion did so because the age

of the foetus was greater than the legal abortion limit. Almost

all the women in Zhirova’s study (93%) delayed seeking

treatment for their unwanted pregnancy, and this delay could

increase the risk of death; therefore it is necessary to prevent

any delay in diagnosis and treatment.

Sepsis and bleeding are the most common causes of mother’s

deaths after abortion (Richardson 2004). In addition to

possible physical complications and death, psychological

problems might also occur after abortion. A study by Broen

et al. (2005) showed that psychological disorders such as

depression and anxiety might also occur because of therapeutic

abortion; however, they are likely to be severe, symptomatic or

persistent in only 10% of women and are more common

among those with a history of psychological problems.

Deveber and Genties (2005)

4report that when a pregnancy

ends, whether by induced abortion or by completed preg-

nancy, the occurrence of psychological disorders is possible.

In contrast, Fisher et al. (2005) state that no evidence was

found of any kind of psychological incompatibility in women

seeking repeated induced abortion. Deveber and Genties

(2005) believe that, although there is no consensus on

psychological issues after abortion, the conclusions of all

relevant studies show that these problems occur after induced

abortion in 10% of women. Because many abortions are

conducted each year, this should be considered an important

public health issue.

Because of religious and social disapproval of abortion, it

has always been subject to legal and social punishments. For

example, in Cameroon, the punishment is 5 years in jail for

the person who conducts the abortion, 1 year for the woman

who has the abortion and 2 years for the person who

prepares the instruments and drugs; however, there are few

legal prosecutions (Schuster 2005). In Iranian law, it is a

crime to harm the foetus and the perpetrator would be

punished decisively (Hosseyni 2006) 5

The study

Aim

The aim of this study was to describe the consequences of

illegal abortions experienced by Iranian women.

Design

A qualitative descriptive design was adopted. The method-

ology was qualitative as this was an inquiry to understand a

problem about which there was little existing knowledge.

Participants

A convenience sample of 27 people who had either an

experience of illegal abortion or whose occupation was

relevant to this experience participated in the study. To

understand the process of illegal abortion and its conse-

quences better, participants were drawn from different

settings. Sample size was determined by theme saturation.

The participants included seven women who had an illegal

abortion, one woman who referred to hospital and begged

doctors for induced abortion, the husband of a woman who

had an incomplete abortion, six midwives, three obstetri-

cians, two lawyers, two psychologists, two clergymen, one

general physician and one politician.

Data collection

The data were collected in 2006. The ﬁrst author conducted

semi-structured, face-to-face interviews. The interviews

began with general questions, followed by more speciﬁc

ones (see Table 1). Each interview took approximately 30–

120 minutes and was tape-recorded. The interviews were

conducted in hospitals, participants’ residences or private

ofﬁces, according to their wishes. After the interviews, the

tapes were transcribed by the ﬁrst author and checked by

research assistant and educator. Data collection was done

concurrently with data analysis and was discontinued when

S. Shahbazi et al.

22009 The Authors. Journal compilation 2009 Blackwell Publishing Ltd

theme saturation was achieved during the last two inter-

views.

Ethical considerations

Approval for the study was obtained from a university

research ethics committee All participants were sent a

transcript of their interview for clariﬁcation and agreed for

their transcript to be used in publications.

Data analysis

Content analysis was used to analyse the data. The ﬁrst step

was data reduction in which the data were manually coded.

After reading the interview transcripts several times, the

researcher identiﬁed signiﬁcant statements, line by line,

without making any assumptions, and then compared tran-

scripts between participants to determine similarities and

differences in the codes. The second step was data display, in

which a diagram was developed to display the relationships

between codes, and then pattern coding was done. This

involved sorting the codes according to areas of illegal

abortion consequences. The third step was conclusion-draw-

ing, in which themes were identiﬁed and named to describe

the consequences of illegal abortion.

Rigour

We followed Lincoln and Guba’s (1985)

6guidelines for

ensuring trustworthiness, which was established through

consistency, prolonged engagement, peer debrieﬁng, depend-

ability and conﬁrmability. Taped interviews and written

transcripts were examined by three researchers to ensure

consistency. Participants who gave important insights were

interviewed a second time, which is called prolonged

engagement. All authors were experienced in conducting

qualitative studies, and all took part in analysing the

transcripts and discussing the themes and sub-themes (peer

debrieﬁng) until consensus was achieved, thus establishing

dependability. Finally, conﬁrmability was ensured by two

participants, who examined and validated our interpretation

of the ﬁndings.

