Thèses sur le sujet « Interruption of pregnancy »

La recherche explore les traces et remaniements du deuil prénatal au cours d'une grossesse suivant une Interruption Médicale de Grossesse (IMG) pour raison fœtale. Le statut du fœtus/bébé y est triplement complexe: entre humain et non humain sur le plan légal ; objet perceptible mais non directement visible dans la réalité matérielle ; à la fois prolongement narcissique et objet interne - partiel et potentiellement total dans la réalité psychique. Cet extrême paradoxe constitue un défi majeur du travail psychique du deuil prénatal. Selon le contexte culturel et les choix singuliers, maternels et paternels, face à ces possibles, les pratiques autours de sa mort seront différentes et aboutiront à des processus de deuil contrastés. Dans le cas particulier d'une IMG, l'expérience clinique nous invite à envisager deux aspects fondamentaux. D'un côté, la décision prise par la mère avec le choix qui s'impose à elle d'interrompre ou non la grossesse - et par là la vie du fœtus/bébé - interroge d'emblée ses éventuelles traces actualisées de culpabilité. De l'autre, être enceinte d'un fœtus porteur d'une pathologie grave représente pour la femme une blessure narcissique renvoyant au concept de honte. Dans leur articulation avec les processus narcissiques et objectaux, la honte et la culpabilité sont des prismes pertinents pour étudier les spécificités d'une grossesse suivant une IMG au cours de laquelle les liens entre objets internes, objets externes, sujet et groupe sont mis en exergue. Dans ce contexte, trois questions constituent la problématique de cette étude: le mode d'investissement du fœtus/bébé décédé est-il réactualisé par l'investissement du fœtus/bébé de la grossesse actuelle ? La grossesse active-t-elle de manière particulières des traces de honte et de culpabilité que nous nommons pour les singulariser vivances ? De quelle façon ces vivances s'articulent-elles avec les mouvements psychiques de la femme dans les processus de deuil ? Méthodologie: Cette recherche qualitative se réfère à une méthodologie hypothético-déductive et s'inscrit dans un référentiel psychanalytique. La population est constituée de 11 femmes (primipares et multipares) enceintes après avoir vécu une IMG pour raison fœtale après 15 Semaines d'Aménorrhée (SA). Des entretiens semi-structurés ont été menés auprès de ces femmes aux trois trimestres de la grossesse. Elles ont également rempli des auto-questionnaires à chaque temps de la recherche (PAI, PGS, EPDS, STAI, DAS, PCLS). L'analyse des entretiens, audio-enregistrés, croise une observation approfondie de chaque cas avec une analyse de contenu thématique, prenant en compte le vécu subjectif de chaque femme, afin de répondre aux hypothèses de recherche. Résultats : Les résultats mettent en avant une réactualisation du processus de deuil au cours de la grossesse suivante. Ils vont dans le sens de la confirmation de la portée heuristique et clinique de l'étude de la honte et de la culpabilité lors d'une grossesse suivant une IMG. La honte se manifeste chez ces femmes par des vécus de dévoilement et d'exclusion, un sentiment de perte de contrôle, voire d'emprise, et un vécu d'échec et d'indignité. L'élaboration des vivances de honte est un bon marqueur de la possible résolution des dimensions narcissiques et développementales du processus de deuil. La culpabilité est très présente, en lien avec la pathologie fœtale, la décision d'interrompre la grossesse et vis-à-vis du bébé de la grossesse actuelle. Dans ce contexte, la honte et la culpabilité sont à comprendre comme les deux pôles d'un gradient continu. Sur le terrain périnatal, l'articulation sémiologique et psychopathologique de la dialectisation entre honte et culpabilité lors d'une grossesse suivant une IMG, permet de donner des repères cliniquement organisateurs dans le cadre d'une prévention transdisciplinaire médico-psycho-sociale des troubles de la parentalité et des dysharmonies relationnelles précoces
The aim of this research is to explore the traces and updates of prenatal grief during a pregnancy subsequent to a Medical Termination of Pregnancy (MTP). The status of the fetus is triply complex: between human and non-human on a legal dimension ; perceptible object but that cannot directly be seen in the plan of material reality; both narcissistic extension and internal object - partial and potentially total - in psychic reality. This extreme paradox is the major challenge of the psychic work during prenatal bereavement. Depending on the cultural background and singular maternal and paternal choices among those possibilities, the practices surrounding the death of the baby will be different and lead to contrasting grieving processes. In the particular case of MTP, the clinical experience leads us to consider two fundamental aspects. On one hand, the decision taken by the mother with the choice that she has to make to interrupt the pregnancy or not - and thereby the fetus/baby's life - questions on possibles feelings of guilt. From the other hand, being pregnant with a fetus with a severe pathology represents a narcissistic injury referring to the concept of shame. Shame and guilt, because of their relationship with narcissistic and object-relation processes seem to be quite relevant to study the specificities of a pregnancy following a MTP. In this context, three main questions constitutes the problematic of this study : Is the investment of the dead fetus/baby updated by the investment of the current fetus/baby ? Is the pregnancy activating in a particular way feelings of shame and guilt ? What is the articulation of these feelings with the grieving process ? Methodology: This qualitative research refers to a hypothetical-deductive method and lays on a psychoanalytic background. Our population is composed with 11 women (primiparous and multiparous) pregnant after a MTP for fetal reasons occurred after 15 weeks of amenorrhea (WA). Semi-structured interviews were conducted on the three trimestre of the pregnancy. They also each time completed self-questionnaires (PAI, PGS, EPDS, STAI, DAS, PCLS). The analysis of the interviews, that were recorded, crosses a thorough observation of each case with a thematic content analysis, taking into account the subjective experience of each woman, in order to answer the research hypotheses. Results: The results highlight an updating of the grieving process during the following pregnancy. They are in line with the confirmation of the heuristic and clinical significance of the study of shame and guilt in a pregnancy following a MTP. For these women, shame is manifested by a feeling of unveiling and exclusion, loss of control, and an experience of failure and unworthiness. The elaboration of shame is a good marker for possible resolution of narcissistic and developmental dimensions of the grieving process. Guilt is very present, connected with fetal pathology, the decision to terminate the pregnancy and towards the baby of the current pregnancy. Shame and guilt can be understood as the two poles of a continuous gradient. Their study in the context of a pregnancy following a medically terminated one makes possible to offer pertinent semiological and psychopathological markers in the framework of primary and secondary prevention of troubles in parentality and in early relational dysharmonies

The doctoral thesis deepens, through comparative law, the topic of conscientious objection to interruption of pregnancy in Italy, Spain and Mexico (Mexico City). The legal theoretical framework lies at the crossroad between the need to maintain pluralism and conscientious objection and the need to guarantee access to a public service. The dissertation is divided into three main sections. The first section provides definitions and contextualizes freedom of conscience and conscientious objection within the constitutional traditions and the regional systems of protection of human rights (the European Court of Human Rights and the Inter-American Court of Human Rights). The second section faces conscientious objections in the field of interruption of pregnancy, describing the evolution of national laws, the jurisprudence and the most recent reforms. Therefore, it identifies the main problems related to the application of these laws, trying to explain the reasons of the social resistance and the still controversial nature. The third and last part describes the fragilities of the current accommodation system and proposes some corrections, in order to build a sustainable model of conscientious objection.

PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO
CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO
O presente estudo busca analisar as concepções e atuações dos assistentes sociais na atenção às mulheres com demanda por interrupção da gestação prevista em lei e nos serviços de saúde do município do Rio de Janeiro que são referência para o atendimento às mulheres em situação de violência sexual. Trata-se de uma pesquisa com abordagem qualitativa, cujos instrumentos utilizados para produção de dados foram a análise de documentação institucional e a entrevista do tipo semiestruturada, realizada com nove assistentes sociais, todas do sexo feminino, que trabalham em três maternidades que atendem mulheres em situação de violência sexual. As entrevistas foram gravadas em MP3 com o consentimento das entrevistadas, nos meses de fevereiro e março de 2014, e tiveram duração total de 206 minutos. Para discussão dos dados utilizou-se a análise de conteúdo em sua modalidade temática. Os resultados apontam para uma invisibilidade tanto pública quanto interna desse tipo de serviço no município estudado, limitando o acesso das mulheres a esse direito assegurado por lei. Prevalece, dentre os sujeitos da pesquisa, uma concepção da interrupção da gestação prevista em lei como um direito da mulher e de que o assistente social deve envidar todos os esforços para sua garantia, apesar de enfrentar dificuldades como a ausência de preparo e abordagem sobre a temática durante a graduação e o desconhecimento em relação à legislação vigente sobre o aborto legal e a forte influência dos valores ético-religiosos na postura dos profissionais de saúde que comprometem o acesso das mulheres a esse direito.
This study assesses the views and actions of social workers in the care of women with demand for termination of pregnancy provided for by law in the health services in the city of Rio de Janeiro that are reference to the assistance to women in situations of sexual violence. This is a research with qualitative approach, whose instruments used for the production of data was the institutional analysis and documentation of the semi-structured interview of the type held with nine social workers, all female, working in three hospitals that serve women in situation of sexual violence in the city of Rio de Janeiro. The interviews were recorded in MP3 with the consent of the interviewees in the months of February and March 2014 and had total duration of 206 minutes. For discussion the data use the content analyses the subject modality. The result shows a public and intern invisibility for this services in this municipality, with limitate the women access for a law right. The research subjects prevalence a conception the pregnancy interruption previous in law with a woman right and the social work obligation to guarantee this right, despite the social workers have some difficulties like no prepare or approach during the graduation about this subject and unknowing with current legislation about legal abortion and an ethical religious values influences the health professional attitude and implicate the women access a this right.

O desenvolvimento tecnológico contemporâneo permite a detecção precoce de malformações fetais, tais como a anencefalia, que inviabilizam a sobrevivência do bebê. Tal constatação implica imediata revelação diagnóstica aos pais, que deverão decidir pela continuidade ou interrupção da gravidez. O presente trabalho tem como objetivo investigar a experiência emocional de casais que se deparam com o diagnóstico de anencefalia fetal, tendo em vista trazer subsídios para um melhor atendimento psicológico. A investigação organizou-se como pesquisa qualitativa, com método psicanalítico, estruturada ao redor de procedimentos investigativos de acesso, registro, interpretação e interlocuções reflexivas sobre atendimentos clínicos. A partir de sessões com casais parentais, realizadas ao longo de oito anos, foram elaboradas duas narrativas transferenciais ficcionais, que preservam elementos essenciais da dramática em pauta. Uma das narrativas aborda uma situação de opção por interrupção gestacional, enquanto a outra focaliza uma decisão de continuidade. Os procedimentos interpretativos permitiram a \"criação/encontro\" dos seguintes campos de sentido afetivo-emocional ou inconscientes relativos: É um pesadelo?, Quem ou o quê está aí?, É preciso decidir. O quadro geral aponta que grande parte do trabalho clínico tem lugar num campo bastante singular, É preciso decidir, que se define pela urgência de tomada de decisão relativa à eventual interrupção de processos vitais. O campo É um pesadelo? aponta para o fato deste tipo de revelação diagnóstica, derivada do uso de uma tecnologia, que detecta problemas que não estão sendo vivenciados como sinais ou sintomas físicos, gerar muito frequentemente reações dissociativas, cujo manejo torna-se, assim, clinicamente indispensável. O outro campo, Quem ou o quê está aí?, assume uma posição de centralidade, nesta clínica, na medida em que porta consigo uma interrogação radical acerca do estatuto ontológico do feto, vivido como um bebê ou como um não-bebê. Uma compreensão sensível e atenta acerca dos diferentes modos como cada casal habita este campo parece fundamental para a provisão de um cuidado psicoterapêutico
The contemporary technological development allows the early detection of fetal malformations, such as anencephaly, which makes the babys survival unfeasible. This assumption leads to the immediate revelation of the diagnosis to the parents who will decide either to continue or interrupt the pregnancy. This paper focuses on the investigation of the emotional experience that couples have when facing a fetal anencephaly diagnosis, bringing instruments for a better psychological care. The investigation process was organized as a qualitative research, through psychoanalytic approach, based on the investigation procedures of access, register, interpretation and reflexive interlocution on clinical care sessions. From the sessions with couples, during eight years, two transferential fictional narratives, that preserve essential elements of drama at stake, were created. One of the narratives approaches a situation of choice for pregnancy interruption, while the other aims at the decision to keep it. The interpretative procedures allowed the \"creation / finding\" of the following fields of affective-emotional sense or relative unconscious: Is it a nightmare?, Who or what is there?, We have to make a decision. The big picture shows that great part of the clinical work takes place in a singular field, We have to make a decision, defined by the sense of urgency around the decision about the eventual interruption of vital processes. The field Is it a nightmare? leads to the fact that this kind of diagnosis revelation, derived from the technology which detects problems that were not being lived as physical signals or symptoms, frequently generates dissociative reactions, making the clinical care mandatory. The other field Who or what is there? has a central role, in this clinic, as soon as it contains an extreme question around the fetuss ontological statute, being a baby or a non-baby. A sensible and attentive comprehension of the different ways in which couples deal with this field is essential for a psychotherapeutic care

