J. biosoc. Sci. (1976) 8, 287-292
ABORTION VIEWS AND PRACTICES AMONG DANISH FAMILY PHYSICIANS MICHALA GAMMELTOFT AND RONALD L. SOMERS Joint Center for Studies of Health Programs, Institute of Social Medicine, University of Copenhagen (Received 1st December 1975) Summary. Sixty-seven GPs from a suburb of Copenhagen were interviewed regarding their experience with and opinion of induced abortion. The younger physicians in the sample were (a) significantly more experienced in areas of medical practice relating to abortion care, (b) significantly more positive in their attitude towards abortion, and (c) significantly more likely to emphasize the provision of contraceptive services to women undergoing pregnancy termination. Independent of the influence of age, a significant positive correlation was found between abortion attitude and the emphasis placed on providing contraception. A physician's selfperceived success in providing post-abortion contraception was found to relate in part to his/her view of the proper role to be played by a GP in abortion cases. Introduction
In October 1973 the Danish Parliament put into effect a law allowing abortion on demand through the 12th week of pregnancy (Danish Government, 1973). Since that time the rate of legal induced abortion (i.e. the number of abortions performed per 1000 women aged 15-44) has increased dramatically, reaching a maximum of 6-45 per quarter in the most recent period for which statistics are available (West Andersen & Tanska, 1975). This increase undoubtedly has resulted, at least in part, from a decline in criminal abortions, and may also reflect a growing popularity of early induced abortion as a means of supplementing contraception. There is some evidence of a recent shift to less sure methods of contraception (Somers & Gammeltoft, 1976), which would imply, given the near constant birth rate of recent years, a greater need for abortion as a back-up method of fertility control. Removal of legal barriers to early induced abortion in Denmark, and the obvious effect that this has had on the provision of legal abortion, has sparked interest in the psychological and social factors which determine whether or not an individual woman will seek abortion services. With the creation of the WHO Task Force on Psycho-Social Aspects of Abortion, international attention has become increasingly focused on the influence which medical care providers may exert on the decisionmaking process of pregnant women. In Denmark, where essentially all women are 287
288
M. Gammeltoft and R. L. Somers
referred for hospital abortion by their family physician, it is natural to begin an investigation of the consumer-provider decision interaction at the office of the GP. The current study reports findings of the initial phase of a general enquiry into the psychosocial characteristics of abortion in Denmark; further findings will be related in subsequent accounts. For those readers not familiar with the Danish medical care system, it is important to note that (a) all legal abortions in Denmark are performed in hospitals and are provided without direct cost to the client, and (b) women who are 18 years of age or older cannot legally be denied access to induced abortion during the first 12 weeks of pregnancy. Method A list was obtained from the National Health Insurance System (Sygesikringen) of all the family physicians practising within the area served by Gentofte Hospital, located in a rather well-to-do suburb of Copenhagen. Using a random number table, 72 physicians (50% of those on the list), were selected as the study sample. Of these physicians, 67 were eventually interviewed; of the five who were not interviewed, three had stopped practising due to advanced age or illness, and two proved impossible to reach by telephone even after repeated attempts. Each physician was notified initially of the project through an introductory letter signed by the head of the Hospital's Department of Obstetrics and Gynaecology. Subsequent contact was made with each physician by telephone in order to arrange for an appointment. The interviews, which lasted an average of about 20 minutes, were all conducted by one of the authors (MG), who herself is a physician. Of the 67 interviews completed, 65 took place between the 25th April and the 1st June, 1975. Two interviews could not be accomplished until the middle of July due to the illness of the physicians involved. The interview schedule consisted of both closed and open-ended questions. Six questions were asked about the physician's education and experience regarding reproductive, social and psychiatric medicine. Included in this group were enquiries about the nature and length of obstetric-gynaecological training which the physician had had, whether the physician had ever worked in a hospital psychiatric department and for how long, whether the physician had participated in any post-graduate training programs in related subjects (e.g. contraception, sexology, psychology, public health, etc.) and the experience, if any, that the physician had in performing abortions within a hospital setting. Three questions were aimed at assessing the physician's attitude towards abortion. One of these questions concerned the physician's opinion of the new Danish abortion law during the time when its passage was still being debated. Another attitude question required the physician to agree or disagree with eight statements about proper grounds for abortion. A third question regarding attitude enquired as to whether the physician would consider performing abortions in his/her office if ever a risk-free method for doing so were developed. Three questions were included for the purpose of characterizing the physician's provision of contraceptive services to abortion-seeking women. These questions
