Introduction

Abortion is a theme permeated by religious and cultural issues, and when it happens, even in situations provided for by the Law, it becomes a public health problem of great severity due to the high risk of complications and death of women. ¹

The World Health Organization defines abortion as the discontinuity of pregnancy until the 20^th or 22^nd week of pregnancy, provided that the conceptus weighs less than five hundred grams. ^2,3 Abortion is the final product of abortion, however, commonly abortion is used to refer to the very process of abortion as synonymous. Abortion can occur spontaneously or provoked. Spontaneous, when the embryo does not develop correctly and the body of the pregnant woman expels it without interventions and provoked, when methods are used to provoke the interruption of pregnancy. ³

Approximately 56 million abortions are performed worldwide each year. In addition to health risks, induced abortion, performed in unsafe conditions, illegally, causes harm to public health because complications generate high financial costs for treatment.⁴⁾ It is worth noting that 97 % of induced abortions occur in developing countries and their complications account for 13.12 % of maternal mortality. Safe induced abortion is seen as reducing maternal death, since interventions will be made with trained professionals and in places with adequate care. ⁵

In Brazil, induced or induced abortion is prohibited by law, except in cases where there is an imminent risk of death for the woman, rape or congenital anomalies.⁶⁾ The country has one of the highest rates of illegal abortion in the world, being about 500,000 per year among women aged 18 to 39 , and consequently about 40 % or 200,000 women die due to its complications.⁷

The Resolution of the Federal Council of Nursing No. 564/2017 ⁸⁾ recommends that it is vetoed to Nursing professionals cause or assist in an abortion process. In situations of abortion that are provided by law, the nurse has the right to refuse their participation if assistance is guaranteed. However, when women seek the health service, in situations of complications resulting from induced abortion, it is mandatory to provide care.

Faced with this problem, a study by Borges, Clemente and Netto ⁹⁾ demonstrated the lack of trained professionals to deal with sensitive issues such as abortion and sexual and domestic violence. Madeiro and Rufino ¹⁰⁾ also addressed, in research conducted with women who suffered abortion and health professionals, the deprivation of professionals in having knowledge about the complications of abortion and the complexity of the necessary care.

In this perspective, university education is fundamental to work with themes and issues related to humanitarian causes and breaking social stigmas, through the promotion of educational-dialogical spaces on comprehensive care -technical, humanistic and respectful, congruent with the demands of the women. ¹¹

Given the above, emerges the present research grounded by the Theory of Social Representations (TSR), in its procedural approach considering the possibility of, through this theory, understand the conception of nursing students about induced abortion based on common sense and, in historical, cultural, ideological and value aspects in the communication that the group shares.

For Jodelet, the TSR is characterized by the procedural approach, accessing the knowledge of social representations from an approach of interpretation of words, understanding the human being as a producer of meanings, and analyzing the symbolic the meanings, the language, through which the human being builds the world we live. ¹²

The study aims to explore the social representations of nursing students about induced abortion and discuss the social representations about nursing care to women in the process of abortion or post-abortion with complications.

Methodology

This is a qualitative descriptive study, based on the Theory of Social Representations, carried out with nursing students at the State University of Bahia (UNEB), Campus XII, located in the municipality of Guanambi-BA. The conduct and presentation of research follows the criteria defined by the Consolidated Criteria for Reporting Qualitative Research (COREQ). ¹³

The University has 135 students enrolled in the nursing course. It was used as inclusion criterion to be a nursing student duly enrolled in semester 2022.2 of UNEB; and exclusion to be under 18.

The research was disclosed to students personally and/or through an application to send instant messages and voice calls to smartphones, through students. Considering the availability of each student, an individual moment was marked in a reserved classroom at UNEB, to avoid any intervention and maintain the participant’s privacy. Thus, in this space, more information about the research was provided, reinforced the invitation, read and signed the Informed Consent Form (ICF).

It should be noted that the research was carried out throughout its history, considering the ethical standards of Resolution No. 510/2016 of the National Health Council. ¹⁴ It was approved by the Ethics Committee of the State University of Bahia under the number CAAE: 64244722.8.0000.0057.

Data production was carried out in November 2022 and, therefore, the semi-structured interview was used, a technique that combines open and closed questions and leave interviewee free to expose and opine about the approach. ¹⁵⁾ Participants were asked questions such as “Tell me, please, what do you know about induced abortion?”; “What is your opinion about induced abortion?”; “How do you relate sexual and reproductive rights to the issue of induced abortion?”; “Have you participated in any classroom activity or classroom discussion or events during your graduation on the issue of abortion? How was the discussion? What are the main points addressed?”. The interviews lasted ten minutes, on average, they were recorded with the consent of the participants.