Findings

Our ﬁndings showed that illegal abortion consequences could

be understood through four themes: physical, psychological,

socio-political and judicial.

Physical consequences

Induced abortion is a procedure that needs skill and equipment

to be done safely. If it is performed by unskilled operators,

using non-standard and unsafe methods and ignoring sterili-

zation principles, it can cause many physical problems for

women. As most operators do not follow-up their patients and

do not teach them about warning signs such as frequent

bleeding, retained products of induced abortion can cause

severe uterine infection and patients may be hospitalized

because of fever, septic shock and severe bleeding.

According to our participants, the reason for delay in

seeking medical assistance was lack of knowledge of the

reasons for and consequences of bleeding after abortion, and

this delay could cause a severe fall in blood pressure, severe

anaemia and even the need for blood transfusion.

Using dangerous instruments was another reason for the

occurrence of severe symptoms after induced abortion.

Referring to an induced abortion which led to colostomy, a

member of the medical team stated:

‘Most of the unmarried women go after unsanitary and dangerous

methods of abortion to hide it from their families, who do not support

it. Therefore, the rate of problems caused by induced abortion is higher

among unmarried women’. An obstetrician said: ‘Illegal and unlawful

sexual intercourses have extreme and expanded consequences because

such pregnancies are prohibited and will end up with using illegal and

expired drugs or into underground networks’.

Psychological consequences

Based on our ﬁndings, in addition to adverse physical s,

women may also face psychological disorders after induced

Table 1 Interview questions

General questions

1. Could you brieﬂy describe your experience of illegal abortion? (for

women)

2. How did you treat a woman who wanted you to terminate her

unwanted pregnancy? (for doctors)

3. Could you describe the hospital personnel’s reactions when you

went to the hospital because of complications after illegal

abortion? (for women)

4. Could you describe your experience of having clients who had

complaint against an abortion provider? (for lawyer)

5. Did you agree to your wife’s decision for having an induced illegal

abortion? (for husbands)

6. What does the government want to do to help women who want to

terminate their unwanted pregnancy without a legal reason? (for

statesman)

7. Could you describe the reason for Islamic restrictions on induced

abortion? (for clergymen)

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abortion. Women usually needed some time to forget about

the bitter memory of this unethical action and cope with their

guilt:

I had nightmares for a year. They were mostly about my abortion.

This continued for 9 months to a year. Then I somehow forgot about

it. I always consider ethical and moral aspects of my actions rather

than religious aspects. After my abortion I donated some money to a

needy family to clear my conscience.

This participant had had an abortion with no complications

about a decade before the interview, and about a year after

her abortion she had coped with its consequences and had no

regrets. However, another woman who had a complicated,

stressful and expensive abortion mentioned it as a bitter and

unforgettable memory. Although she had no regrets, the

experience became a stress factor whenever she thought

about pregnancy again:

I have no regrets at all but sometimes the memory comes back to me

and makes me stressed out. I think, ‘What if I get pregnant again?’…I

can’t forget it. Believe me, I think about it every day. I always discuss

it, especially with my sister and mother. And whenever I pray to God

in private I ask for His forgiveness. I’m really sad because of what I

did.

Socio-political consequences

A psychologist who participated in this study believed that

the rates of depression and sadness are higher among

unmarried young women than married women, because they

are emotionally immature, have limited social support and

are concerned about the effect of abortion on their future

marriage. Sometimes these concerns become so serious that

they make them avoid marriage:

Many of these cases remain hidden and become the source of their

depression. It wouldn’t be revealed and nobody would ever know.

Then everybody thinks that she is depressed because life is so

complex and cruel (poor thing! Everything is so hard on her, she has

so much to study and her job is so hard). But the root of her

depression is something else [abortion]. These girls’ problems should

be studied. These are the girls who may never get married. There are

some girls who don’t want to get married because they’ve lost their

virginity or experienced abortion.