Danish physicians: abortion views and practices
289
dealt with (a) the estimated proportion of women who, after having an abortion, return to the physician for contraceptive counselling, (b) whether or not the physician made special arrangements with abortion-seeking women to return for such counselling, and (c) whether or not the physician was accustomed to inserting IUDs for women who wanted to use this contraceptive method. Two questions were asked concerning the extent of influence that the physician perceived having on the decision-making process of abortion-seeking women. The interview schedule also contained an additional seventeen items which were directed at obtaining information about (a) the physician's personal situation (age, marital status, number of children, number of years in practice, etc.), (b) the physician's ideas about the proper role of GPs as regards abortion care, (c) the relative risk associated with induced abortion and childbirth, (d) the most common reasons which women present for desiring an induced abortion, and (e) the extent and nature of the abortion-related care which the physician customarily provides to pregnant women. The physicians as a group seemed very willing to co-operate with the investigation; the interviewer was able, with remarkably few exceptions, to obtain answers to all the questions which were posed. Results Frequency distributions Of the 67 physicians interviewed, 56 were male and 11 were female and the ages ranged from 32 to 71 years (mean, 52 years; SD, 9-4). The group on the whole was professionally well-established, the average number of years in practice being 17-8 (SD, 10-2). All but one physician in the sample had undergone some hospital training before settling into general practice. The mean length of such training was 6-5 years (SD, 3-8). Most of the group (85 %) had served in an obstetricgynaecology or a surgery-gynaecology department, although the particular characteristics of such departments and the length of employment therein were found to vary considerably. A smaller proportion (73 %) had actually performed induced abortions during their hospital training. Only 31 % of the physicians had served in a psychiatric department. The vast majority of the sample (96 %) were married, and on the average they had 2-3 children. Most of the physicians interviewed (81 %) claimed to have been in favour of the latest Danish abortion law during the time when its adoption was being debated in the parliament. Four physicians stated that they had become more positive and five indicated that they had become more negative towards abortion since the passage of the latest law. The remaining physicians declared that their attitude towards induced abortion had not changed significantly in response to the law. Only one physician was found to hold an overtly negative attitude towards induced abortion. Approximately one physician in three felt that GPs have some influence on the abortion decision-making process of women. The overwhelming majority (91 %) felt that women usually have made up their mind about having an abortion before coming to see their family physician. About half the physicians sampled had, in the previous 6 months, advised a woman to have an induced abortion, and about half the physicians stated that they had, in the same period, advised a woman to
290
M. Gammeltoft and R. L. Somers
abandon her wish for an induced abortion. Although GPs are legally required to inform women of the risks associated with induced abortion, many of the interviewed physicians volunteered that they down-played these risks because they did not want to scare pregnant clients who had decided in favour of termination. Of every six physicians queried, one felt that the risks of induced abortion were greater than the risks of childbirth, three were inclined to the opposite opinion, and two viewed the risks as essentially equal. Only 13 % of the physicians had, in the previous 6 months, seen a women who regretted having had an induced abortion. Correlations Scales were constructed whereby physicians could be given a single composite score in each of four areas of enquiry: (1) education and experience relating to reproductive, social and psychiatric medicine, (2) attitude towards abortion, (3) success with and emphasis on post-abortion contraceptive services, and (4) perceived influence on the abortion decision-making process. A formula was devised which appropriately weighted and combined the coded answers to the questions pertaining to each area of enquiry. In this way the responses of a physician to a series of related questions could be characterized with a single numerical value; this greatly facilitated the statistical analysis of the data. The scores in each area