Termination of a Wanted Pregnancy: Emotional Attachment and Loss in Second-Trimester Abortion Following Prenatal Diagnosis

Abstract

The advancement of prenatal diagnostics has led to an increase in discoveries of serious fetal conditions. Expecting parents are faced with having to make decisions regarding termination within short timeframes and strict regulations. This article phenomenologically explores women’s experiences of considering, applying for, and undergoing second-trimester abortion. Ten women whose pregnancies were terminated between 17th and 22nd week due to serious fetal conditions were interviewed. The experiences are elaborated through four themes: Critical choices in compressed timeframes, Changes in emotional attachment, Moments of no return, and A demanding and lonely grieving process. Although all the women felt they had made the right decision, their experiences varied. In different ways, the abortion process left traumatic marks on their lives. They had to enter new and awkward relationships with healthcare providers in unfamiliar surroundings and experienced significant bodily changes. Their expectations were transformed into feelings of alienation both toward their own body and the fetus. Disruption between the body and the outside world left them without any constructive means to resolve their situation. Their situation was worsened by healthcare providers who were unable to meet their grief. Grief became somewhat more bearable when the women could see and hold the dead fetus, provided it was presented in a dignified manner. Without any follow-up, the women were left alone to make sense of their grief. The article underscores the need to acknowledge that women may experience abortion as a loss and for sensitive care that recognizes shifting emotional attachments throughout the process.

Introduction

Despite some significant setbacks, there is a general global trend toward liberalizing abortion legislation (Austveg, 2023). When abortion rights are regulated and implemented, the underlying assumption is that women are facing unwanted pregnancies. However, with the rapid development of prenatal screening and fetal diagnostics, an increasing number of women and their partners find themselves in a situation where they may choose to terminate a pregnancy that is both planned and wanted. This situation challenges ideas about abortion seekers’ lack of emotional attachments to the fetus that seem inherent in both abortion legislation and discourse (Donley & Lens, 2022).

In Norway, self-determined abortion has been permitted up until the 12th week of pregnancy since 1978 (Abortloven [The Abortion Act], 1978). Since then, approximately 28,000 second-trimester abortions have been processed by an abortion board (Norwegian Institute of Public Health, 2025). In 2024, a total of 12,811 abortions were performed in Norway, including 631 second-trimester terminations approved by an abortion board. Of these, 389 were conducted on the grounds of serious fetal conditions identified through prenatal screening and diagnostic procedures (Løkeland et al., 2025). A recent legal reform that was implemented in June of 2025 has expanded the right to self-determined abortion until the 18th week (Abortloven [The Abortion Act], 2024).

Over the past few decades, significant technological advancements have occurred in prenatal screening and fetal diagnostics. In consequence, pregnant women can gain knowledge about the condition of the fetus at a much earlier time, and a significantly wider range of conditions may be detected (Becker, 2000).

In Norway, prenatal diagnostics (PD) through ultrasound examinations are routinely offered twice in a pregnancy (weeks 11–14 and 17–19) through the public antenatal care program (Oslo University Hospital HF, 2022). Women belonging to risk groups are additionally offered non-invasive prenatal testing (NIPT ¹ ). Furthermore, all pregnant women have the option to undergo NIPT-based examinations at their own expense, regardless of risk status (Bioteknologiloven [The Biotechnology Act], 2021).

Serious fetal conditions encompass a broad spectrum of medical diagnoses, each varying significantly in terms of outcomes, prognosis, and anticipated quality of life. At the most severe end of the spectrum are conditions deemed incompatible with life, such as anencephaly; further along are genetic or developmental anomalies, that are presumed viable with uncertain prognoses and may entail lifelong medical interventions (Bigler & Petrie, 2011; Copel, 2025; Silva et al., 2022). Defining a condition as “serious” is a complex undertaking that involves not only medical prognoses but also ethical considerations and value judgments, making it a contested concept (Solberg et al., 2023).

To discover serious conditions with the fetus is often unexpected and overwhelming for the parents (Heaney et al., 2022). Additionally, termination of pregnancy due to fetal anomalies (TOPFA) requires decisions, usually within a very short time span. In studies, the diagnostic phase has been described by parents as a shocking, chaotic, and emotionally demanding experience when confronted with the possibility of a serious condition affecting the fetus (Damm, Hvidtjoern, et al., 2025; Lafarge et al., 2014). In addition, the diagnosis may be uncertain and based on probabilities that may be difficult to grasp (Lou et al., 2025).

Information to support decision-making is crucial for making an informed decision. In a review describing the needs of parents who had terminated a pregnancy due to fetal anomaly, most parents reported having gathered information from various sources, but the most valuable information about the anomaly and procedures came from healthcare professionals. Being well-informed by healthcare professionals reduced parents’ fear and distress, unlike being poorly informed about what to expect (Heaney et al., 2022).