The total number of participants was 16 students and defined based on the logic of data saturation that is understood as the perception of the researcher to have enough information to respond to the objectives of the research, given the understanding of the logic of the object, redundant and repetitive results, not requiring new collections, participations which culminates in the suspension of the data production stage. ¹⁶

For data analysis, the software Iramuteq (Interface de R pour les Analises Multidimensionnelles de Textes et de Questionnaire) was used, following the patterns suggested according to the manual. This software is a tool for data processing and exploitation, providing several possibilities for text. ¹⁷

In this study, the Descending Hierarchical Classification Method (DHC) was used, which classifies the text segments. To this end, the analysis of the Simple over ST type was performed, which is predetermined by the software and recommended when long texts are disposed. ¹⁸

Six steps were proposed for qualitative research in the process of organization, treatment and analysis of the data:¹³ 1^st Organized and prepared the data (making of the corpus) for the analysis, followed the guidelines of the manual 2^nd: Reading all data with reflection on the general meaning of the data, taking care not to change them during the transcription; 3^rd: Performed a detailed analysis by the coding process with the support of IRaMuTeQ software by separating the words; 4^th: new detailed analysis by the coding process, with new readings of the interviews, mainly after the organization of the data by the system in ECU (Elementary Context Units) and the words highlighted in each class; 5^th: Identified as the description and themes would be represented in the qualitative narrative, according to the themes that emerged from the analysis of the data was made the theoretical support based on the literature and 6^th: Extracted the meaning of the data according to the understanding of the researcher and confronted with information identified in the literature.

In the transcription and organization stage of the interview corpus was defined as Initial Context Unit (ICU) and the analytical substrate, executed in the software for data processing. After that, the ICU were grouped, giving rise to the Elementary Context Units (ECU) and the creation of a dictionary of smaller forms, through the chi-square test (X²) that reveals the associative force between the words. ¹⁸

The speech clippings of the participants were also used to illustrate the classes, because they present important elements for contextualization of the words/terms that configure the DHC. These cuts were cited exactly as they were fragmented by the software, after processing, including the score, which was evaluated at the time of writing the corpus. And, to ensure the anonymity of the participants, they were identified by the letter E, followed by the order of participation.

Results and discussion

The participants were 16 nursing students from the second, fourth, sixth, eighth and ninth semesters, all female, aged between 18 and 42. Of these, ten spoke of being of the Catholic religion, four evangelicals and two denied following some kind of religion.

Although it was a limiting factor of our work the short time of the interviews and the semester in which the student is, the literature brings that this can be due to the lack of knowledge of the students about the subject, approach in graduation reflecting the lack of depth of the answers. This is also done by the traditional teaching model in which the teacher conducts the subject of personal beliefs and values. ^19,20

From the grouping of words made by the system, the classification of text segments was obtained in three classes, differentiated by colors. These classes are illustrated by the dendrogram figure (Figure 1).

Figure 1: Dendrogram (DHC) of the classes provided by the Iramuteq software. 

The presentation of this dendrogram shows the divisions that were made in the corpus, until arriving in these classes. The reading is done from left to right in which the divisions are correlated to the text segments and show the vocabulary of the words with average frequency among themselves and divergent among them. ¹⁸

The software divided the corpus into two subcorpus that are constituted by the ECU, thus: subcorpus 1 - Constituted by class 1 (73 ECU); subcorpus 2 - Classes 2 (85 ECU), 3 (55 ECU) with 77.74 % of use of the corpus. According to the manual, the corpus must have the use of at least 75 %, thus it can be affirmed that there was a relevant use for the research.¹⁸

The following dendrogram (Figure 2) is the product of Iramuteq, which through DHC favors the visualization and the relationship of the words between them. There is no change between Figure 1 and it in relation to classification, but in this way, it is possible to visualize the number of times that the word was cited, according to its hierarchy.

From the detailed analysis of the dendogram, and in each of the classes individually, it was noticed that in each segment the words have an agreement. The classes gained greater meaning from the comparison of the dendogram with the fragments of the speeches, in which they demonstrated meaning and meaning for the interviews of the undergraduate students in nursing.

Figure 2: Dendogram (DHC) with terms/words that make up each class. 

After the data were processed, new readings, word classification and class naming began: Class 1 - Nursing care for women in an abortion situation; Class 2 - Representation of induced abortion from the perspective of sexual and reproductive rights and their legalization to reduce the risk of complications and death; Class 3 - Conscientious objections to legal or illegal abortion. To describe each class, an analysis of the words individually was performed, observing in which segments of texts they were inserted, correlating with the literature. The fragments of the interview were mentioned as they appeared in the software, exactly as they were cited, including the score that was evaluated in the making of the corpus.

Final thoughts

Students’ social representations of abortion deny respect to women’s decision-making and recognition of the need for legalization of abortion. In turn, the social representations about care reveal the current scenario of health care to women that is marked by the lack of comprehensive care, and for an assistance carried by prejudices/judgments and distanced from public policies that aim to promote quality and humanized assistance.

In the construction of the social representations of abortion, the participants perceived duality because they expressed feelings ranging from empathy and respect for the opinion of those who abort, to stigma and prejudice linked to opinion.

Although the size of the population can be considered as limited, the study is not intended to generalize the results and reflects a reality that may be common to other academic contexts in countries where abortion is illegal. In addition, it offers subsidies that can incite a greater discussion/critical reflection on the theme of abortion in undergraduate courses in health, specifically nursing and in permanent education processes, in the direction of training committed professionals in providing comprehensive care, without discrimination.

It is considered necessary that the theme be discussed more frequently in graduation so that it can expand the knowledge about the theme in front of the professional challenges that deal with the complexity of the necessary care for women in the process of abortion or post-abortion miscarriage with complications.