of enquiry, as well as those for certain single interview items (e.g. age), were ranked, and correlations between scores were determined using Kendall's rank correlation coefficient r (Kendall, 1970). The age of the physician was found to correlate significantly with many of the physician's abortion views and practices. Specifically, the younger physicians in the sample were (a) more experienced in areas of medical practice relating to abortion care (non-directional a level of significance P = 0-04), (b) more positive in their attitude towards abortion (P = 0-01), and (c) more likely to have success with and to emphasize the provision of post-abortion contraceptive services to women undergoing pregnancy termination (P = 0-0006). Physicians who had a positive attitude towards abortion were generally found to be those who perceived having greater success with, and who placed greater emphasis on, contraception (P = 0-0001); calculation of Kendall's partial rank correlation coefficient demonstrates that this latter relationship holds independent of the influence of age. Those physicians who felt that they met with greater success in their contraceptive efforts more frequently included as part of the GP's role in abortion care the function of 'information provider' (P = 0-005), while those physicians who perceived meeting with less success in providing contraceptive services more often mentioned 'arranger/referral source' when asked to characterize the GP's role (P = 0-02). No significant correlations could be found in the area of 'perceived influence on the abortion decision-making process'. Discussion As the first attempt to question Danish family physicians on their abortion views and practices, the present study was designed to be exploratory rather than definitive. There remains, of course, a need for further research, especially as regards more representative geographic and socio-economic settings. The results of this study
Danish physicians: abortion views and practices
291
must be considered as relatively 'soft', being simply the compilation of physicians' perceptions of their own feelings and actions without reference to second-party verification. An obvious methodological improvement would be to develop measures of client evaluation, and thus to compare, on an individual case basis, professional and consumer perceptions of abortion-related services. In this way, more objective assessments of professional influence on consumer choice could be made. To gain a better appreciation of the Danish GP's function in the area of pregnancy termination, it will be necessary to devise more sensitive instruments to examine the influence of role perception on the provision of services. The present study finds evidence for the notion that role perception influences contraceptive care, but there are likely to be many more behavioural manifestations of role perception yet to be detected. The effects of attitude on behaviour also deserve greater scrutiny. Numerous studies in Britain (Dennis (1971); Aitken-Swan (1971, 1973); Farmer (1971, 1973); McCance & McCance (1971); Olley (1973)) have demonstrated that physician behaviour in regard to abortion is idiosyncratic and subject to a diversity of attitudinal influences. Furthermore, the aetiology of attitude formation remains to be studied in greater detail. In the United States there have been several attempts to elucidate the possible relationship between various personal and professional characteristics of physicians and their proclivity to hold certain attitudes towards abortion. A questionnaire circulated widely in 1973 (Anon, 1973) found significant differences of opinion according to the physician's age, religion, and geographic area of residence. Serena et al. (1971), investigating the attitudes held by Michigan physicians towards their state's abortion laws, also report that age seemed to affect attitude. In the light of these findings it is not too surprising that in the present study physician age was determined to correlate significantly with abortion attitude. The high correlation which was found between a physician's provision of contraception and his/her attitude towards abortion might be taken as indicative of an underlying value system regarding fertility planning. The situation can be considered analogous to the high positive correlation between abortion experience and contraceptive experience which would be expected in populations where only some couples attempt to regulate their fertility (Tietze & Dawson, 1973, p. 5). Physicians who both favour abortion and encourage contraception can be regarded as having a greater desire to prevent unwanted births, as can women who utilize both contraception and induced abortion. In summary, then, the present study would seem to highlight a number of areas related to Danish abortion practice which are worthy of further investigation and refinement. Acknowledgments The authors wish to express their gratitude for the able assistance of their colleagues. Particular thanks are due to Mr Thomas W. Teasdale whose data processing greatly facilitated the statistical analysis. The research was supported generously by the Danish Medical Research Council, Sygekassernes Helsefond, and the George C. Marshall Memorial Fund in Denmark.