For women who must decide whether to terminate a wanted pregnancy due to serious conditions with the fetus, experiences of ambivalence have proved to be prominent both during the decision-making phase and throughout the whole process toward TOPFA (Blakeley et al., 2019; Heinsen, 2022; Lafarge et al., 2019; Lou et al., 2025). The value of individualized, professional care during termination has been highlighted, particularly through support from specialized midwives and the opportunity to spend time with the fetus (Damm, Lou, et al., 2025; Heaney et al., 2022). The emotional and practical aftermath of termination has been described as a sudden change of pace, marked by shock, isolation, and the lack of support (Heaney et al., 2022; Lafarge et al., 2014).

In Norway, Sommerseth and Sundby (2010) and Risoy and Sirnes (2015) have examined how Norwegian women navigated the decision-making process for second-trimester abortions after going through PD with finding of fetal anomalies. These studies highlight the influence of social and cultural attitudes toward abortion and support systems, the complex decision-making process with moral considerations, the need for clear communication and compassionate care from healthcare professionals, and the emotional impact (distress and grief). However, both studies have particular emphasis on the decision-making phase. No studies have so far examined the comprehensive experience from prenatal screening, through decision-making, abortion, and the time after, for women who have abortion due to fetal anomalies. Summarized, the review of current research highlights that women in high-income countries face challenges when carrying a fetus with a serious condition. Despite technological advancements and legal regulations in the Norwegian context, there was a notable lack of studies on women’s experiences with applying for second-trimester abortions and having their applications processed by a board. Moreover, there was no patient advocacy organization promoting the voices of women with experiences with abortion in the second trimester. Therefore, in preparation for the new law, the Ministry of Health and Care Services (Helse-og omsorgsdepartementet, 2022) commissioned researchers at the University of Bergen (UiB) to investigate women’s experiences of having an abortion in the second trimester under the previous law. The authors of this article were all part of that research team. The study examined women’s experiences of having their abortion application processed by a board. The findings, that focused on the situation of meeting an abortion board in particular, were published in 2023 (Haaland et al., 2023). However, participants shared rich and existential descriptions of their experiences related to the entire abortion process in their interviews. This allowed for a phenomenological analysis that the limited scope of the commissioned study did not include. This paper aims to explore the women’s comprehensive experiences when seeking abortions due to serious fetal conditions. Statistics on abortion in Norway indicate that most of second-trimester abortions are due to the discovery or suspicion of serious fetal conditions. Both in medicine and in politics, women’s perspectives are often marginalized, even in issues concerning women’s health (Becker, 2000; Romanis et al., 2020; Young, 1984).

Understanding the experiences of women who have such abortions is the first step toward creating quality abortion care in the second trimester. Insights from the Norwegian context may be of value to other contexts where PD are available.

A Phenomenological Perspective

This study is grounded in a phenomenological tradition that places the concept of “lifeworld” at its core. It is informed by insights from Max van Manen who stands within a hermeneutic tradition. His engagement with the work of Heidegger and Merleau-Ponty (van Manen, 2014, 2026b) considers fundamental structures or deeper layers of human existence, regardless of situation, culture, and history, as existentials. van Manen (2026a) particularly highlights existentials such as body, spatiality, world, relations, and temporality. He states that these “are helpful universal ‘themes’ of human existence to explore meaning aspects of our lifeworld and of the particular phenomena that we may be studying” (van Manen, 2026a, last para).

Following van Manen’s thinking, the researcher is always part of the lifeworld and can never escape it (van Manen, 2014). Taking this into consideration, the authors tried to become aware of their earlier experiences, knowledge, and values in all steps of the research process. To gain an understanding of the experiences of the women being interviewed, maintaining openness and sensitivity was necessary. The interdisciplinary author team consisted of a medical doctor, two nurses, and a medical anthropologist. All team members had experience with research on abortion-related issues. First author, M.K., also had clinical counselling expertise through long-term involvement in consultations addressing complex reproductive decisions, including abortion. K.C. is a clinician and has experience with providing care for abortion seekers. Our professional and ethical values shaped our commitment to foregrounding women’s voices. Motivated by our clinical and research experience with women considering abortion, we aimed to remain open to each woman’s individual story.

Method: Settings, Recruitment, Sample, and Data Collection

This study was designed as an interview study with in-depth interviews with women who had terminated a pregnancy in the second trimester. Women whose cases had been processed by an abortion board at a hospital in Norway were included in this study, provided they applied for a second-trimester abortion under the Abortion Act (1978). The project primarily relied on self-recruitment and took place via social media and snowball sampling (Patton, 2015). Self-recruitment was chosen as recruitment strategy after careful consideration of potential burden to participants (see the Ethical Considerations section). Self-recruitment was also arranged for through several hospitals yet yielded no participants with TOPFA experience. An information letter was sent to potential participants. Women with relevant experiences contacted the last author, M.E.S.H. Of the 13 women originally interviewed, we reanalyzed data from 10 who had petitioned for an abortion due to a serious fetal condition. The remaining three had abortions for reasons unrelated to the fetus and were excluded from reanalysis.