L'objet de ce travail est d'analyser l'évolution du processus de deuil lors d'une grossesse suivant une interruption médicale de grossesse (IMG). 8461 enfants sont nés sans vie en France en 2012 et 59 à 86% des femmes démarre,t une nouvelle grossesse dans les 6 mois suivant la perte; le deuil périnatal constitue un problème de santé publique puisque 25% évoluent vers un deuil pathologique. Le statut de l'objet perdu et la représentation que s'en font les mères participent du destin de ce foetus perdu; l'évolution des pratiques favorisant l'humanisation du foetus et l'objectalisation de ce dernier est critiquée par certains auteurs. Nous relevons un maque de consensus dans la littérature sur l'impact de cette nouvelle grossesse sur le processus de deuil; selon certains, elle pourrait interrompre le travail de deuil, pour d'autres au contraire favoriser une reprise élaborative. Ces grossesses suivantes, teintées du deuil, semblent représenter un facteur de risque dans l'attachement prénatal avec des conséquences sur le lien à l'enfant puîné. Nous interrogeons donc la relation entre le processus de deuil périnatal et le processus d'investissement de l'enfant à venir lors d'une grossesse suivante. Méthodologie utilisée: suivi longitudinal de 7 femmes enceintes lors d'une grossesse suivant une IMG après 15 SA, aux 3 trimestres de la grossesse et aux 3 mois de l'enfant suivant, selon une analyse qualitative au moyen d'entretiens de recherche clinique et une analyse quantitative de la dépression (EPDS), anxiété (STAI), deuil périnatal (PGS) et attachement prénatal (PAI) au moyen d'autoquestionnaires. Les résultats qualitatifs, traités de façon singulière selon une analyse psychodynamique, sont regroupés ensuite en fonction de nos hypothèses. Les résultats quantitatifs sont intégrés dans un corpus plus large pour permettre une analyse statistique des données. Résultats: entre le normal et le pathologique, les affects, les émotions, les représentations oscillent sur ce continuum, au fil de la grossesse, des termes et dates anniversaires, des manifestations sensorielles éprouvées. La grossesse suivante permet de revisiter la grossesse précédente; elle donne l'opportunité aux mères endeuillées de mettre en mots les affects brutes consécutifs à la perte, de mettre du sens pour inscrire cet événement traumatique dans l'histoire individuelle, conjugale et familiale. Certaines patientes, pour qui le travail de deuil pouvait sembler figé, ont pu mettre la transparence psychique de cette nouvelle grossesse à profit pour ré-élaborer la perte précédente et donner une juste place à chacun des deux bébés. L'actualisation du processus de deuil lors de la grossesse suivante sera fonction de la structure psychique des patientes; la dépression et l'angoisse sont également des marqueurs de l'élaboration de la perte et de la place faite à l'enfant puîné. L'analyse quantitative des données statistiques montre la présence d'anxiété particulièrement au début de la grossesse suivante
The objet of this work is to analyze the evolution of the process of mourning during a pregnancy following a termination of pregnancy (TOP). 8461 children were born dead in France in 2012 and 59 to 86% of women start a new pregnancy in the six months following the loss; the perinatal mourning constitutes a problem of public health because 25% lead to a pathological mourning. The status of the lost object and maternal representations participate in the fate this lost foetus. The evolution of the practices favoring the humanization of the foetus and the objectalisation of the latter is criticized by some authors. We find a lack of consensus in the literature on the impact of this new pregnancy on the process of mourning. According to certain authors, she could interrupt the work of mourning, for others on the contrary, favor a elaborative resumption. These following pregnancies, tinged with the mourning, seem to represent a risk factor in the prenatal attachment with consequences on the link to the puisne child. We thus question the relation between the process of perinatal mourning and the process of investment of the child coming during a following pregnancy. Used methodology: longitudinal follow-up of seven pregnant women during pregnancy following a TOP after 15 weeks, three times during the pregnancy and at three months after the birth of the subsequent child according to a qualitative analysis (interview of clinical research) and a quantitative analysis of depression (EPDS), anxiety (STAI), perinatal mourning (PGS) and prenatal attachment (PAI) by means of auto-questionnaires. The qualitative results, treated in a singular way according to a psychodynamic analysis, are then included according to our hypotheses. The quantitative results are integrated into a wier corpus to allow statistical analysis of the data. Results: between the normal and the pathological, affects, feelings and representations oscillate on this continuum, in the course of the pregnancy, the terms and anniversaries, the proven sensory demonstrations. The following pregnancy allows to revisit the previous pregnancy; she gives the opportunity to the mothers saddened to put into words the gross affects consecutive to the loss, to put of the sens to register this traumatic event in the individual, conjugal, and family history. Somme women,for whom the work of mourning could seem motionless, were able to put the psychic transparency of this new pregnancy in profit to redevelop the previous loss and to give a just place to each of both babies. The updating of the process of mourning during the following pregnancy will be function of the psychic structure of the woman. The depression and the anxiety are also markers of the elaboration of the loss and the place made for the puisne child. The quantitaive analysis of the statistical data shows the presence of anxiety, particularly at the begining of the following pregnancy

Les études sur les couples traités par fécondation in vitro (FIV) ont jusqu'à présent porté essentiellement sur l'évaluation du succès en FIV. Très peu de données sont disponibles sur le devenir à long terme de couples traités par FIV. L'objectif de ce travail était d'estimer la fréquence de réalisation du projet parental à long terme, et d'étudier les facteurs associés aux interruptions précoces des traitements et aux naissances naturelles.L'enquête DAIFI-2009 a inclus 6 507 couples ayant débuté un programme de FIV en 2000-2002 dans l'un des 8 centres de FIV participant à l'étude. Les données médicales des couples et leur parcours dans le centre ont été obtenus à partir des dossiers médicaux des centres de FIV pour tous les couples. L'information sur le devenir des couples après le départ du centre a été obtenue par questionnaire postal auprès des couples en 2008-2009 (38% de participation 7 à 9 ans après l'initiation des FIV). L'étude des facteurs associés à la participation à l'enquête postale suggérait que la fréquence de réalisation du projet parental estimée sur les répondants seulement pourrait être biaisée. Les différentes méthodes mises en œuvre pour corriger la non réponse (pondération, imputation multiple) n'ont pas modifié l'estimation de la fréquence de réalisation du projet parental. Au total, 7 à 9 ans après l'initiation des FIV, 60% des couples ont réalisé leur projet parental de façon biologique, suite à un traitement ou suite à une conception naturelle. Lorsque les adoptions sont aussi prises en compte, 71% des couples ont réalisé leur projet parental. Après l'échec d'une première tentative de FIV, un couple sur 4 (26%) a interrompu les FIV dans le centre d'inclusion. Globalement, les couples avec de mauvais facteurs pronostiques ont un plus grand risque d'interrompre les FIV. Cependant, la proportion plus importante d'interruption parmi les couples avec une origine inexpliquée de l'infécondité pourrait s'expliquer par la survenue plus fréquente de naissance naturelle dans ce sous-groupe de couples. Parmi les couples n'ayant pas eu d'enfant suite aux traitements, 24% ont ensuite conçu naturellement en médiane 28 mois après l'initiation des FIV. Parmi les couples ayant eu un enfant suite aux traitements, 17% ont ensuite conçu naturellement en médiane 33 mois après la naissance de l'enfant conçu par AMP. Les facteurs associés aux naissances naturelles sont des indicateurs d'un meilleur pronostic de fertilité, particulièrement chez les couples sans enfant AMP.L'enquête DAIFI-2009 a permis d'apporter des informations sur le parcours à long terme des couples traités par FIV qui n'avait jusqu'à présent été que peu étudié, souvent sur de faibles effectifs et avec un suivi plus court. Ces résultats doivent apporter de l'espoir aux couples inféconds, puisque la majorité d'entre eux ont finalement réalisé leur projet parental, même si cela peut prendre de nombreuses années.