292
M. Gammeltoft and R. L. Somers References
ATTKEN-SWAN,
J. (1971) Some social characteristics of women seeking abortion. /. biosoc. Sci.
3,96. J. (1973) Epidemiological background. In: Experience with Abortion, A Case Study ofNorth-East Scotland. Edited by G. Horobin. Cambridge University Press, London. ANON (1973) 33,000 doctors speak out on abortion. Mod. Med. 14th May, 31. DENNIS, K. (1971) Indications for therapeutic abortion in Aberdeen, 1956-67. / . biosoc. Sci. 3, 101. FARMER, C. (1971) Mechanism of selection and decision-making in therapeutic abortion. /. biosoc. Sci. 3,121. FARMER, C. (1973) Decision-making in therapeutic abortion. In: Experience with Abortion, A Case Study of North-East Scotland. Edited by G. Horobin. Cambridge University Press, London. KENDALL, M. (1970) Rank Correlation Methods, 4th edn. Griffin, London. DANISH GOVERNMENT (1973) Law on Induced Abortion (Lov om svangerskabsafbrydelse) Government reprint of Law No. 350. MCCANCE, C. & MCCANCE, P. (1971) Abortion or no abortion—what decides? /. biosoc. Sci. 3, 116. OLLEY, P. (1973) Social and psychological characteristics at referral. In: Experience with Abortion, A Case Study of North-East Scotland. Edited by G. Horobin. Cambridge University Press, London. SERENA, B., SULLIVAN, P., STACK, J.M., SMITH, R. & ELIOT, J.W. (1971) Attitudes toward Michigan's abortion law. Mich. Med. 70,8. SOMERS, R. & GAMMELTOFT, M. (1976) The impact of liberalized abortion legislation on contraceptive practice in Denmark. Stud. Fam. Plann. (in press). TIETZE, C. & DAWSON, D. (1973) Induced abortion: a factbook. Rep. Popul. Fam. Plann. 14 (December). WEST ANDERSEN, K. & TANSKA, I. (1975) Legal abortion procedures in the third quarter 1974 (Legale abortindgreb ijuli kvartal 1974). Ugeskr. Lag. 137, 9. ATTKEN-SWAN,
ABORTION VIEWS AND PRACTICES AMONG DANISH FAMILY PHYSICIANS MICHALA GAMMELTOFT AND RONALD L. SOMERS Joint Center for Studies of Health Programs, Institute of Social Medicine, University of Copenhagen (Received 1st December 1975) Summary. Sixty-seven GPs from a suburb of Copenhagen were interviewed regarding their experience with and opinion of induced abortion. The younger physicians in the sample were (a) significantly more experienced in areas of medical practice relating to abortion care, (b) significantly more positive in their attitude towards abortion, and (c) significantly more likely to emphasize the provision of contraceptive services to women undergoing pregnancy termination. Independent of the influence of age, a significant positive correlation was found between abortion attitude and the emphasis placed on providing contraception. A physician's selfperceived success in providing post-abortion contraception was found to relate in part to his/her view of the proper role to be played by a GP in abortion cases. Introduction
In October 1973 the Danish Parliament put into effect a law allowing abortion on demand through the 12th week of pregnancy (Danish Government, 1973). Since that time the rate of legal induced abortion (i.e. the number of abortions performed per 1000 women aged 15-44) has increased dramatically, reaching a maximum of 6-45 per quarter in the most recent period for which statistics are available (West Andersen & Tanska, 1975). This increase undoubtedly has resulted, at least in part, from a decline in criminal abortions, and may also reflect a growing popularity of early induced abortion as a means of supplementing contraception. There is some evidence of a recent shift to less sure methods of contraception (Somers & Gammeltoft, 1976), which would imply, given the near constant birth rate of recent years, a greater need for abortion as a back-up method of fertility control. Removal of legal barriers to early induced abortion in Denmark, and the obvious effect that this has had on the provision of legal abortion, has sparked interest in the psychological and social factors which determine whether or not an individual woman will seek abortion services. With the creation of the WHO Task Force on Psycho-Social Aspects of Abortion, international attention has become increasingly focused on the influence which medical care providers may exert on the decisionmaking process of pregnant women. In Denmark, where essentially all women are 287
288
M. Gammeltoft and R. L. Somers