The 10 women were between 28 and 48 years old (average: 35 years) when interviewed and had undergone second-trimester abortions due to fetal conditions between the 17th and 22nd weeks of pregnancy. Most had undergone a late-term abortion in the past two to three years before being interviewed. Their experiences had taken place at six different hospitals in Norway. The women’s educational levels span from completed high school to completed multiple degrees at university level. The parity of the 10 women ranged from zero to more than three.

Individual interviews were conducted in 2023, when the old legislation still applied. An interview guide with several overarching themes was developed to ensure a consistent focus across all interviews. It addressed the women’s experiences throughout the abortion board process, before, during, and after the board meeting. Each question was designed to give the participants ample opportunity to speak freely about their experiences, both positive and negative, in each phase. Participants were given the option of digital or in-person meeting for the interview.

The first author carried out four interviews and the last author, six interviews. Two of the interviews were conducted face to face, and eight were conducted virtually, using Zoom. Recordings were made with a digital recorder and transcribed verbatim by a professional company and then checked for accuracy by the interviewer. The interviews lasted between 30 and 99 minutes (average: 59 minute). Some of the short interviews were conducted with women who had prior experience articulating and summarizing their experiences. However, those without such experience required longer time to elaborate on their narratives. Some women found it challenging to share their experiences. They wished to convey them, but without dwelling too long on what they had been through.

Ethical Considerations

The study was planned and carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) (WMA, 2024). The Regional Committee for Medical and Health Research Ethics (REK) assessed the project as not requiring presentation because it is not covered by the Norwegian Health Research Act (Ref. 577290). Out of concern for the privacy and well-being of our participants, a group of vulnerable individuals with potentially traumatic experiences, participation relied on self-recruitment. This was considered the most benign recruitment approach with least risk of burden and harm to potential participants. Retrospective recruitment through hospital charts or patient files is not an option, as access is strictly regulated by Norwegian law (“The Health Research Act,” 2008).

Voluntary informed consent was obtained from all participants, either in writing for in-person interviews or recorded on a separate audio file for digital interviews. Signed consent forms, audio files with consent, and the code keys were stored separately from other data material. Transcripts were de-identified. Both transcripts and sound recordings were stored at a secure and encrypted server. The project team consulted with the UiB’s Data Protection Officer for Research, and the project was duly registered in UiB’s System for Risk and Compliance (RETTE Ref. F2576). Participants had the right to withdraw from the study without any repercussions. However, no participants chose to do so. Given Norway’s small population and the limited number of abortions, anonymity was safeguarded by recruiting participants from multiple regions and by not disclosing detailed information. The names that are used in this article are pseudonyms.

An in-depth interview about experiences with second-trimester abortion causes reflection on and discussing potentially traumatic memories, which required careful planning and support. To minimize harm to the women, the two researchers who conducted the interviews had experiences from interviewing people during and after life crises. Participants were offered follow-up support after the interview with healthcare professionals who were experienced in addressing emotional and psychological challenges related to pregnancy and abortion.

Analysis

A phenomenological approach involves being open to the phenomena as they appear, reveal, and show themselves in experience. By actively thinking through our own preconceptions concerning abortion-related theory, attitudes, values, and experiences, our goal was to capture the meaning of the material through wonder and reflection. van Manen writes that: “Wonder does not rely on method and cannot simply be caused as when asking for answers in questioning. Just as inspiration may be the antecedent to writing poetry, so wonder may be the antecedent to inquiry” (van Manen, 2026b, para 2). Accordingly, we read the transcripts of the interviews with open and wondering minds to understand the women’s unique experiences.

In line with the recommendations from van Manen (1990, p. 101), we leaned on the existentials to “explore meaning aspects” of the women’s experiences as part of our reflections and wondering. To understand the invariant meaning in the women’s experiences, we asked questions to the text to distinguish this phenomenon from other phenomena (van Manen, 1990, p. 107), like: “What is it like to feel the kick from the fetus before versus after the discovery of a serious condition with the fetus?” (lived body/time/relation).

All authors read all transcripts separately to gain a comprehensive understanding of the women’s experiences. Furthermore, the first and second authors separately identified preliminary themes in each interview and across all interviews before agreeing on a set of preliminary themes. Finally, the entire group reflected together on these preliminary themes and identified the final set of themes that express the invariant meaning of the interview material.