Another psychologist told us about the effect of abortion on

spousal relationships in one of her patients:

This woman showed postabortion depression with severe symptoms

of phobia; she was scared of people. She thought that someone was

following her around and that there was something moving in her

abdomen. She had nightmares and had all the typical symptoms of

depression, like anorexia, insomnia and extreme hatred of sexual

relations. I even had a case that, because the woman became so cold

after her abortion, her husband wanted to divorce her.

Women who go to hospital for postabortion problems

usually hide the truth about their induced abortion because

they are afraid of the legal consequences. One of the

participants told us about healthcare personnel’s attitudes

towards these women:

They don’t have a good attitude toward women who go to hospitals

for postabortion problems. They think that everyone with an induced

abortion must have illegal relationships and is a street woman. They

never care to ﬁnd out the real reason that caused these women to

have an abortion. They just treat them differently.

Judicial consequences

Participants in this research believed that women’s and

healthcare personnel’s tendency to hide abortion is one of the

main reasons for not having accurate statistics on illegal

abortions. Families mostly worry about their reputation and

the complicated bureaucracy of courts, while medical staff

worry about prosecution.

Sometimes women who are victims of illegal abortion

operation prevent their husbands from suing the operator;

because they believe that the operator did them a favour by

ending their pregnancy and should not be punished or sued

for any further complications:

My husband was complaining and didn’t want to pay her [the

operator], saying that he spent ten times more for my treatment and

for that he was going to sue her. He still wants to sue her and always

talks about it. But I told him to stop. She had done her job right;

maybe I was too sensitive that these complications happened to me.

Legal experts believe that there are several reasons for not

having any clear statistics available on illegal abortion, and

these include fear of punishment, collusion with the physician

or general fear of judicial system. As induced abortion in Iran

is against law and religion, not only there is no beneﬁt for

families to report it, but also it involve them in legal issues

and penalties:

If it is proved that the woman has willingly undergone abortion, she

won’t beneﬁt from the lawsuit. Therefore they would rather to

conspire with the physician instead of ﬁling a lawsuit.

In Iran, abortion is only allowed in special cases. Based on the

abortion therapy law, which has its origins in Islamic

principles and the social and religious environment of Iranian

society, abortion is only allowed in the case of pregnancies

which lead to serious life-threatening problems for women

S. Shahbazi et al.

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and disorders which can cause foetal death during pregnancy

or immediately after delivery; in other cases abortion is

contrary to the religion and hence illegal. With regard to

limiting legal abortion indications to cases which threat the

woman’s or fetus’s life, one of the health policymakers

interviewed in our study said:

This law can be a solution in cases of life-threatening problems for

mothers, serious economical problems, or severe psychological or

other issues for families. This law might not cover some other issues,

but we must wait to see reactions and feedbacks toward this law and

how it functions before we make further decisions.

According to a politician who participated in this study, clear

statistics on documented and registered abortions conducted

because of other reasons are needed to expand this law and

send it to Parliament for approval.

One of the psychologists believed that women do not

report their abortions because they are afraid of bringing

dishonour to their families. Also, they avoid legal procedures

because they are so complicated and they believe that they are

useless:

The doctor can’t report it because it’s against administrative laws,

and families don’t report it because they don’t want scandals. There

are cases where the families are aware but they don’t report it…also

the law has a lot of administrative complexities. It means that when

you go to the Public Prosecutor’s Ofﬁce for a lawsuit, the bureau-

cracy and useless wrangles make people so sick of it and they give up

their rights.

Discussion

Study limitations

The sample size was relatively small but, because this was a

qualitative study, it provided rich data and a culturally

sensitive perspective on illegal abortion consequences for

Iranian women. However, theme saturation was achieved

and the usefulness of the data is more important than

generalization of the ﬁndings.

Some women who are hospitalized because of complica-

tions of an illegal incomplete abortion do not feel able to talk

about it. During the 6 months of the study, only two women

agreed to be interviewed. Other participants were introduced

by these two and then agreed to interview. The therapy team

who participated in the study believed that it would not be

possible to gain research access to abortionists because they

mostly conduct abortions in basements and secret places.