referred for hospital abortion by their family physician, it is natural to begin an investigation of the consumer-provider decision interaction at the office of the GP. The current study reports findings of the initial phase of a general enquiry into the psychosocial characteristics of abortion in Denmark; further findings will be related in subsequent accounts. For those readers not familiar with the Danish medical care system, it is important to note that (a) all legal abortions in Denmark are performed in hospitals and are provided without direct cost to the client, and (b) women who are 18 years of age or older cannot legally be denied access to induced abortion during the first 12 weeks of pregnancy. Method A list was obtained from the National Health Insurance System (Sygesikringen) of all the family physicians practising within the area served by Gentofte Hospital, located in a rather well-to-do suburb of Copenhagen. Using a random number table, 72 physicians (50% of those on the list), were selected as the study sample. Of these physicians, 67 were eventually interviewed; of the five who were not interviewed, three had stopped practising due to advanced age or illness, and two proved impossible to reach by telephone even after repeated attempts. Each physician was notified initially of the project through an introductory letter signed by the head of the Hospital's Department of Obstetrics and Gynaecology. Subsequent contact was made with each physician by telephone in order to arrange for an appointment. The interviews, which lasted an average of about 20 minutes, were all conducted by one of the authors (MG), who herself is a physician. Of the 67 interviews completed, 65 took place between the 25th April and the 1st June, 1975. Two interviews could not be accomplished until the middle of July due to the illness of the physicians involved. The interview schedule consisted of both closed and open-ended questions. Six questions were asked about the physician's education and experience regarding reproductive, social and psychiatric medicine. Included in this group were enquiries about the nature and length of obstetric-gynaecological training which the physician had had, whether the physician had ever worked in a hospital psychiatric department and for how long, whether the physician had participated in any post-graduate training programs in related subjects (e.g. contraception, sexology, psychology, public health, etc.) and the experience, if any, that the physician had in performing abortions within a hospital setting. Three questions were aimed at assessing the physician's attitude towards abortion. One of these questions concerned the physician's opinion of the new Danish abortion law during the time when its passage was still being debated. Another attitude question required the physician to agree or disagree with eight statements about proper grounds for abortion. A third question regarding attitude enquired as to whether the physician would consider performing abortions in his/her office if ever a risk-free method for doing so were developed. Three questions were included for the purpose of characterizing the physician's provision of contraceptive services to abortion-seeking women. These questions
Danish physicians: abortion views and practices
289
dealt with (a) the estimated proportion of women who, after having an abortion, return to the physician for contraceptive counselling, (b) whether or not the physician made special arrangements with abortion-seeking women to return for such counselling, and (c) whether or not the physician was accustomed to inserting IUDs for women who wanted to use this contraceptive method. Two questions were asked concerning the extent of influence that the physician perceived having on the decision-making process of abortion-seeking women. The interview schedule also contained an additional seventeen items which were directed at obtaining information about (a) the physician's personal situation (age, marital status, number of children, number of years in practice, etc.), (b) the physician's ideas about the proper role of GPs as regards abortion care, (c) the relative risk associated with induced abortion and childbirth, (d) the most common reasons which women present for desiring an induced abortion, and (e) the extent and nature of the abortion-related care which the physician customarily provides to pregnant women. The physicians as a group seemed very willing to co-operate with the investigation; the interviewer was able, with remarkably few exceptions, to obtain answers to all the questions which were posed. Results Frequency distributions Of the 67 physicians interviewed, 56 were male and 11 were female and the ages ranged from 32 to 71 years (mean, 52 years; SD, 9-4). The group on the whole was professionally well-established, the average number of years in practice being 17-8 (SD, 10-2). All but one physician in the sample had undergone some hospital training before settling into general practice. The mean length of such training was 6-5 years (SD, 3-8). Most of the group (85 %) had served in an obstetricgynaecology or a surgery-gynaecology department, although the particular characteristics of such departments and the length of employment therein were found to vary considerably. A smaller proportion (73 %) had actually performed induced abortions during their