El objetivo principal del estudio fue describir la evolución del proceso de duelo y la sintomatología depresiva a lo largo de un año después de haber sufrido una pérdida perinatal y estudiar qué factores se asocian a unos peores/mejores resultados a largo plazo. Se contactó con 125 mujeres que habían sufrido una pérdida perinatal y fueron atendidas en el Hospital de la Vall d’Hebron. Se establecieron dos grupos según el tipo de pérdida: interrupción médica del embarazo (IME) y muerte prenatal/postnatal. Se realizaron tres evaluaciones tras la pérdida: al mes, a los 6 meses y al año. Setenta mujeres participaron en el primer seguimiento, 46 en el segundo y 41 en el tercero. Se utilizaron tres instrumentos: la versión reducida de la Perinatal Grief Scale (PGS), que evalúa aspectos específicos del duelo perinatal; el Beck Depression Inventory (BDI) que valora sintomatología depresiva; y la Dyadic Adjustment Scale (DAS) que mide aspectos relativos a la satisfacción marital. Los principales resultados del estudio fueron la presencia de sintomatología propia del duelo (PGS) y depresiva (BDI), sobre todo en el primer tiempo tras la pérdida y la disminución progresiva de las puntuaciones en la escala de duelo a lo largo de los seguimientos. Se observó una asociación positiva entre las puntuaciones de las subescalas Dificultades de afrontamiento al mes y Desesperanza del primer tiempo y las puntuaciones totales de duelo a más largo plazo. No se observó una relación estadísticamente significativa entre los factores socioeconómicos, los antecedentes mentales previos, la satisfacción marital y las variables asistenciales respecto a las puntuaciones de la PGS y el BDI. Tampoco se encontró relación entre la historia obstétrica ni respecto a las semanas de gestación en que se produjo la pérdida y las respuestas estudiadas, a excepción de las semanas de gestación y las puntuaciones del BDI al mes. La asociación entre quedarse embarazada durante el estudio y la evolución en cuanto al duelo y la depresión no fue estadísticamente significativa, aunque el grupo de mujeres embarazadas mostró puntuaciones ligeramente más altas. Respecto al tipo de pérdida, no se observaron diferencias estadísticamente significativas entre los dos grupos considerados y las puntuaciones de las escalas de duelo y depresión, aunque el grupo de muertes pre/postnatales tenía una media de puntuaciones mayor en la PGS al mes y a los 6 meses, mientras que al año las puntuaciones diferían poco e incluso eran ligeramente más altas para el grupo de mujeres que habían hecho una interrupción. En este mismo grupo, el pronóstico de la malformación tampoco se asoció significativamente con la evolución del duelo y la sintomatología depresiva. La variable ver al hijo resultó ser un aspecto controvertido, pues en el grupo de mujeres que sufrieron una IME la media de puntuaciones en las escalas de duelo y depresión al año era mayor para las que habían decidido verlo. Algunos resultados del estudio apoyan los resultados obtenidos en otras investigaciones, tales como que el duelo perinatal sigue el mismo curso que otros duelos; no se observan diferencias significativas en función del tipo de pérdida; la mayoría de mujeres están satisfechas con la asistencia médica recibida y que un pobre ajuste marital está relacionado con puntuaciones más altas de duelo y sintomatología depresiva. Aspectos como ver al hijo, son susceptibles de ser estudiados en un futuro debido al impacto que provocan en la mujer y a los hallazgos encontrados. A modo de conclusión general se ha de destacar que el duelo perinatal es un constructo complejo, con múltiples variables implicadas, que comporta malestar significativo.
The main objective of the study was to describe the evolution of the grieving process and the depressive symptomatology over one year, after having suffered a perinatal loss and to determine factors associated with the best/worst long-term results. We contacted 125 women who had undergone a perinatal loss and who had been treated at the Hospital in Vall d’Hebron. Two groups were formed according to the type of loss: medical termination of pregnancy (MTP) and prenatal/postnatal death. Three assessments were carried out after the loss: at one month, 6 months and one year. Seventy women participated in the first follow-up, 46 in the second and 41 in the third. Three instruments were used: the short version of the Perinatal Grief Scale (PGS) which assesses specific aspects of perinatal bereavement; the Beck Depression Inventory (BDI) which assesses depressive symptomatology, and the Dyadic Adjustment Scale (DAS) which measures aspects of marital satisfaction. The main results of the study were the presence of symptoms that are characteristic of grief (PGS) and depression (BDI), especially in the first period after the loss, as well as a progressive reduction in scores on the grief scale over all three periods. A positive association between the subscale scores of Difficulties of coping at one month and Hopelessness during the first period, and the total scores of grief at a longer term was observed. No statistically significant relationship between socioeconomic factors, previous mental history, marital satisfaction and assistance variables regarding PGS scores and BDI was observed. Neither was a relationship with the obstetric history observed, nor one regarding the pregnancy week in which the loss occurred and the responses studied, except for one between the weeks of pregnancy and BDI scores at one month. The association between becoming pregnant during the study and evolution of the grieving and depression was not statistically significant, although the group of pregnant women showed slightly higher scores. Regarding the type of loss, no statistically significant differences between the two groups and the scores of the scales of grief and depression were observed, although the pre/postnatal death group had higher mean scores for PGS at one month and at six months, whereas the scores at one year differed little and were even slightly higher for the group of women who had terminated. In this group, the prognosis of the malformation was not significantly associated with the evolution of grieving and depressive symptomatology. The variable 'seeing the child' proved to be a controversial issue: the average scores for the group of women who had suffered an MTP on the scales of grief and depression at one year was higher for those who had decided to see it. Some results of the study support the results of other investigations, such as the finding that perinatal grief follows the same course as other grief; there are no significant differences in the type of loss; most women are satisfied with the medical care received and that a poor marital relationship is associated with higher scores of grief and depressive symptomatology. Aspects such as 'seeing the child' are likely to be studied in the future because of the impact they have on women and the findings. As a general conclusion is worth noting that perinatal grief is a complex construct, that involves multiple variables and which entails significant distress.