Two people were introduced to us as conductors of

abortions, but in their interviews they did not agree that

they did this. A woman who despite her husband’s disap-

proval had an illegal abortion in a basement conducted by a

man who she believed was one of the hospital’s employees,

did not agree to interview because it would remind her of

bitter memories. When women were asked to bring their

husbands to the interview or to give us their phone numbers,

they immediately answered: ‘My husband won’t cooperate’.

They also claimed that their husbands would not have time to

participate or would not approve of the data gathering

method, i.e. interviewing. Even some of the specialists did not

agree to be interviewed when they realized that abortion was

the topic of the study. However, except for two women who

were interviewed in the hospital and a midwife and a

gynaecologist who agreed to cooperate during direct recruit-

ment, most of the participants were introduced by other

participants; this illustrates the need to use a recruitment

approach which allows potential participants to have trust in

the researchers in studies of this sensitive nature. Only

married women who had illegal abortions were interviewed,

which limited this study. Unmarried women usually avoid

interviews or talking about their experiences because they

keep their abortion a secret because of family and social

issues.

Physical consequences

In countries where abortion is illegal, induced abortions are

the main healthcare problem for women in the reproductive

years (Amirul Islam 2005) 7

. The common problems that may

occur after induced abortion include incomplete abortion,

infection, severe bleeding and rupture and injuries of intra-

pelvic organs, such as uterine perforation or rupture (Behjati

Ardakani et al. 2004) 8

. A member of medical team who

participated in this study had a patient with a septic abortion,

the infection spread to her colon and she had to have a

colostomy. Singh et al. (2005) 9

also reported a case in which

the patient had to have complete colostomy and removal of

the sigmoid colon because of septic abortion.

Our ﬁndings show that women who face postabortion

problems usually delay seeking medical care, which leads to

critical health conditions. Rana et al. (2004) also showed that

delay in getting treatment for postabortion complications

causes severe bleeding, infection, hospitalization and the need

for blood transfusion. Rossier et al. (2004) 10

also showed that

postabortion complications occurred in women who self-

aborted their pregnancies more than in those whose induced

abortion was done by traditional operators or healthcare

staff. In the present study, most of the abortions were done by

non-professional operators and in non-standard conditions.

Most of the women had tried to end their pregnancies by

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taking herbal medicine, carrying heavy objects or injecting

themselves before seeking induced abortion.

According to participants, while not all illegal abortions

were performed in non-standard and unsanitary places, some

women had had safe and healthy abortions conducted by

skilled professionals in private clinics. Rasch et al. (2004)

believe that complications after induced abortion depend on

the operator’s skills. In most countries, physicians conduct

induced abortion in their clinics in conditions as safe as legal

abortion in hospitals. The abortion might be illegal under this

condition, but it is safe.

Participants in this study believed that sexual intercourse

before marriage is increasing among Iranian teenagers, but

that they do not have enough information about birth control

methods and this leads to unwanted pregnancies. Because in

Iranian culture these pregnancies lead to dishonour and

scandal for the girl and her family and can cause problems in

her marriage, these girls usually have an illegal abortion.

Santhya and Verma (2004) have also written that abortion is

connected with scandal especially in women who are not

married. The Planned Parenthood Federation (2000) has also

stated that, because teenagers usually have unsafe abortions

and they delay more than older women, their risk of having

serious problems afterwards is higher. Having a healthy and

clean abortion is expensive and most single women cannot

afford it. Silberschemidt and Rasch’s (2001) with teenagers

who were hospitalized in the capital of Tanzania because of

complications from abortion during 1997, showed that 38 of

51 participants had a safe abortion while 13 had unsafe

abortions done by unskilled operators. Ganatra and Hirve

(2002), in their qualitative study, showed that lack of support

and cooperation by families and sexual partners had an effect

on achieving a safe and healthy abortion in unmarried

teenagers.

Because many aspects of teenage girls’ sexual behaviours

are still not understood, there are no documented statistics on

pregnancies and illegal abortions in this group. Iranian

teenagers, like those in other countries, are at the risk of

dangerous sexual behaviours before marriage while, because

of religious restrictions, there is little or no teaching for

teenagers about dangerous sexual behaviours.