Throughout the process, we employed a hermeneutic approach, alternating between understanding the whole from the parts and the parts from the whole.

The analysis ended with four essential themes: Critical choices in compressed timeframes, Changes in emotional attachment, Moments of no return, and A demanding and lonely grieving process. While these themes convey essential aspects of the women’s experiences, there were also notable variations between participants.

Findings

We scanned through the whole body; here is an arm and here is a leg and all that. And then she became quiet. She had been looking at the head, and there wasn’t … she couldn’t see anything, it was all black because you couldn’t see the brain. I thought about it afterwards, that this is clearly not something that happens every day. Because we started to cry and she did too. And then she said that there wasn’t much she could tell us, but that another expert from another hospital would see us. And then there was another ultrasound. I really struggle to remember parts from those ultrasounds because I was so shocked. I was very very scared and very sad, and so was my boyfriend. But we remember very different things from that ultrasound, and I remember very little. This was kind of one of the most momentous events in my life, so it’s very strange that I don’t remember anything, but I guess I was in shock. (Teresa)

Teresa’s account illustrates how participants’ lives could undergo a profound change upon learning about the severity of their fetus’s condition. While the women’s experiences differed, it is striking how they described their experience of second-trimester abortion as a traumatic upheaval in their lives. Most of the women received the first indications that something may be at fault with the fetus during the second-trimester ultrasound examination. The confirmation of a serious condition was described as “a life crisis” (Anita), “a nightmare” (Ingrid and Anita), and “the worst experience of their life” (Teresa). Some used expressions like “a total curtain fall” (Kathrine) and “the world collapsed” (Astrid). As one woman put it: “It hadn’t been on our agenda at all that anything could happen.”

This message was the beginning of a long and demanding process. Having to apply for an abortion and appear before a board to terminate the pregnancy came as an unexpected and, for some, frightening surprise. Fundamental dimensions of the women’s lifeworld were affected, which meant that they had to enter into new and awkward relationships in unfamiliar surroundings where they felt uncomfortable. They experienced major bodily changes and had to make vital decisions within short timeframes. This meant that they had to live with physical and mental consequences for a long time, changes that transformed the women’s lifeworld.

Critical Choices in Compressed Timeframes

Several of the women interviewed dwelt on how choice was experienced when making decisions on whether to carry on with the pregnancy. They had to make a decision that they experienced as impossible, within very tight margins of time, even before the condition of the fetus had been fully clarified. Their pregnancy had already passed the limit for self-determined abortion and many of them were afraid that time would run out. Still, they had many questions that they wanted to be answered. Like many of the participants, Kathrine described how the condition of the fetus weighed heavily on the women’s minds while making a decision: “We had questions like: is the baby in pain? Will it survive the pregnancy? What are the prospects for the future?”. Stine explained how the short timeframe affected her decision-making process:

If I had been earlier the pregnancy I don’t think I would have gone through with an abortion without knowing more. At the growth scan, when everything was discovered, there was already little time. I remember the midwife said “we don’t have much time. You don’t have a lot of time to decide.” I didn’t fully understand what that meant at the time, but now I see that it was … I think I must have been 21 weeks and 4 days then. Based on the measurements or calculations. So there really wasn’t time for anything.

Paradoxically, the women described how they wanted time to pass both quickly and slowly. They would like health professionals to “put on the brakes,” and slow down the process, but realized that the decision was urgent, and wanted to get the abortion over with as quickly as possible. Still, they needed more time, both for their own part and for that of the fetus, but the more time passed, the worse they feared the situation might become for both of them. Hilde, whose husband was abroad, said: “I was just thinking; slow down, slow down, slow down, I’m not ready. I don’t understand what’s going on, and my husband isn’t here. I can’t make this decision alone.” Even though the pregnancy was wanted, the thought of carrying a child who probably wouldn’t live was unbearable. Silje expressed it this way: “I felt that I didn’t have a choice. It was kind of more like ‘how big of a dead baby do you want?’”

Just as unbearable was the thought of giving birth to a child for an unworthy and probably also short life, as one woman said. She wanted the child to be like other children, without pain and exclusion. For some, the fact that the fetus’ condition was hardly compatible with a life worth living also contributed to a feeling of having no choice. Stine described it by saying:

The boy I lost, he would never have been alive today anyway, because the chances were so slim. So, I talk about it as having lost a child, because I was given a choice I didn’t want, and I had no choice because we would have lost him anyway.

While time to make a decision felt short, all waiting time felt long and incomprehensible, whether they were waiting to meet the board or to carry out the abortion. Teresa explained that:

I just wanted it over with as soon as possible. The thing is this life is going on inside you, so it is impossible to escape it, it is just so incredibly present. Time has never moved as slowly as then. And then a day can feel like … it is unbearable. A whole day until I find out if I am allowed to have the abortion or not.