Cette thèse analyse les pratiques du diagnostic prénatal (DPN) en France et au Brésil, entre mondialisation des savoirs et des techniques et régulations locales, à la recherche des modalités d’anticipation du handicap. Le DPN s’est développé dans les pays d’Europe et d’Amérique du Nord en lien direct avec les législations sur l’avortement. Il a pris ancrage dans le suivi des grossesses comme l’un des modes de prévention des handicaps à la naissance. Son expansion aux pays où l’accès à l’avortement est restreint oblige à des adaptations fonction des régulations locales. Les dispositifs réglementaires encadrent le travail professionnel (travail en réseau, pluridisciplinarité) et l’enregistrement des pratiques (omniprésent en France, absent au Brésil). Ils modulent, en France, l’expérience des femmes ayant vécu une interruption de grossesse pour pathologie fœtale, comme en témoigne l’analyse de questionnaires semi directifs soumis à deux groupes de femmes à deux époques différentes. En 1999 les femmes réclament plus d’autonomie dans la prise de décision d’interruption. En 2005, elles sollicitent plus volontiers une décision partagée avec les praticiens, mais considèrent que la décision leur revient plus spécifiquement lors des termes tardifs, dans les situations à risque de retard mental, de grande incertitude pronostique, ainsi que dans le cadre de situations spécifiquement recherchées lors du parcours anténatal (telle la trisomie 21). Ces dispositifs réglementaires conditionnent aussi l’usage des techniques et les informations délivrées aux couples. Au Brésil, dans un contexte d’accès restreint à l’avortement et de fortes inégalités sociales, l’échographie en situation de normalité foetale glorifie la « naissance sociale anticipée» de l’enfant et de sa famille. En cas d’anomalie fœtale, une rupture radicale se produit. A l’hôpital public, qui concerne la majorité des femmes, la poursuite obligée de la grossesse règle l’attitude des praticiens : l’étude ethnographique menée à Rio de Janeiro montre que les obstétriciens optent alors pour l’éducation des femmes (dans l’espoir d’un accès progressif à l’autonomie, chemin espéré vers une société plus juste). Les pédiatres provoquent pour leur part un glissement sémantique proposant une utilisation positive de l’incertitude médicale qui modifie le cadre de la réflexion préservant une approche dynamique de l’accueil de l’enfant. Dans le secteur privé au Brésil, les interruptions de grossesse possibles hors des cadres légaux, sont maintenues sous le sceau du secret et ne laissent que peu entrevoir la dynamique décisionnelle préalable. L’anticipation du handicap lors des consultations prénatales met partout en avant la crainte du retard mental et de la souffrance pour l’enfant, le couple ou la fratrie, mais le discours varie selon les contextes : l’analyse comparative des observations souligne qu’en France, les praticiens utilisent la médecine basée sur les preuves pour informer le couple et réduire risques et incertitude en vue d’un choix nécessaire et dans le respect de l’autonomie décisionnelle des couples. Au Brésil, à l’hôpital public, la hiérarchie des priorités diffère: devenir mère, avoir un enfant vivant passent au premier plan. Le risque est présenté comme faisant partie de la vie et l’incertitude dynamique préserve l’avenir de l’enfant malade au sein de sa famille. Ces approches différenciées du risque et du handicap amènent à évoquer les évolutions récentes du champs du handicap qui ont peu pénétré l’univers du DPN. Portées notamment par les « disability studies », études menées par les personnes elles mêmes concernées par le handicap, elles considèrent le handicap comme un processus dynamique résultant d’une interaction entre l’état de santé et une situation sociale donnés. La thèse suggère en conclusion un rapprochement des savoirs, des expériences et des pratiques entre l’univers du prénatal et celui du handicap par le biais d’un dialogue inter et transdisciplinaire
In search of modes of anticipating disability, this thesis examines and compares prenatal diagnosis (PND) practices in France and Brazil. In Europe and North America, PND has developed directly in line with legislation on abortion and is rooted in the monitoring of pregnancy, as one of the ways of preventing disability at birth. Its expansion into countries where access to abortion is restricted, is led by the globalization of knowledge and techniques, and has to be adapted to suit local regulations. Regulatory frameworks govern professional work (networking, multidisciplinarity) and the recording of PND practices (omnipresent in France, non-Existent in Brazil). As can be seen from our analysis of semi-Directive questionnaires given to two groups of women at two different periods of time, in France such mechanisms modulate the experiences of women who have undergone an abortion due to a foetal pathology. In 1999 women wanted greater autonomy when deciding whether or not to terminate a pregnancy. In 2005 they were more readily in favour of sharing decision-Making with doctors, but felt that the decision was theirs to make when it was a question of late-Term pregnancies, of situations with a risk of mental retardation, of major prognostic uncertainty, and of situations subject to specific tests during the prenatal period (such as Down’s Syndrome). These regulatory mechanisms also affect how technical tools are used and the information given to couples. In Brazil, in a context of restricted access to abortion and of very significant social inequality, an ultrasound in a situation of foetal normality glorifies the “anticipated social birth” of the child and its family. When a foetal anomaly is diagnosed, a radical rupture occurs. In public hospitals – used by the majority of women – obligatory continuation of pregnancy regulates doctors’ attitudes: the ethnographic study carried out in Rio de Janeiro shows that obstetricians have opted for the education of women (in the hope of gradual access to autonomy, hopefully the road towards a fairer society). Paediatricians produce a semantic shift, encouraging a positive use of medical uncertainty, which modifies the decision-Making framework and maintains a dynamic approach to welcoming the child-To-Be. In the private sector in Brazil, terminations of pregnancy which are possible outside of any legal framework are kept behind a wall of secrecy, revealing next to nothing about the prior decision-Making process. During prenatal consultations, the anticipation of a disability systematically brings out fears of mental retardation and of the suffering which will be caused to the child, the couple or siblings, but the discourse varies, depending on the context: a comparative analysis of our observations shows that, in France, doctors use evidence-Based medicine to inform couples and to reduce risks and uncertainties with a view to making a necessary choice, whilst at the same time respecting the couple’s decision-Making autonomy. In public hospitals in Brazil, there is a different hierarchy of priorities: the primary focus is that of becoming a mother and having a life-Born child. Risk is presented as being part of life and the dynamic aspects of medical uncertainty safeguard the future of the “sick” child within its family. These differentiated approaches to risk and disability lead us to consider recent evolutions in the field of disability which has so far had little impact on PND. Led in particular by “disability studies” – studies carried out by people who are themselves affected by disability – these evolutions consider disability to be a dynamic process resulting from an interaction between a given state of health and a given social situation. In its conclusion, the thesis suggests that the knowledge, experiences and practices of the prenatal world and that of disability be brought together through inter and transdisciplinary dialogue
Essa tese analisa as práticas de diagnóstico pré-natal (DPN) na França e no Brasil, entre a mundialização de saberes, técnicas e regulações locais, focando as modalidades de antecipação da deficiência. O DPN desenvolveu-se nos países da Europa e América do Norte de forma diretamente relacionada com as leis sobre o aborto. Enraizou-se no monitoramento da gravidez como um dos modos de prevenção das deficiências. Sua expansão em países onde o acesso ao aborto é restrito leva a adaptações de acordo com as regulamentações locais. Disposições regulamentares enquadram o trabalho profissional (em rede, pluridisciplinar) e o registro das práticas (onipresente na França e ausente no Brasil). Elas modulam, na França, a experiência de mulheres que se submeteram ao aborto devido a uma patologia fetal, conforme evidenciado pela análise de questionários semi-estruturados aplicados em dois grupos de mulheres em duas épocas diferentes. Em 1999, as mulheres exigiam mais autonomia na tomada de decisões de interrupção. Em 2005, elas procuravam mais frequentemente uma decisão compartilhada com os médicos, porém consideravam que a decisão cabia a elas, especificamente em gestações mais adiantadas, em situações com risco de retardo mental, com elevada incerteza prognóstica, e no contexto de situações específicas rasteadas ao longo do percurso pré-natal (tal como a síndrome de Down).Estes mecanismos reguladores também condicionam o modo de utilização das técnicas e as informações fornecidas para os casais. No Brasil, em um contexto de acesso restrito ao aborto e de fortes desigualdades sociais, a ultrassonografia em situações de normalidade fetal glorifica o "nascimento social antecipado" da criança e a « ampliação » da família. Em caso de anomalia fetal, uma ruptura radical se produz.No hospital público, para onde vai a maioria das mulheres, a impossibilidade de interromper a gestação define a atitude dos profissionais: o estudo etnográfico realizado no Rio de Janeiro mostra que os obstetras optam então pela educação das mulheres (na esperança de um ganho progressivo de autonomia, em direção a uma sociedade mais justa). Os pediatras realizam, por sua vez, uma mudança semântica, proporcionando um uso positivo da incerteza médica que muda o contexto do debate, preservando uma abordagem dinâmica sobre a chegada da criança. No setor privado no Brasil, a interrupção da gravidez, possível fora dos quadros jurídicos, é mantida sob o selo do segredo e dá pequeno vislumbre da dinâmica anterior da decisão.A antecipação da deficiência durante o pré-natal dissemina o medo do retardo mental, do sofrimento para a criança, para o casal ou irmãos, mas o discurso varia de acordo com o contexto: a análise comparativa de observações destaca que na França, os médicos utilizam a medicina baseada em evidências para informar o casal e reduzir o risco e a incerteza, tendo em vista uma escolha necessária e o respeito à autonomia das decisões dos casais. No Brasil, no hospital público, a hierarquia de prioridades é diferente: tornar-se mãe, ter um filho vivo vêm em primeiro plano. O risco é apresentado como parte da vida e a dinâmica da incerteza salvaguarda o futuro do filho doente no seio de sua família. Estas abordagens diferenciadas de risco e deficiência nos remetem ainda mais aos recentes achados nas áreas da deficiência, que pouco penetraram no universo do DPN. Impulsionados principalmente pela área dos « disability studies », pesquisas conduzidas pelas próprias pessoas afetadas pela deficiência, esses estudos consideram a deficiência como um processo dinâmico, resultante de uma interação entre um estado de saúde e uma situação social determinada. A tese apresenta como conclusao a necessidade da aproximaçao entre o universo do pré-natal e o da deficiência, por meio de um diálogo inter e transdisciplinar, compartilhando conhecimentos, experiências e práticas