Psychological consequences

Abortion can have also psychological consequences. In this

study, women explained their satisfaction with the abortion

based on the consequences. They had no regrets, but those

who had postabortion complications were dissatisﬁed and

complained about the operator. Our ﬁndings also showed

that psychological problems such as depression occur in a few

women and mostly in girls, but they eventually coped with

the situation although they never forgot about it. With regard

to psychological issues, Cawluck et al. (2006) 11

state that most

women who abort unwanted pregnancies feel guilty and

angry afterwards. However, Broen et al. (2005) 12

reported that

women who had support from their sexual partner when

having an abortion overcame their negative feelings soon

afterwards. If important people in a woman’s life, especially

her sexual partner, do not support her decision about ending

the pregnancy and put her under pressure to do something

she does not want to do, she may face severe psychological

repercussions.

One of the psychologists who participated in this study

mentioned that the probability of postabortion depression is

greater in unmarried girls than married women; the former

usually hide their unwanted pregnancy and abortion and so

they do not get support from their family. Also, some of our

women who felt guilty said that this feeling was caused by

their religious thoughts. However, other participants, even

those who had abortions a long time ago, did not mention

severe psychological issues that needed treatment. Neverthe-

less, some of the women became sad or even cried when

talking about their experiences. One participant who had an

abortion a long time previously (15 years ago) still felt guilty

and sorry for her foetus. However, another participant said

that nightmares and bad feelings had just happened for a

short time and after a while she had adjusted to her situation

and did not feel regrets any more. Facing unpleasant

consequences of induced abortion or getting pregnant again

were the main reasons that women felt regretful. However,

whether feeling regretful or not, they all felt a kind of

constant sorrow because they all believed that abortion was

an unethical an unreligious act. Warning others about

unwanted pregnancy and using secure contraception methods

after abortion are obvious signs of regret after abortion.

Based on Islamic rules, abortion after quickening is

forbidden even if there is a risk to mother’s physical or

mental health. However, abortion is allowed before quick-

ening if the pregnancy causes risks to the woman’s health;

this is because the mother has a conscious existence but the

foetus has not reached this position yet, and the mother’s life

comes before the vegetative life of foetus (Hosseyni 2006).

Socio-political consequences

Another result of illegal abortion is its socio-political conse-

quences. Social and political limitations cause women to have

hidden illegal abortion. They avoid going to government-

funded health centres after having an abortion to prevent

hospitalization, public disclosure, being blamed by their

S. Shahbazi et al.

62009 The Authors. Journal compilation 2009 Blackwell Publishing Ltd

families, having to pay large sums of money for the

healthcare, or because they are afraid of anaesthesia (Phet-

erson & Azize 2005).

Jewkes et al. (2005)

13 writes that, in South Africa, women

who cannot go to hospitals for abortion have only one other

option and this is self-abortion; the hospitals have long

waiting lists, which would take women into the second

trimester, or the services are too expensive. Another reason

that stopped women in our study from going to public health

centres for help was fear of the personnel’s reaction and

worrying about conﬁdentiality. Some of the women were

called murderers by nursing staff. Being questioned about

ethical issues related to abortion by nursing staff was one the

main reasons that women did not go to public health centres

for help. In fact, there were women who could have had a

legal abortion but instead tried induced abortion because they

were afraid of hospital personnel’s reactions. Therefore

hospital personnel’s beliefs and reactions have a strong

impact on women’s decision about their abortion method.

In the present study, most of the women who experienced

postabortion complications preferred tolerating pain to being

scolded by healthcare staff, and as a result delayed going to

hospital and tried to hide their induced abortions.

Rasch et al. (2004) claim that in countries where abortion

is illegal, women do not like to admit to induced abortion.

Also interviewing hospital personnel, Schuster (2005) found

that they found it hard to take a history from women with

induced abortion. Therefore, to encourage women to talk

about their induced abortions, it is necessary for healthcare

personnel to reassure them that all the information they give

will remain conﬁdential.

Some of our participants believed that women who had

temporary marriages (this is a kind of marriage in Iran in

which couples decide to stay together only for a limited time

and therefore the wife must not become pregnant during this

time) as well as unmarried girls would not be accepted in

hospitals easily and would be treated rudely by hospital staff.

However, one the obstetricians, who was in charge of the

gynaecology ward, denied this and said that such reactions

were rare and if they happened they were just to warn women

to be more careful.