Even though the meetings with the board were experienced somewhat differently, several of the women found it unnecessary, partly pointless, and that it took up precious time. They felt that they had already received sufficient medical information and that the board contributed no additional insights.

Changes in Emotional Attachment

After receiving the overwhelming information, many of the women emphasized their bodily attachment to the fetus. One expressed it like: “I had started to feel kicks and movements, and just the thought that it wouldn’t happen anymore was terrible.” For many, it was difficult and surreal to grasp what was happening: “Thinking about a late-term abortion. I just couldn’t fully comprehend what I was dealing with.”

The women’s attachment to the fetus changed and many noticed a distancing attitude to the fetus, followed by a need for a rapid initiation of the abortion. Teresa explained: “It was so scary that he already had grown so big inside me, and it’s that feeling of having a living child in your belly that is not supposed to live, it’s just such a grotesque thing,” and further: “When you’re in the middle of it, it almost feels like you sometimes want to distance yourself from your belly and from the child, and just get it over with.” Similarly, Stine stated that: “I just remember the thought as soon as I realized that this was serious. I just thought: ‘Get the baby out’, I didn’t want to deal with anything.”

For some, like Johanne, the burden further increased when she had to wait through the weekend for the board’s conclusion: “When my decision was made, I just wanted to get it over with. To go home and spend another night with a child in my belly that I wasn’t going to carry to term, that delayed the whole process.”

This rapid shift from being attached to the fetus to suddenly being sure about having an abortion surprised the women. At the same time, they all characterized it as a demanding decision. Ingrid explained by saying: “You will always have doubt. It is a quite big decision to make, to end a life. Especially when you have come so far as to feel movements.”

Moments of No Return

Once the decision was finally made, what appeared to be the most crucial events remained: taking the pill, undergoing the abortion, seeing and holding the fetus afterward, and leaving the hospital without a child. These moments marked points of no return. Astrid described the crucial moment when she took the abortion pill:

No one forces you to take that pill. (...) I had to actively start the labor or end the pregnancy myself. The woman actively does that. She takes that pill. Swallow it with a glass of water, and then it’s sort of started. “If I had sat there thinking, no, I don’t want to after all,” then I wouldn’t have done it.

Teresa explained why this felt like a defining moment for her: “You can never escape that what killed the child was the pill that I chose to take. It’s just a fact.” This moment, in addition to the fact that the seriousness of the decision was never addressed by health personnel, intensified their sense of the trauma. Ingrid described the feeling she had after having taken the pill: “I remember that night, you know what you’re about to go through, and you still feel movement. Afterwards I sometimes think that I’ve ended something that is alive. It was quite brutal.” Margrete elaborated on how this tense and uneasy feeling intensified when she met at the hospital to carry out the abortion delivery: “I didn’t even know if the baby was dead because I felt it kicking the night before.”

The abortion itself was also a traumatic experience that put an end to pregnancy. Hence, the circumstances surrounding the woman turned out to be of great importance. Some found it difficult to undergo the abortion on a maternity ward among joyful new parents with healthy newborns. Others struggled with the perceived lack of expertise in a gynecological unit. They expressed a sense of displacement and not belonging, which added to their emotional load. Margrete explained that:

My experience was that the nurse had no competence or empathy whatsoever. I don’t think she had read my medical record either, so I don’t know if she even knew it was a late-term abortion. And I don’t think she knew that there was a diagnosis behind it. So, I felt like she saw me as some careless woman who had neglected to use contraception, or something like that.

After the abortion, several women wanted to see the dead fetus—an experience that can also be described as a defining moment. Many described that the emotional bond to the fetus was reestablished and referred to it as their child. All described the abortion more or less as a birth. Therefore, they found it offensive when the staff brought it in a pus tray and had wished for a more dignified ending. Several of the women had also experienced that their renewed attachment to the fetus was not taken seriously by the healthcare system. Margrete told us that: “The health care service has adopted a language that doesn’t match with reality at all. They talk about expelling pregnancy products, while in reality I am giving birth to my baby.” Stine experienced that the doctor did not understand why she was upset since, according to him, she did not actually have a baby, but rather “a product of pregnancy.” This contrasts with how many of the participants experienced holding the dead fetus. Except for the fact that the fetus was lifeless, they were surprised and delighted that it looked like a normal child: “It was the happiest moment of my life, because he was so beautiful […] Just a very small baby. He had fingernails, and his ears were fully developed, he was so beautiful,” said Hilde.

