Exploring Women’s Abortion Trajectories
According to the WHO, six out of ten unintended pregnancies end in induced abortion, and approximately 45% of all abortions are considered unsafe. Unsafe procedures can lead to serious health complications and even death. WHO emphasizes that the lack of safe and timely access is not only a public health issue, but also a fundamental human rights issue.
The right to abortion has always been divisive
The right to abortion has always been both controversial and divisive. This is evident not only today, but also throughout history. For example, we can mention King Baudouin. When Belgium legalized abortion in 1990, King Baudouin temporarily stepped down from his royal duties, explaining that his Catholic conscience would not allow him to sign the law. From April 3 to 5, he abdicated so that the government could enact the legislation without his direct endorsement. Despite this symbolic moment of resistance, the legalization marked a turning point for reproductive rights in Belgium.
In the years that followed, institutions such as the Vrije Universiteit Brussel (VUB) played a significant role in promoting safe access, evidence-based practices, and non-judgmental support services, contributing to the broader European conversation on reproductive health and human rights. VUB Dilemma is a center within the Vrije Universiteit Brussel that provides counseling and support to women facing an unwanted pregnancy or considering ending a pregnancy. It also offers education and guidance on contraception and actively participates in social discussions on reproductive rights. What is especially important is that the VUB Dilemma provides support when it is most needed. As they state, “Even after an abortion, you can contact Dilemma and various other organizations for medical and psychosocial aftercare, as well as guidance on contraception.”
Understanding women’s trajectories to abortion is crucial
In Belgium, around 9 out of 1,000 women of reproductive age seek abortion on demand each year, which totals more than 19,000 women. However, 200 to 600 women annually seek an abortion after the legal deadline of 14 weeks and are denied assistance. They are then forced either to continue the pregnancy, which can negatively affect the mother’s mental health and the child’s development, or to travel abroad, most often to the Netherlands, where the laws are more liberal. Although abortion is a safe procedure, the risks increase as the pregnancy progresses.
While some countries are tightening their laws, discussions are underway in Belgium to extend the legal deadline and reduce stigma. The “emotional vulnerability” criterion as a prerequisite for abortion on demand was removed in 2018, and the waiting period was extended. However, empirical data specific to the Belgian context remain limited. Understanding women’s trajectories to abortion is crucial for informing this politically sensitive debate.
This is precisely the topic of a study by Belgian scientists, which examines women’s trajectories to abortion in Flanders, Belgium. The authors of the study are Anna Wallays, Leen De Kort, and Sarah Van de Velde from the University of Antwerp, and Lobke Van Ryckeghem from the Vrije Universiteit Brussel. We spoke with Anna Wallays, who is the corresponding author of the study “Women’s trajectories to abortion care in Flanders, Belgium: A qualitative study.“
About the study
The study was conducted in Flanders, the Dutch-speaking northern region of Belgium, home to more than half of the country’s population. A total of 29 women participated in interviews after completing a quantitative questionnaire. The focus was on the barriers they faced before contacting a clinic, including pregnancy recognition, emotional dilemmas, and social pressure. Abortion pathways begin to take shape even before pregnancy itself, as the perceived risk of pregnancy influences the trajectory. This indicates that abortion pathways are non-linear, with women moving between different stages. The experiences highlight emotional complexity, the influence of socioeconomic factors and partner support, and the importance of safe and accessible abortion care in Belgium.
The study received ethical approval from the University of Antwerp. Participation was voluntary, and participants could choose a location for the interview where they felt safe. The interviewer was experienced in working with sensitive topics, and participants could refuse to answer questions or withdraw at any time without consequences.
Legislation and research method
As explained in the study, research from other countries, mainly the UK and the US, shows that irregular menstruation, lack of pregnancy symptoms, denial of pregnancy, or the belief that one is not fertile often lead to delays in seeking abortion. Concerns about partners’ or parents’ reactions and relationship disagreements also often make decision-making difficult. In addition to this pressure, women report fear of medical procedures, long waiting lists, lack of qualified providers, and logistical challenges such as travel, taking time off work, or arranging childcare.
Abortion legislation and practice vary in terms of waiting periods, legal deadlines, cost coverage, availability of resources, and healthcare organizations, which further complicates access and creates stigma. Most previous research used theoretical frameworks with a one-sided focus, failing to capture the complexity of women’s abortion pathways. In this context, the more comprehensive model developed by Coast et al. is particularly valuable. This model encompasses three domains: Abortion-specific and time-based experiences, including pregnancy awareness and events specific to seeking an abortion. Individual context – characteristics that influence whether a woman receives abortion services, including support from interpersonal networks. Broader context – the international, national, and local framework in which a woman and her abortion are situated.
Abortion on request is permitted up to 14 weeks of gestation, following a mandatory initial consultation and a six-day waiting period. Procedures must be performed by a licensed physician, mostly in LUNA centers, which provided 94% of abortions in 2023, covered by public health insurance. Women seeking abortion are typically aged 25 to 35, often in relationships, employed, with secondary education, and may already have children.
The study: experiences of 29 women
Women seeking abortion at one of five Dutch-speaking centers in Flanders and Brussels were invited to participate in in-depth, semi-structured interviews after completing a quantitative questionnaire. In total, 29 women aged 20 to 35 and older participated. Gestational age at admission was most often between the 4th and 7th week of pregnancy. Most women had an abortion, usually through an in-clinic suction aspiration procedure, while a smaller number had a medical abortion at home. One woman experienced a spontaneous abortion, and two decided to continue the pregnancy.