Another postabortion problem discussed in this study was

disruption in sexual intercourse between spouses. A few

researchers have studied the effect of induced abortion on

relationships or sexual intercourse with spouses. Rasch et al.

(2004) reports that in more than 20% cases induced abortion

has a negative effect. Bradshaw and Slade (2003) stated that

there are different statistics regarding the effect of abortion

on relationships between couples. Some declared that after

abortion they have got more satisfaction and their sex appeal

has increased but it has decreased in some other and some

have reported no change. Fok et al. (2006) conducted a study

with 1040 Chinese women who had had an abortion and

found that 8–30% felt that they had a decrease in every

aspect of their desire for sex after abortion. In addition, desire

for sex and satisfaction in one third of these women were

affected. According to psychologists in our research, fear of

becoming pregnant again disrupts sexual intercourse. It

mostly affects women’s desire for sex and, in some cases,

both partners in the relationship.

Judicial consequences

Another sequel of illegal abortion is judicial consequence.

Based on our ﬁndings, there are no lawsuits regarding

postabortion complications in Iranian courts because this

would probably lead to legal penalties for the prosecutors. In

addition, because of the complicated judicial bureaucracy in

Iran, ﬁling a lawsuit only leaves the prosecutor with

emotional and physical exhaustion and has no other. Cook

et al. (2004) 14

believe that it is possible to devise appropriate

abortion laws, in view of the practical implications of

epidemiological, social scientiﬁc and healthcare research such

as studies of maternal deaths because of unwanted pregnan-

cies and induced abortion.

Modern thinking has changed views on abortion law from

a criminal punishment approach towards a protection and

health development approach (Cook et al. 2004). Many

Islamic countries have changed their abortion laws and

permitted abortion in necessary cases based on the new

perspective emanating from the WHO (Behjati Ardakani

et al. 2004). In Iran, abortion is legal when the life of either

mother or foetus is in danger or when judges conclude that it

is too difﬁcult for parents to have another baby because of

poverty or mental illness. Although these exceptions include

52 diseases, most abortions have other reasons which make

them a crime in the eyes of law.

In the present study, participants believed that there were

no lawsuits regarding postabortion complications in Iran

because induced abortion is illegal and is conducted secretly.

All of the medical team who participated in the study

believed that abortion was a crime, but only a few women

with abortion history believed this. In fact, women were

worried about ethical and emotional aspects of abortion

more than its legal aspects. This means that hiding induced

abortion is mainly related to social pressure rather than fear

of legal punishment. Unmarried girls and their families

especially never try to ﬁle a lawsuit because they do not

want to ruin their reputations. However, operators who

encourage women to keep their names and addresses secret

JAN: ORIGINAL RESEARCH Illegal abortions in Iran 1

2009 The Authors. Journal compilation 2009 Blackwell Publishing Ltd 7

and do not accept a patient for abortion without a recom-

mendation, are obviously afraid of legal punishment because

they conduct a procedure which is outside their professional

limits and is therefore against the law.

Conclusion

To revise abortion laws, real data are needed about unsan-

itary abortions and their complications. Therefore, it is

necessary to ﬁnd ways to encourage women to talk about

their reproductive health problems. Until possible legal

revisions based on Islamic principles and human ethics are

developed, it seems that preventing unwanted pregnancies

and giving appropriate support to women who unwillingly

become pregnant are the most practical solution; this could

have a positive effect on reducing these kinds of abortions

and their consequences.

Acknowledgement

We would like to thank all the participants for their help.

This research was funded by Isfahan University of Medical

Sciences.

Funding

This research received no speciﬁc grant from any funding

agency in the public, commercial, or not-for-proﬁt sectors.

Conﬂict of interest

No conﬂict of interest has been declared by the authors.

Author contributions

SS, NF and FT were responsible for the study conception and

design. SS performed the data collection. SS, NF and FT

performed the data analysis. SS were responsible for the

drafting of the manuscript. NF and FT made critical revisions

to the paper for important intellectual content. NF and FT

provided administrative, technical or material support. NF

and FT supervised the study.

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What is already known about this topic

•Despite the increase in effective and safe methods of

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•Induced abortion is a common procedure throughout

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