The influence of rurality on women's decision making and pregnancy choices following an unintended pregnancy: A systematic review

Abstract

Almost half of all pregnancies worldwide and 34% of pregnancies in high-income countries are considered unintended. Several studies from high-income countries report that women from rural areas are more likely to continue their unintended pregnancy and give birth, while urban women are more likely to have an induced abortion. To explore how rurality influences women's decision making and pregnancy choices following unintended pregnancy by examining the global trends for women who reside in rural areas of high-income countries. This study is a systematic review of qualitative, cross-sectional and mixed-methods studies. A systematic review of peer-reviewed literature, published from January 2000 through to March 2024, retrieved from five databases: CINAHL, Embase, MEDLINE, PsycINFO and PubMed. Restrictions were applied to obtain original research that has been undertaken in high-income countries. The review included studies featuring participants that were either rural women who experience an unintended pregnancy or health care professionals providing direct care to rural women. Nineteen studies met the inclusion criteria and were included in this review. Several factors that influenced rural women's decision making following an unintended pregnancy were identified: access to abortion services; role of health care professionals; temporal factors; social norms and stigma; social factors and determinants; culture, ethnicity and religion; reproductive coercion and abortion legislation. The Social-Ecological Model highlighted the levels of interaction, the role health care professionals, family members and the wider community in supporting or obstructing rural women's decision making. Rural women's pregnancy decision making and reproductive autonomy can be compromised by intimate partners, family members, health professionals and rural culture. Health professionals have a pivotal role in supporting and respecting rural women's decision making when seeking an abortion and ensuring that rural women have timely access to abortion care. Registration number: PROSPERO CRD 42023409917.

Keywords: induced abortion; pregnancy; rural; systematic review; unintended pregnancy.

Figure 1.

PRISMA diagram for study selection. PRISMA: preferred reporting items for systematic reviews and meta-analyses.

Figure 2.

Decision-making factors identified using the social–ecological model.