hospital training. Only 31 % of the physicians had served in a psychiatric department. The vast majority of the sample (96 %) were married, and on the average they had 2-3 children. Most of the physicians interviewed (81 %) claimed to have been in favour of the latest Danish abortion law during the time when its adoption was being debated in the parliament. Four physicians stated that they had become more positive and five indicated that they had become more negative towards abortion since the passage of the latest law. The remaining physicians declared that their attitude towards induced abortion had not changed significantly in response to the law. Only one physician was found to hold an overtly negative attitude towards induced abortion. Approximately one physician in three felt that GPs have some influence on the abortion decision-making process of women. The overwhelming majority (91 %) felt that women usually have made up their mind about having an abortion before coming to see their family physician. About half the physicians sampled had, in the previous 6 months, advised a woman to have an induced abortion, and about half the physicians stated that they had, in the same period, advised a woman to
290
M. Gammeltoft and R. L. Somers
abandon her wish for an induced abortion. Although GPs are legally required to inform women of the risks associated with induced abortion, many of the interviewed physicians volunteered that they down-played these risks because they did not want to scare pregnant clients who had decided in favour of termination. Of every six physicians queried, one felt that the risks of induced abortion were greater than the risks of childbirth, three were inclined to the opposite opinion, and two viewed the risks as essentially equal. Only 13 % of the physicians had, in the previous 6 months, seen a women who regretted having had an induced abortion. Correlations Scales were constructed whereby physicians could be given a single composite score in each of four areas of enquiry: (1) education and experience relating to reproductive, social and psychiatric medicine, (2) attitude towards abortion, (3) success with and emphasis on post-abortion contraceptive services, and (4) perceived influence on the abortion decision-making process. A formula was devised which appropriately weighted and combined the coded answers to the questions pertaining to each area of enquiry. In this way the responses of a physician to a series of related questions could be characterized with a single numerical value; this greatly facilitated the statistical analysis of the data. The scores in each area of enquiry, as well as those for certain single interview items (e.g. age), were ranked, and correlations between scores were determined using Kendall's rank correlation coefficient r (Kendall, 1970). The age of the physician was found to correlate significantly with many of the physician's abortion views and practices. Specifically, the younger physicians in the sample were (a) more experienced in areas of medical practice relating to abortion care (non-directional a level of significance P = 0-04), (b) more positive in their attitude towards abortion (P = 0-01), and (c) more likely to have success with and to emphasize the provision of post-abortion contraceptive services to women undergoing pregnancy termination (P = 0-0006). Physicians who had a positive attitude towards abortion were generally found to be those who perceived having greater success with, and who placed greater emphasis on, contraception (P = 0-0001); calculation of Kendall's partial rank correlation coefficient demonstrates that this latter relationship holds independent of the influence of age. Those physicians who felt that they met with greater success in their contraceptive efforts more frequently included as part of the GP's role in abortion care the function of 'information provider' (P = 0-005), while those physicians who perceived meeting with less success in providing contraceptive services more often mentioned 'arranger/referral source' when asked to characterize the GP's role (P = 0-02). No significant correlations could be found in the area of 'perceived influence on the abortion decision-making process'. Discussion As the first attempt to question Danish family physicians on their abortion views and practices, the present study was designed to be exploratory rather than definitive. There remains, of course, a need for further research, especially as regards more representative geographic and socio-economic settings. The results of this study
Danish physicians: abortion views and practices
291