After the abortion was carried out, the close bodily connection to the fetus was gone, and they could no longer feel life, which they found sad. Now they had to deal with a completely different existence that felt empty without the fetus. Astrid described the strangeness of her body being in a maternity phase without a baby: “I left the room where I had spent all that time, I walked home alone—without a pram to push.” She further elaborated on the social aspect by stating that:

Maybe that is what makes it so difficult. Looking back, defining what you have been through. It was tough for the people around me, I remember my friends were very unsure of how to handle this. And also, for me, to define what this really [was] … I had become a mother now, yes, but I wasn’t, because I didn’t have a child to bring home with me, right?

Together, these moments of no return: taking the first pill, going through an abortion that felt like a birth, holding their dead fetus, and finally leaving the hospital without a child, all contributed to the feeling of having experienced an existential crisis.

A Demanding and Lonely Grieving Process

The women described how the information about their fetus suffering from a serious condition brought about a demanding and othering grieving process. All of them talked about feeling they were at risk of losing a much-wanted child. Even if they received varying amounts of support from health care providers, family, and friends along the way, they still had a feeling of existential loneliness. Already during the ultrasound, when the midwife suspected something was wrong, most women got a bad feeling. The silence that followed added to their anxiety. Although the experts they met afterward were honest, all information throughout the entire process focused primarily on medical issues and the state of the fetus. The woman’s reactions were hardly discussed, and they did not know where to turn for information, neither about their mental nor physical state: “Yeah, it was just the facts, sort of. It wasn’t about how you feel inside. You lose a child—I say that—I lost my child.” It was as if no one understood the great loss they felt. Hilde expressed her grief like this: “I do not want to be on earth without my child.”

Some, like Anita, also called for more care and empathy from the board members: “The person leading that conversation, I remember I felt that she was very judgmental. She was very insensitive and had in no way any understanding of how I felt or how tough this was for me.” It may seem as if even short remarks without sufficient sensitivity from healthcare workers intensified the grieving process. Others still appreciated talking through the situation with someone with experience.

Once the abortion was carried out, most women were left to themselves: “The follow-up stopped at the hospital.” Some were offered to meet a priest, which was of little interest to several of them. Stine stated that: “If there was one thing I didn’t want to deal with while I went through this, it was Christianity. There couldn’t be any God.” Others thought that perhaps a priest would condemn them. Some were offered a phone call with a midwife after about six weeks, which they appreciated, but they were still left to themselves for many weeks. Thus, the women were poorly prepared for both physical and psychological reactions and expressed that they had to find their own way. For some, having a clear understanding of the reason for the decision to terminate the pregnancy was crucial for being able to “live with it,” and efforts were made to seek and understand the medical history of the fetus.

A few of the participants were given a short sick leave at the hospital, but most were rejected on the grounds that they were not sick: Anita was told that: “Your body is fit to go to work, so strictly speaking you don’t need sick leave for more than a couple of days.” She found it hurtful not to have the emotional strain acknowledged. The women who still wanted sick leave had to arrange this themselves with their general practitioner after returning home. Several also contacted a psychologist for further follow-up, without feeling that they got the help they needed.

The interviewed women felt they were falling through the cracks, occupying a unique position in which no adequate healthcare support was available: “I belong to an intermediate category that does not fit in.” Not being cared for in their vulnerability seemed to increase the feeling of existential loneliness. Margrete described this by saying: “The moment you hand over your child and leave the hospital, all follow-up stops. Then there’s nothing, and that is the biggest point of complaint, I think.” Kathrine felt surprised when they said she could go home right after the abortion: “It was like: ‘You can leave whenever you want’. And I think maybe that was the worst part in a way: To just leave.” Neither her mind nor her body was ready.

Some had left the hospital without knowing when and where the fetus would be buried, which increased their emotional burden. Margrete explained that: “One of the things that bothered me a lot afterwards was that we didn’t know where she was. And it gives me such a feeling of being a bad parent, simply because I didn’t know where my child was.” In the aftermath, some women realized that their emotional connection with the fetus was still strong. They had wanted a grave to visit in their neighborhoods, but they didn’t realize this because everything happened so quickly. Stine reflected on this by saying: “In hindsight, all of this has changed my perspective. Because now I call him my child, and I would have preferred to have a place of my own to visit him instead of a memorial garden.” Astrid explained: “If I had known about it, I would have buried him by the grave of my partner’s grandmother. He didn’t need to have a name on any gravestone, but just to know that he has existed.”

The women expressed in various ways that they missed being treated with humanity, understanding, and care and that they had to find their own way through the grieving process.

Discussion

The fact that several fundamental dimensions of the women’s lifeworld were affected provides grounds for understanding their situation as an existential and traumatic experience. Shortage of time was experienced critically because the abortion limit was approaching. Within these tight time margins, in addition to the unsuitable surroundings, they had to decide whether to terminate or complete the pregnancy. The critical diagnosis changed the women’s attachment to the fetus and thus also their attention to their own bodies. Since the world is perceived from the body, bodily changes will affect perception and disrupt the harmony between body and world that characterizes good health (Toombs, 1993, p. 62). These dimensions are not separate but intertwined into a whole in the human lifeworld.