A partir de données en population, nous avons: 1) évalué le risque de cardiopathies congénitales (CC) chez les fœtus conçus par assistance médicale à la procréation (AMP); et 2) déterminé les effets de l’AMP sur la prise en charge prénatale et le devenir périnatal des fœtus porteurs de CC. Nous avons observé que l'AMP était associée à une augmentation de 40% du risque de CC sans anomalies chromosomiques associées (OR ajusté = 1,4 IC95% 1,1-1,7). Nous avons également retrouvé qu'il existait des associations variables selon la catégorie de CC et la méthode d'AMP considérées. Nous avons observé que l'AMP était associée à une multiplication par 2,4 du risque de tétralogie de Fallot (OR ajusté = 2,4 IC95% 1,5-3,7), alors que nous n’avons pas retrouvé d’association statistiquement significative pour les trois autres CC spécifiques étudiées. Dans notre population, l'exposition à l'AMP ne semblait pas modifier le recours au diagnostic prénatal et à l'interruption médicale de grossesse chez les fœtus porteurs de CC comparés aux fœtus porteurs de CC conçus spontanément. Nous avons par ailleurs observé que le risque de prématurité des fœtus porteurs de CC conçus par AMP était environ 5 fois plus élevé que celui des fœtus porteurs de CC conçus spontanément (OR ajusté = 5,0 IC95% 2,9-8,6). En nous basant sur une méthodologie d'analyses de cheminement, nous avons retrouvé que les grossesses multiples contribuaient pour environ 20% au risque plus élevé de tétralogie de Fallot associé à l'AMP que nous avons observé. Enfin, les grossesses multiples contribuaient pour environ 2/3 du risque de prématurité associé à l'AMP chez les fœtus porteurs de CC
Using population-Based data, we: 1) assessed the risk of congenital heart defects (CHD) in assisted reproductive techniques (ART) conceived fetuses; and 2) evaluated the effects of ART on prenatal management and perinatal outcomes of fetuses with CHD. We observed that ART were associated with a 40% increased risk of CHD without associated chromosomal anomalies (adjusted OR = 1.4 95%CI 1.1-1.7). We also found varying associations between the different methods of ART and categories of CHD. We observed that ART were associated with 2.4-Higher odds of tetralogy of Fallot (adjusted OR = 2.4 95%CI 1.5-3.7), whereas no statistically significant association was found for the three other specific CHD included. In our population, ART exposure did not seem to modify prenatal diagnosis and termination of pregnancy for fetal anomaly in fetuses with CHD compared to fetuses with CHD conceived spontaneously. The risk for premature birth in fetuses with CHD conceived following ART was 5-Fold higher as compared to fetuses with CHD conceived spontaneously (adjusted OR = 5.0 95%CI 2.9-8.6). Using a path-Analysis method, we found that multiple pregnancies contributed for about 20% to the higher risk of tetralogy of Fallot associated with ART that we had found. Finally, multiple pregnancies contributed for the 2/3 of the risk of premature birth associated with ART in fetuses with CHD

En droit positif, la qualification de l’enfant à naître est incertaine et celui-ci ne bénéficie d’aucun statut. Pour autant, son intérêt est pris en considération depuis le droit romain à travers l’adage « infans conceptus pro nato habetur quoties de commodis ejus agitur » selon lequel l'enfant conçu est réputé né chaque fois qu’il en va de son intérêt. À l’origine, cet adage était exclusivement tourné vers la matière patrimoniale. Aujourd’hui, la préservation de l'intérêt de l’enfant à naître a connu des évolutions majeures dépassant largement cette maxime latine. Plusieurs facteurs ont été à l’origine de l’extension de la prise en considération de cet intérêt : la légalisation de l’interruption de grossesse, les techniques d’assistance médicale à la procréation, le développement de la recherche scientifique, l’évolution de la médecine prénatale et fœtale. La question de la préservation de l’intérêt de l’enfant à naître est aujourd’hui sans cesse renouvelée en raison du développement constant des pratiques médicales et scientifiques, et sous l’impulsion de la notion d’intérêt de l’enfant né.L'intérêt de l’enfant à naître entre en conflit avec d’autres droits et intérêts concurrents peu conciliables. Ces droits et intérêts font l’objet de revendications fortes dans la société et entraînent de vifs débats quant aux solutions de conciliation. L’antagonisme de ces droits et intérêts aboutit à d’importantes contradictions et incohérences difficilement surmontables. Aussi, appréhender l'intérêt de l’enfant à naître en droit positif consiste à analyser ses manifestations à l’aune de la conciliation avec les droits et intérêts concurrents. Notre étude vise à déterminer le contenu de l’intérêt de l’enfant à naître en droit français, afin de mettre en exergue les cohérences et les incohérences existantes, et ce dans une perspective de rationalisation
In positive law, the qualification of the unborn child is unclear and he has no status. However, his interest is taken into consideration since Roman law through the adage « infans conceptus pro nato habetur quoties de commodis ejus agitur » according to which the conceived child is deemed to be born whenever it is in his interest. Originally, this adage was exclusively focused on the patrimonial rights. Today, the preservation of the interest of the unborn child has undergone major changes far beyond this Latin maxim. Several factors explain this fact : the legalization of the termination of pregnancy, techniques of assisted procreation, the development of scientific research, evolution prenatal and fetal medicine. The question of preserving the unborn child’s interest is today constantly renewed because of the constant development of medical ans scientific practices, and under the impetus of the concept of the born child’s interest. The unborn child’s interest conflicts with other competing rights and competing interests. These rights and interests are the subject of strong demands in society and lead to intense debates over conciliation solutions. The antagonism of these rights and interests leads to important contradictions and inconsistencies that are difficult to resolve. Therefore, to apprehend the interest of the unborn child in positive law is to analyze its manifestations in termes of conciliation with competing rights and interests. Our study aims to determine the content of the interest of the unborn child in French law, in order to highlight the existing coherences and inconsistencies, and this in a perspective of rationalization

Protection of a human foetus The aim of this thesis is to deal with the protection of the human foetus in the scope of the Czech legal environment as well as in the relation with the international law. The work provides the insight into the specific law areas as constitutional law, criminal law and also private law and deals with the specific rules contended in the single act as the Interruption of the pregnancy act and the new Specific medical services act. The substantial part of the legal discussion is supported by examination of the decisions of the courts both international and national which reflect the protection of human foetus. The thesis focuses on the protection of human foetus in its complexity and shall provide the comparative material which compares the protection of the human foetus within the specific law disciplines. The analysis of single legal problems and issues of the protection of the human foetus is not exhaustive and focuses on the protection and state of the human foetus in specific statutes. The protection of the human foetus represents quite discussable issue which provides a large number of questions to be answered and leads to the discussions which are reflected in this work. The key issue is researched under the actual conditions of the legal system and also with the...