Interviews lasted between 40 and 120 minutes, mostly conducted in participants’ homes, with some conducted in public spaces or at the University of Antwerp. The interview guide was based on the conceptual framework of Coast et al. and iteratively updated, with questions exploring how women discovered their pregnancy and how they made the decision to have an abortion. Women over 18 who spoke Dutch or English and were registered for admission to the center were included.
Many participants discovered their pregnancy through typical symptoms, such as missed periods, nausea, or fatigue. However, symptoms were often attributed to stress or hormonal changes and were difficult to confirm with only a home test. The moment of confirmation triggered strong emotions: shock, sadness, panic, but also immediate clarity. Some immediately knew they wanted an abortion, while others needed time to reflect. The decision was deeply personal and often burdened with guilt or shame, mainly due to societal expectations around motherhood. Socioeconomic factors, relationship stability, and partner support strongly influenced decision-making. Most women emphasized that abortion was a deliberate, rational decision made out of responsibility, not impulse. Nevertheless, the path to the procedure was often filled with uncertainty and a lack of information. Many were unaware that the procedure is usually performed in abortion centers rather than hospitals. Fear of exceeding the legal 14-week limit often added pressure.
Although many experiences with medical staff were positive, some women encountered uninformed or moralizing approaches from GPs or gynecologists, sometimes leading to delays and increased anxiety. Most women felt relieved upon arriving at the center. Staff were professional, empathetic, and supportive, and counseling helped women confirm their decision. Although emotionally demanding, most women felt peace after the procedure, knowing they had made the right decision for themselves.
This study is one of the few available empirical studies on abortion in Belgium, and it is the first to examine pathways to abortion care
How can the findings of the study be applied in practice?
Anna Wallays: The most important value of this study is that it provides empirical evidence to support the ongoing debate on abortion laws in Belgium. At the Belgian government’s request, an independent expert committee evaluated the abortion law and made several recommendations to liberalize the current law. Yet, no legislative changes have followed to date. The study’s findings are consistent with international evidence and therefore demonstrate that many patterns and tendencies observed in previous research also apply to the Belgian context. Women’s lived experiences add a human dimension to the debate and can provide a sense of recognition that was previously lacking.
Do you think there are enough studies of this type in Belgium, and how can the experience from Belgium help at the European level?
Anna Wallays: This study is one of the few available empirical studies on abortion in Belgium. Moreover, to our knowledge, it is the first to examine pathways to abortion care. Understanding these pathways is particularly valuable. Currently, a bipolar tendency toward the radicalization or liberalization of abortion law is observed in numerous countries. This kind of research, which provides insight into lived experiences, can serve against further polarization. The study shows that even in Belgium, which is in the European context often seen as a model country in terms of (sexual and reproductive) healthcare, there are still many barriers to abortion care. It shows that we all still have a long way to go to timely and accessible abortion care for all.
Behind every decision lies a story
Social pressure and stigma continue to strongly shape women’s experiences. Many felt the need to justify their decision, even when confident in it. This was particularly evident among women who already had children or were at the “ideal” age for motherhood. Yet, despite the fear of judgment, women emphasized the importance of safe, accessible, and humane access to abortion. They stressed that the decision is not made lightly, but results from careful consideration of personal circumstances, abilities, and responsibilities.
The study shows that abortion pathways are deeply personal, complex, and intertwined with social, emotional, and institutional factors. The decision to terminate a pregnancy is not a simple act but a process requiring understanding, support, and respect. These women’s experiences remind us that behind every decision there is a story – and these stories should form the foundation of public debate on reproductive health and rights in Belgium.
The decision-making process and path to abortion are not linear but shaped by prior perceptions, structural factors, and personal experiences. Abortion pathways begin even before pregnancy itself, as the perceived risk of pregnancy strongly influences actions. Knowledge of the reproductive cycle and contraceptive use shapes feelings of safety and awareness of risk. Awareness of pregnancy and the decision-making process about abortion are interconnected and continuously influence each other. Women’s experiences show how social and institutional factors together shape the path to abortion in Belgium.
What a woman experiences before, during, and after an abortion….
The study shows that paths to abortion are complex, deeply personal, and shaped by emotional, social, and institutional factors. Although safe medical procedures exist, women continue to face obstacles, stigma, and social pressure. Globally, an estimated 47,000 women die each year due to unsafe abortions, highlighting the urgent need for accessible, evidence-based, and safe reproductive healthcare.
As experts from the Vrije Universiteit Brussel emphasize, “Fake news and alternative facts… hinder our ability to have an honest and objective debate on termination of pregnancy. As humanists, we must remain alert to the spread of disinformation and the disregard for evidence-based science” (Amy, Danckaert, Devroey, Verougstraete, 2023). This reminds us that a woman’s right to her own body requires a transparent, scientifically grounded, and ethically informed public debate.
What a woman experiences before, during, and after an abortion is shaped not only by laws and societal debates but also by emotions, personal experiences, and the states she goes through. Behind every decision lies a story, and understanding these stories is crucial for building a society in which women not only have the right to make their own decisions but also have access to the support they need most.
Image: VUB Dilemma
These publications were produced as part of the Maria Leptin EMBO Fellowship, which allowed us to spend two months exploring the world of science at VUB in Brussels. Importantly, all articles were the result of our own choice of topics and in accordance with our interests.