Similar to other studies (Damm, Lou, et al., 2025; Heinsen, 2022; Lafarge et al., 2014, 2019), our findings indicate that both receiving information suggesting that the fetus has a serious condition and undergoing a termination of pregnancy in the second trimester were profoundly distressing experiences for the women involved. In a systematic review by Lafarge et al. (2014), a TOPFA experience was even referred to as an existential crisis. Because the pregnancy was strongly desired, women in our study were faced with what they felt was an impossible choice. Others felt like there was no choice at all, contrasting the terminology used to describe the decision-making process involved in second-trimester abortions.

During the decision-making process, after having been informed about diagnoses and prognoses, several of the women were surprised and overwhelmed by a sudden bodily detachment and distancing attitude to the fetus followed by an urge to get it out of their body as soon as possible. The abrupt termination of attachment led to an emotional upheaval, which they had not been prepared for. How technologies of fetal screening and diagnostics reconfigure the moral status of the pregnant woman as parent and the fetus as both person and patient has earlier been described in the literature (Rapp, 2000; van Manen, 2020; Verbeek, 2008). The women in our study experienced a further reconfiguration as they received information about the poor health of their fetus that they had to act upon. Or as Verbeek (2008) puts it: “ultrasound translates ‘expecting a child’ into ‘choosing a child’, or choosing to terminate pregnancy” (p. 16). Hence, the possibility of abortion can potentially cause the woman to distance themselves from the fetus, as was the case for some women in our study.

The sudden distancing attitude toward the fetus contrasts with many of the women’s restoration of attachment to the fetus after termination, described as a surprise at the normality and beauty of their dead fetus. A study by Lou et al. (2025) showed great ambivalence about women’s desire to spend time with the fetus after termination. While some valued seeing or holding it, others preferred not to do so. Both Lafarge et al. (2013) and Lou et al. (2025) conclude that healthcare personnel should respond sensitively to the individual woman’s different attitudes and perceptions of the aborted fetus.

An abortion with a sudden removal of the fetus naturally led to altered perception and disrupted harmony between body and world, which also affected the women’s social life. Notably, the lived relations to the fetus and to others involved in the abortion process seemed to have a particular bearing on the woman’s existential experience of having a second-trimester abortion, including her social relations. The emotional attachment shaped the women’s experience of time in the difficult decision-making process. It also shaped defining moments of no return like taking the first pill or seeing the dead fetus. Most importantly, their relation to the fetus also shaped their complex grieving process and created an awkward relationship with healthcare workers and others who they felt did not understand their experience of loss.

Echoing other studies on second-trimester abortions (Heinsen, 2022; Lafarge et al., 2019; Lou et al., 2021), our study shows how emotional attachment to the fetus shifts and changes back and forth throughout the process, creating a complex moral and emotional landscape to navigate. This emotional labor of reconfiguring their relation to the fetus resonates poorly with established social, political, and bureaucratic scripts for abortion processes that seem to take for granted that abortion seekers want to terminate an unwanted pregnancy.

Experiences of Loss

The women’s experiences with the comprehensive process of going through a TOPFA resonate considerably with phenomenological examinations of grief (Fuchs, 2018; Ratcliffe, 2023). In his attempt to map out a basic structure of grief after bereavement, Fuchs (2018) highlights how a grieving person experiences a “fundamental ambiguity between presence and absence of the deceased” (p. 43). He further notes that this is “an ambiguity which may also manifest itself in being painfully torn between acknowledgement and denial of the loss” (p. 44). This may resemble the processes of reconfiguring their emotional attachment to the fetus described by the women in this study. Moreover, Fuchs (2018) describes how a perceived ambiguity between presence and absence affects the grieving persons’ experience of their own bodies. This occurs as their embodied experience of their loved one is abruptly cut off. In the case of women going through TOPFA, this experience of intercorporeality was even more direct since they had felt the fetus as inseparable from own bodies. Fuchs (2018) also describes how temporality is impacted by bereavement. He explains that the grieving may feel as though they are experiencing two forms of time: one in which time has frozen and another in which the world continues to move forward without the deceased. This description of temporality resonates with this study’s findings of women’s experience of time as going both too fast and too slow during the difficult decision-making process. Women’s experiences of terminating a wanted pregnancy thus carry a lot of similarities to situations of loss.