Dissertação de Mestrado em Estudos Sobre as Mulheres apresentado à Universidade Aberta
Resumo - As constantes mudanças operadas a nível legislativo e científico, possibilitam que as mulheres e famílias tenham a faculdade de interromper a gestação, quando as malformações fetais são diagnosticadas no decurso da gravidez e se enquadrem dentro do quadro legal. As vivências das mulheres na interrupção médica de gravidez vão servir de base ao estudo qualitativo que realizamos. É um estudo fenomenológico, essencialmente exploratório com um desenho descritivo. Para a compreensão do fenómeno formulamos as seguintes questões de investigação: O que experimentam estas mulheres quando confrontadas com a malformação fetal? Como percepcionam todo este percurso nomeadamente se sentem dor ou sofrimento? Há sentimentos de perda e luto? E como conseguem enfrentar todo este processo complexo? A amostra do estudo é constituída por dez mulheres. A amostragem em oito destas é não probabilística acidental e em duas por selecção racional ou intencional, designadas por memórias de interrupção. A população alvo é constituída pelas grávidas que recorreram a dois hospitais da área da Grande Lisboa para efectuar a interrupção de gravidez. As entrevistas semi-estruturadas ocorreram em dois momentos. O primeiro momento, antes da alta hospitalar, o segundo, com as participantes já no domicílio passado poucos meses após a interrupção médica de gravidez. A análise de conteúdo permitiu-nos categorizar e compreender a vivências destas mulheres no decurso deste período. Através da análise dos dados e das entrevistas das participantes procuramos compreender este fenómeno através das emoções, sentimentos e representações percepcionadas no decurso deste período. As duas memórias de interrupção ocorreram num único momento e serviram para triangulação dos dados
Resumen - Las continuas mudanzas de carácter legislativo y científico que se han realizado, permiten a las mujeres y sus familiares la posibilidad de interrumpir el embarazo por existir malformaciones fetales, si éstas son diagnosticadas y si son amparadas por los criterios legalmente establecidos. La vivencia de la interrupción médica del embarazo realizadas por estas mujeres servirá de base para el estudio cualitativo que se realizó. Este estudio es de índole fenomenológica y exploratoria, y su diseño es descriptivo. La intención de comprender el fenómeno hizo que surgiesen las cuestiones de investigación: Qué es lo que experimentan las mujeres que se ven obligadas a enfrentarse con una malformación fetal? Cuál es la percepción que tienen de la situación si sufren? Cómo es el proceso de pérdida y luto? Cómo consiguen enfrentarse a esa realidad? La muestra de este estudio se constituye de diez mujeres. La selección fue no probabilística accidental para ocho participantes y de manera racional intencionada para dos, designadas éstas por memorias de interrupción. La población “alvo" está constituida por las embarazadas que se dirigieron a dos instituciones hospitalares del área de Lisboa para realizar la interrupción del embarazo. Las entrevistas semi-estructuradas que fueron realizadas al primer grupo de señoras, se hicieron en dos momentos diferentes: una primera vez antes del alta hospitalar y una segunda vez en el domicilio unos meses más tarde. El análisis de los contenidos permitió categorizar y comprender las vivencias de estas mujeres en relación con esta situación. Mediante el análisis tanto de los datos como de las entrevistas, se pretendió comprender las emociones, sentimientos y representaciones de estas señoras. Las dos memorias de interrupción se desenvolvieron en un único momento y sirvió para triangular los datos
Abstract - The constant scientific and legal changes allow women and families to decide upon a pregnancy interruption when foetus malformations are diagnosed during the pregnancy. This decision must be legally accepted. Women’s experiences in therapeutic abortion will be our focal point in this qualitative research. It is an essentially exploratory and phenomelogical study with a descriptive background. For a greater understanding of these issues, the following questions were applied. They are: What do women feel when faced with foetal malformations? How do they live this situation, namely if they feel pain or suffering? Are their feelings of loss and grief? How do they face this complex process? The study’s sample evolves ten women. Eight of the ten individuals were non-random sampling and two were selected intentionally and therefore designated as “interruption memories". The target population are pregnant women who visit two hospitals in Lisbon after deciding to interrupt their pregnancy. Semi-structured interviews took place in two different moments of time and in two different places. The first, before hospital discharge, and the second, a few months after the pregnancy interruption, in their homes. It was possible to categorize and understand the experiences of these women during this time period by the analyses of the contents of all the interviews. With these results we are trying to understand this situation using emotions, feelings and perceived representations during this time span. The two “interruption memories" occurred in a single moment and served for the triangulation of contents

Apesar do investimento nos cuidados de saúde reprodutiva, nomeadamente ao nível das medidas de Planeamento familiar e contraceção no nosso país, a gravidez inesperada ainda ocorre, pressupondo, em vários casos, uma tomada de decisão entre prosseguir ou interromper a gestação que não foi planeada. Os estudos apontam que para muitas mulheres o processo decisório é complexo, sendo influenciado e /ou condicionado por diversos fatores. O presente estudo exploratório tem como objetivo geral explorar (retrospetivamente) as experiências e significados sobre a tomada de decisão de um grupo de mulheres que consideraram a Interrupção Voluntária da Gravidez (IVG) e prosseguiram a gravidez, pretendendo reconhecer as suas experiências e expectativas durante o processo de tomada de decisão. As participantes foram 5 mulheres selecionadas através de um processo de amostragem não probabilística por conveniência. Atendendo à metodologia qualitativa foram realizadas entrevistas a partir de um guião elaborado para o efeito, recorrendo-se posteriormente a uma abordagem semi indutiva dos dados com recurso ao software NVivo. Os resultados principais indicam a utilização inadequada dos métodos contracetivos no período da ocorrência da gravidez inesperada e a não realização de consultas de planeamento familiar, ainda que disponibilizadas pelo sistema de saúde público. Demonstraram também a complexa vivência psicológica associada ao processo de ponderação da sua interrupção, influenciada por múltiplos fatores, entre eles o suporte do companheiro e de outras figuras significativas. Os resultados mostram a necessidade de fomentar recursos direcionados para o apoio psicológico destas mulheres, no período de ponderação perante uma gravidez inesperada.
Despite the investment in reproductive healthcare, namely in terms of family planning and contraception measures in our country, unexpected pregnancy still occurs, presupposing, in several cases, a decision made between continuing or interrupting an unplanned pregnancy. Studies show that for many women the decision-making process is complex, being influenced and/or conditioned by several factors. This exploratory study aims to explore (retrospectively) the experiences and meanings of decision-making by a group of women who considered the Voluntary Interruption of Pregnancy and continued their pregnancy, intending to recognize their experiences and expectations during the decision-making process. Participants were 5 women selected through a non-probabilistic convenience sampling process. Taking into account the qualitative methodology, interviews were carried out from a script prepared for this purpose, later resorting to a semi-inductive data approach using the NVivo software. The main results indicate the inadequate use of contraceptive methods during the period of the occurrence of the unexpected pregnancy, and the non-attendance of family planning consultations, even if made available by the public health system. They also demonstrated the complex psychological experience associated with receiving news of the unplanned pregnancy and the weighing process of its interruption, influenced by multiple factors, including the support of the partner and other significant figures. The results show the need to foster resources aimed at the psychological support of these women, during the period of pondering when faced with an unexpected pregnancy.

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.
A interrupção voluntária da gravidez (IVG) tem vindo a ser realizada em outros países há alguns anos, dividindo a opinião dos investigadores no que se refere aos riscos para a saúde mental das mulheres. O objectivo geral deste trabalho é perceber até que ponto a IVG induz alterações psicológicas nas mulheres que recorrem a este processo, mais concretamente, verificar se existe variabilidade nos níveis de depressão, ansiedade e stress no pré e pós IVG. Questionaram-se 30 participantes do sexo feminino no Centro Hospitalar de Setúbal - Hospital de São Bernardo, com idades compreendidas entre os 17 e os 40 anos. Utilizouse como instrumentos um questionário Sócio-Demográfico e Clínico e uma Escala de Ansiedade, Depressão e Stress (EADS-21), aferida para população portuguesa por José L. Pais-Ribeiro, Ana Honrado e Isabel Leal (2004) a partir da Depression, Anxiety and Stress Scale (DASS) de Lovibond & Lovibond (1983). O nosso estudo mostrou que a IVG não “induz” alterações psicológicas que ultrapassem a fronteira dos estados reactivos “normais” face ao processo em causa. No entanto, verificou-se que variáveis como o estado civil, habilitações literárias, religião, factores sócio-económicos, experiências passadas de interrupções da gravidez, idade e duração da gravidez, influenciam a resposta emocional das mulheres que recorrem à IVG.
The voluntary interruption of pregnancy (VIP) has been performed in several countries for many years, dividing the points of view of key opinion leaders, concerning the risks of mental health problems of women. The aim of the present work was to understand the extent of psychological changes induced by VIP in women that had gone through the procedure. Possible variations in the levels of depression, anxiety and stress, before and after VIP, were tested on 30 female subjects, aged between 17 and 40, from Centro Hospitalar de Setúbal – Hospital de São Bernando. The instruments used in this study were a Sociodemographic and Clinical questionnaire and a Scale of Anxiety, Depression and Stress (EADS-21), validated for the Portuguese population by José L. Pais-Ribeiro, Ana Honrado e Isabel Leal (2004), based on Depression, Anxiety and Stress Scale (DASS) from Lovibond & Lovibond (1983). Our study suggests that the VIP does not induce psychological changes beyond the border states of normal reaction to the concerned process. However, it was observed that factors such as marital status, education, religion, socioeconomic situation, past experience of pregnancy interruption, age and number of pregnancy weeks play an important role in the emotional response to a VIP.