must be considered as relatively 'soft', being simply the compilation of physicians' perceptions of their own feelings and actions without reference to second-party verification. An obvious methodological improvement would be to develop measures of client evaluation, and thus to compare, on an individual case basis, professional and consumer perceptions of abortion-related services. In this way, more objective assessments of professional influence on consumer choice could be made. To gain a better appreciation of the Danish GP's function in the area of pregnancy termination, it will be necessary to devise more sensitive instruments to examine the influence of role perception on the provision of services. The present study finds evidence for the notion that role perception influences contraceptive care, but there are likely to be many more behavioural manifestations of role perception yet to be detected. The effects of attitude on behaviour also deserve greater scrutiny. Numerous studies in Britain (Dennis (1971); Aitken-Swan (1971, 1973); Farmer (1971, 1973); McCance & McCance (1971); Olley (1973)) have demonstrated that physician behaviour in regard to abortion is idiosyncratic and subject to a diversity of attitudinal influences. Furthermore, the aetiology of attitude formation remains to be studied in greater detail. In the United States there have been several attempts to elucidate the possible relationship between various personal and professional characteristics of physicians and their proclivity to hold certain attitudes towards abortion. A questionnaire circulated widely in 1973 (Anon, 1973) found significant differences of opinion according to the physician's age, religion, and geographic area of residence. Serena et al. (1971), investigating the attitudes held by Michigan physicians towards their state's abortion laws, also report that age seemed to affect attitude. In the light of these findings it is not too surprising that in the present study physician age was determined to correlate significantly with abortion attitude. The high correlation which was found between a physician's provision of contraception and his/her attitude towards abortion might be taken as indicative of an underlying value system regarding fertility planning. The situation can be considered analogous to the high positive correlation between abortion experience and contraceptive experience which would be expected in populations where only some couples attempt to regulate their fertility (Tietze & Dawson, 1973, p. 5). Physicians who both favour abortion and encourage contraception can be regarded as having a greater desire to prevent unwanted births, as can women who utilize both contraception and induced abortion. In summary, then, the present study would seem to highlight a number of areas related to Danish abortion practice which are worthy of further investigation and refinement. Acknowledgments The authors wish to express their gratitude for the able assistance of their colleagues. Particular thanks are due to Mr Thomas W. Teasdale whose data processing greatly facilitated the statistical analysis. The research was supported generously by the Danish Medical Research Council, Sygekassernes Helsefond, and the George C. Marshall Memorial Fund in Denmark.
292
M. Gammeltoft and R. L. Somers References
ATTKEN-SWAN,
J. (1971) Some social characteristics of women seeking abortion. /. biosoc. Sci.
3,96. J. (1973) Epidemiological background. In: Experience with Abortion, A Case Study ofNorth-East Scotland. Edited by G. Horobin. Cambridge University Press, London. ANON (1973) 33,000 doctors speak out on abortion. Mod. Med. 14th May, 31. DENNIS, K. (1971) Indications for therapeutic abortion in Aberdeen, 1956-67. / . biosoc. Sci. 3, 101. FARMER, C. (1971) Mechanism of selection and decision-making in therapeutic abortion. /. biosoc. Sci. 3,121. FARMER, C. (1973) Decision-making in therapeutic abortion. In: Experience with Abortion, A Case Study of North-East Scotland. Edited by G. Horobin. Cambridge University Press, London. KENDALL, M. (1970) Rank Correlation Methods, 4th edn. Griffin, London. DANISH GOVERNMENT (1973) Law on Induced Abortion (Lov om svangerskabsafbrydelse) Government reprint of Law No. 350. MCCANCE, C. & MCCANCE, P. (1971) Abortion or no abortion—what decides? /. biosoc. Sci. 3, 116. OLLEY, P. (1973) Social and psychological characteristics at referral. In: Experience with Abortion, A Case Study of North-East Scotland. Edited by G. Horobin. Cambridge University Press, London. SERENA, B., SULLIVAN, P., STACK, J.M., SMITH, R. & ELIOT, J.W. (1971) Attitudes toward Michigan's abortion law. Mich. Med. 70,8. SOMERS, R. & GAMMELTOFT, M. (1976) The impact of liberalized abortion legislation on contraceptive practice in Denmark. Stud. Fam. Plann. (in press). TIETZE, C. & DAWSON, D. (1973) Induced abortion: a factbook. Rep. Popul. Fam. Plann. 14 (December). WEST ANDERSEN, K. & TANSKA, I. (1975) Legal abortion procedures in the third quarter 1974 (Legale abortindgreb ijuli kvartal 1974). Ugeskr. Lag. 137, 9. ATTKEN-SWAN,
