Strategic Studies of Culture

Strategic Studies of Culture

Decision-Making Process of Women Regarding Continuing Pregnancy or Abortion: A Qualitative Study in Tehran

Document Type : Original Article

Authors
Hajieh -bibi Razeghi -Nasrabad 1
Soheila Sadeghi Fassaei 2
1 Associate Professor of Demography, Faculty of Family Science, University of Tehran, Tehran, Iran. (Corresponding author)
2 Professor of Sociology, Faculty of Social Science, University of Tehran, Tehran, Iran
10.22083/scsj.2025.503422.1256
Abstract
Introduction: Globally, more than half of pregnancies are unintended or unplanned, and approximately two-fifths of these end in abortion (Lokubal et al., 2021; World Health Organization, 2021). In Iran, abortion is performed under conditions where intentional abortion is not legally permitted. In Shia jurisprudence, abortion is strictly considered “haram” (forbidden) except in exceptional cases and is equated with intentional murder (Razaghi Nasrabad & Sanjari, 2017; Rostami et al., 2013; Mohammadi, 2007). However, whether performed within legal frameworks or through illegal channels, the decision-making process and actions toward abortion require in-depth study. This issue cannot be limited to an individual woman’s decision alone; rather, various actors appear to play roles in this process, from gathering information to making decisions and ultimately either acting on abortion or refraining from it. Identifying the stages, actors, and mechanisms of abortion is the focus of this article, which aims to provide a deeper understanding of the decision-making and action process through a qualitative study.
Methods: The study adopted a qualitative approach using grounded theory methodology, with participatory observation and in-depth interviews as tools. The sample included 46 ever-married women in Tehran, identified through purposive and snowball sampling, as well as referrals to physicians and midwives in 2024. Some interviews were audio-recorded, while others were transcribed by the researcher during the interviews. Coding was conducted in three stages: open, axial, and selective. The validity and reliability of the research were ensured through four criteria: credibility, transferability, dependability, and confirmability.
Findings: Among the participants, 22 had experienced abortion: 10 unintentional and 11 intentional (illegal), with one participant having experienced both. The remaining participants had experienced unplanned pregnancies (unintended or mistimed). The decision-making process involved three stages: cognitive, decision-making, and action (either continuing or terminating the pregnancy). In the cognitive stage, individuals sought information about abortion from various sources, including social media, friends or acquaintances, physicians, and traditional healers. The choice of sources depended on pregnancy type (unintended or complicated), awareness of laws, personal or peer experiences, and socio-cultural context. For pregnancies threatening maternal or fetal health, medical professionals were the primary source. In unintended pregnancies, participants relied on diverse sources, including traditional healers, herbalists, and social networks-the latter being the most accessible and frequently cited resource, especially among women with recent unintended pregnancies. In the decision-making stage, two themes emerged: (1) “Reproductive decisions as a joint project with the spouse” and (2) “The dual role of family, physicians, and friends as inhibitors or facilitators.” These highlighted how collective actions and decisions within social networks sway individuals toward continuing or terminating pregnancies. Experiences of women who underwent abortion revealed two broad categories: (1) legal abortions, conducted under medical supervision in hygienic hospital settings, and (2) self-initiated abortions, pursued through unsafe, illegal channels without official support. Except for three cases, none sought post-abortion medical consultation or care. Some were advised by drug sellers to confirm uterine evacuation after one to two weeks. Those experiencing severe pain or bleeding post-abortion visited private clinics but avoided public hospitals due to fear of stigma, legal repercussions, or documentation in medical records.
Discussion and Conclusion: The decision-making process for abortion is complex and turbulent. After learning of a pregnancy, individuals combine information from diverse sources with personal values, fears, and familial circumstances. Social and familial networks critically influence decisions. In self-initiated abortions driven by personal choice, some women persisted despite severe risks-a reflection of socio-cultural pressures where preventing the birth of an unwanted child outweighs personal health consequences. These individuals felt so desperate that they disregarded potential abortion complications or their own well-being. Establishing formal platforms for accurate information on abortion consequences, stricter oversight of pregnancy-related advertisements, family support systems, and specialized counseling centers are essential to mitigate adverse physical and mental health outcomes.
Keywords
abortion
fertility
decision marking
family
Iran
Subjects
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