Donley and Lens (2022) have argued that despite a series of commonalities between pregnancy loss and abortion, such as physical experiences and experiences of grief and stigma, recognition of these similarities has been absent from discussions on abortion rights and abortion care. The authors argue that abortion rights movements have failed to talk about experiences of loss after abortion in fear of ceding ground to anti-abortion groups who push for legal recognition of fetal personhood. Due to this tension, women with experiences of loss after abortions are rarely heard in abortion debates, and their experiences are seldom taken into consideration when crafting abortion laws or abortion-care practices. In consequence, the clinical and bureaucratic steps that abortion-seeking women must go through are developed with another ideal type of abortion seeker in mind, a woman with an unwanted pregnancy who is not emotionally connected to the fetus.

Also, healthcare workers may have a different ideal type in mind when interacting with abortion seekers in the second trimester. Descriptions of doctors using medical terminology to describe the fetal remains, sometimes in stark disharmony with women’s experiences of having lost a child, were fraught with frustration. This frustration can be interpreted as a result of objectification or alienation (Carel, 2013; Merleau-Ponty, 1945/2013). The tension speaks to the role of language in social recognition and may demonstrate how terminology shaped by biomedical science may become a barrier to good communication between health professionals and patients.

As researchers, we have also felt the limitations of language, particularly in our efforts to find a language that fully resonates with the women’s lived experiences. For example, while the women consistently spoke of their child, we have, to avoid confusion in the professional community, used the word fetus.

The dissociation between the women’s feelings of loss and the ideal type of abortion seeker that seemed to be inherent in the abortion-care system also had bearings on how their grief was experienced and handled. Encounters with health workers who talk about the physical condition of the fetus without recognizing the emotional state of loss that many experienced seemed to add to the emotional burden of many of our participants. Their descriptions are in line with what Ratcliffe (2023) considers about grief as something that involves “a profound alteration in the experience of self, world, and other people, of a kind that is hard to make sense of or convey to others who have not themselves had such an experience” (p. 1). The women’s experiences may be similar to what Ratcliffe (2012) has described as “existential feelings.” In his analysis, such feelings make “a shift in the overall structure of world- experience” (p. 26). Ratcliffe moreover distinguishes grief from mourning by stating that while grief is the internal emotional process, mourning “involves acting according to socially and culturally prescribed norms” (Ratcliffe, 2023, p. 4). In other words, mourning includes a social process with rituals and customs that require social recognition of the loss. Since the emotional connection to the fetus was left mainly unrecognized by general society and the health care system, the women in our study may have experienced situations of grief without mourning, adding to the feeling of alienation and loneliness. On top of this, many women described critical lack of follow-up after the abortion was carried out, leaving them to find their own way through the grieving process.

Methodological Strengths and Limitations

The study’s strength lies in the great variety among the participants. Their educational backgrounds varied. They were recruited from hospitals in different parts of the country and had met various abortion boards. Furthermore, both first-time pregnant women and women who had been pregnant previously participated. All shared rich and clear memories from their second-trimester abortion experiences, also those who had experiences that went back quite some time. A possible weakness is that only two of the participants chose in-person interviews, while the rest opted for digital meetings. This means that the interviewers could not observe the participants’ body language to the same extent. Yet, digital interviews in this study demonstrated high quality and richness in content, comparable to in-person interviews.

As the study was a part of the Ministry of Health and Care Services’ commission to address the knowledge gap in preparation for the new law, the project was conducted under considerably rigid time restrictions. This posed an important limitation specific to recruitment. With more time, a wider range of participants may have been recruited. For example, all participants were Norwegian-speaking and seemed mainly to represent Norwegian majority culture. The lack of representation of further disempowered groups of abortion seekers is an important limitation of our study. The research team is currently planning a more comprehensive study in the near future to address this persisting gap. With more accommodating timeframes, we are aiming to recruit participants with a broader range of age, educational level, vulnerability, culture, language, and recentness of experience.

Conclusion and Implications

The traumatic experiences the women went through meant that the expectations and joy of pregnancy were transformed into a feeling of alienation, both toward their own body and the fetus. The harmony between body and the outside world was broken, and they saw no possibility of resolving the situation in a good way. The fact that health personnel were unable to meet their grief either with words or actions further worsened the situation. It nevertheless seemed that the grief became more bearable when they were given the opportunity to see and hold the dead fetus, provided it was arranged in a dignified manner. The fact that the women were not followed up afterward meant that they had to find their own way through the grieving process.

The variation in attachment to the fetus during decision-making and after termination that several of the women highlighted, wondered about, and reflected on afterward may be important for healthcare professionals to recognize. How is it possible to support women who are overwhelmed by sudden changes in attachment to a fetus with a serious condition during and after termination? From our perspective, health professionals must focus on women’s reactions throughout the abortion process and ensure that they are followed up in the period afterward. This may have implications for both the experience of a possible later pregnancy and for trust in health professionals in general.

Women who experience loss after abortion are seldom given attention in public or policy discussions, resulting in legislation and care practices shaped around an assumed ideal type of abortion seeker that does not reflect their needs or emotional realities.