The thesis deals with the issue of spontaneous abortion as well as induced termination of pregnancy and its potential negative impacts on woman's mental and physical health. The theoretical part summarizes the findings about particular kinds of pregnancy loss and defines the possibilities of psychological adaptation to this loss. The author paid the close attention to Post-abortion syndrome (PAS), which is regarded as a special form of Post- Traumatic Stress Disorder. The thesis is further focused on the emotional, social, psychological and physical effects following abortion, the most threatened group of women with a higher probability of having PAS and finally the way of medical treatment. In the empirical part, the main symptoms of PAS were detected by means of the Helpline database analysis. Detection of these syndromes enabled to compile the questionnaire related to pregnancy loss. The main task was to discover the perceived changes in a woman's life after the pregnancy loss. In the final part of the work, the questionnaire regarding pregnancy loss had been tested and finally the main benefits together with limits had been critically evaluated.

Malgré la diversité des recherches sur la parentalité adolescente, l'analyse des trajectoires parentales et des facteurs qui peuvent moduler l'effet de cet événement sur la scolarité demeure peu documentée. C'est précisément sur cet aspect que se penche la présente étude. L'objectif général de ce mémoire est de voir dans quelle mesure les différentes trajectoires adoptées par les jeunes parents sont associées à l’obtention des diplômes scolaires. Évidemment, les parents adolescents forment un groupe qui est plus à risque de ne pas avoir obtenu de diplôme secondaire vers 20 ans. Cependant, nous soutenons que la trajectoire parentale est différente pour chaque individu et qu'elle peut modifier la probabilité d’obtention des diplômes secondaire et postsecondaire. Les résultats des analyses de régression sur les données de l'Enquête auprès des jeunes en transition nous montrent que ce n’est pas le simple fait d’être parent qui influe sur la scolarité des jeunes, mais plutôt le type de trajectoires scolaires empruntées par ces derniers. Ainsi, certaines trajectoires parentales moins stables et plus précoces ont plus d’impact sur la non obtention d’un diplôme d’études secondaire, que les trajectoires parentales stables, qu’il s’agisse de monoparentalité ou de famille cohabitante. La précocité est donc un facteur d’influence différencié selon le type de parcours conjugal. De plus, nous observons que cette association entre certaines trajectoires parentales et l’obtention d’un diplôme s’observe également chez les hommes même si le type de trajectoire parentale est globalement moins explicatif que pour les femmes. Finalement, les variables reliées à la performance scolaire à 15 ans médiatisent en partie l’impact des trajectoires parentales sur le statut scolaire à 23 ans, ce qui suggère que l’association peut s’interpréter aussi comme un effet de la scolarité sur la parentalité.
Although many studies on teenage parenthood have been realized, little research examined the effect of parental trajectories on school graduation. The aim of this study is to better understand how teen parents' life trajectories influenced the probability of getting a diploma. Obviously, young parents have higher risk of not being graduated of high school before their 20 years old. However, we support that teen parents' life trajectories are different for each. In consequence the probability of getting a diploma can be modified. Based on data from the Youth in Transition Survey collected between 2000 and 2007, our results from regression analyses suggest that the simple fact of being a teenage parent does not explain all consequences on school graduation. The probability of getting a diploma would rather be influenced by teen parents' life trajectories. Additionally, results suggest that instable and early parenthood contribute to the likelihood of not being graduated at 23 years old. Our result shows that early parenthood has to be analyzed differently and a combination between precocity and instability help to better understand the effects of adolescent parenthood on diplomation. An association between academic performances at 15 years old and the level of education at 23 years old was also found, which may explain why this association may influences the probability of getting a diploma.

Ce mémoire porte sur l’avortement en Allemagne depuis les vingt dernières années. La première partie s’attardera d’une part, aux différentes lois en matière d’avortement des deux États allemands avant les événements de 1989 et d’autre part, à l’analyse du discours tenu par le mouvement féministe ouest-allemand et est-allemand face à l’avortement. La deuxième partie examinera le débat qui entoura l’avortement lors du processus de la Réunification. En effet, la loi sur l’avortement de la République démocratique allemande était beaucoup plus libérale que celle de la République fédérale d’Allemagne et la majorité des citoyens et politiciens d’ex-RDA refusèrent que la loi restrictive ouest-allemande soit tout simplement étendue à l’Allemagne réunifiée. Il s’ensuivit un débat qui devint rapidement une sorte de symbole du clivage présent entre les Allemands de l’Est et ceux de l’Ouest, mais aussi entre les féministes des nouveaux et des anciens Länder. C’est finalement en 1995 qu’une nouvelle loi fut votée par le Parlement, loi qui, encore aujourd’hui, régit l’avortement. Vingt ans après la chute du Mur, le débat sur l’avortement reprit sa place dans l’actualité avec un nouveau projet de loi visant à restreindre l’accès aux avortements pratiqués après la 12e semaine de grossesse. La troisième partie portera donc sur ce débat plus actuel et examinera si le clivage Est-Ouest face à l’avortement à l’époque de la Réunification, est toujours présent aujourd’hui en Allemagne, ce qui, selon les conclusions de ce mémoire, semble bien être le cas.
This MA thesis is about abortion in Germany over the past twenty years. The first part will focus on one hand on the different laws regarding abortion in the two German states before the events of 1989 and on the other hand on the analysis of the discourse held by West and East German feminist movements regarding abortion. The second part will examine the debate surrounding abortion during the Reunification process. Indeed, the abortion law of the German Democratic Republic was much more liberal than the one of the Federal Republic of Germany and the majority of citizens and politicians of the former GDR refused that the West German restrictive law was simply to be extended to the reunified Germany. A debate followed that quickly became a kind of symbol of the division that existed between East and West Germans but also between feminists from the new and old Länder. Finally, in 1995, a new law was passed by Parliament, legislation that still governs abortion today. Twenty years after the Berlin Wall fell, the debate about abortion rose up in the headlines again with a new bill aimed at restricting abortion access after the 12th week of pregnancy. The third part will therefore focus on this more topical debate and examine whether the East-West division regarding abortion at the time of the Reunification still exists today in Germany which, according to the findings of this MA thesis, seems to be quite the case.
Diese Magisterarbeit bezieht sich auf Abtreibung in Deutschland in den letzten zwanzig Jahren. Der erste Teil beschäftigt sich einerseits mit den unterschiedlichen Gesetzen der zwei deutschen Staaten bezüglich Abtreibung vor den Ereignissen von 1989 und andererseits mit der Analyse des jeweiligen feministischen Diskurses zu Abtreibung in Ost- und Westdeutschland. Der zweite Teil wird die Debatte über Abtreibung während des Wiedervereinigungsprozesses untersuchen. In der Deutschen Demokratischen Republik war das Abtreibungsgesetz liberaler als in der Bundesrepublik Deutschland und die Mehrheit der Bürger und Politiker der ehemaligen DDR lehnte es ab, das restriktive westdeutsche Gesetz auf das wiedervereinigte Deutschland einfach auszudehnen. Es folgte eine Debatte, die schnell eine Art Symbol der Spaltung wurde, nicht nur zwischen den Ost- und Westdeutschen, sondern auch zwischen den Feministinnen der neuen und alten Länder. 1995 verabschiedete schlieβlich das Parlament ein neues Gesetz, das bis heute die Abtreibung regelt. Zwanzig Jahre nach dem Mauerfall ist die Debatte über die Abtreibung durch einen Gesetzentwurf wieder entflammt, der die Verschärfung der Abtreibungsbestimmungen nach der 12. Schwangerschaftswoche vorsieht. Der dritte Teil der Magisterarbeit wird sich auf diese aktuelle Debatte beziehen und untersuchen, ob die Ost-West-Spaltung bezüglich der Abtreibung zur Zeit der Wiedervereinigung noch heute vorhanden ist. Nach den Schlussfolgerungen dieser Magisterarbeit scheint das der Fall zu sein.