Factors associated with being in favor of punishing a woman who aborts

Objective: To identify the factors that are associated with the opinion with reference to punishing with prison any woman or a known woman who had a voluntarily abortion, in a country with restrictive laws Study Design: Secondary analysis of data from a survey conducted among civil servant from a large municipality in the state of Sao Paulo, Brazil, who answered a questionnaire which included information on the respondents’ opinion whether any women or a woman they know, who had an induced abortion should be imprisoned as established in the law. The association of sociodemographic variable with such opinion was analyzed. Results: Personal history of abortion and higher educational level were independently associated to be against punishing any woman or a woman they knew who had an abortion. Higher family income, and being a female were associate to be against the punishment for any woman, while lower religiosity and older age of the pregnant woman were also associated to be against the punishing with prison a woman they know who aborted. Conclusions: History of having an abortion and higher education were the main factors associated to be against punishing a woman who aborted. Religiosity was not as relevant as when asking of the opinion on abortion in abstract. *Correspondence to: Anibal Faúndes, Cidade Universitária, Campinas, State of São Paulo, Brazil, E-mail: afaundes@uol.com.br


Introduction
Induced abortion is mostly unsafe in countries with restrictive abortion laws. According to recent estimation, 25 million unsafe abortions are carried out per year, 97 percent of them in low or middle income countries in South-Central Asia, sub-Saharan Africa and Latin America [1].
A main reason for keeping restrictive legislation in those countries is the belief that liberalization of the law would lead to an increase in the number of abortions, a belief not supported by the evidences, which shows that abortion rate tends to decrease after liberalization of the abortion laws [2][3][4].
An even more important motivation the legislator have to keep abortion law restrictive is the belief that most people are in favor of punishing women who abort with prison, as the restrictive laws say. This belief is based in opinion polls, which usually shows that most people would like to keep the laws quite restrictive, limited to just a few exceptions, such as the protection of women's life and health. Rarely if ever, the question asked is whether people agree to punish a woman who had an induced abortion with prison, as every restrictive abortion law requires.
We believe that abortion is not a welcome event for most people, and at answering opinion polls, people believe that if they were in favor of liberal abortion law they would be "in favor of abortion". As almost nobody is "in favor of abortion" the answer is against more liberal abortion law.
If we move from such rather abstract concept to the real world, by asking whether people are in favor of punishing with prison a woman who have a voluntary induced abortion, we may have a different answer. We did such study and published the results, but we did not analyze which factors were associated to be in favor of punishing with prison women who have an induced abortion [5].
The identification of those factors would allow to have a better understanding of public opinion and which are the chances of moving the policy makers to modify the abortion law to improve the health and wellbeing of women, contributing, at the same time, to reduce its numbers.
This paper presents such analysis from a sample of civil servants from a municipality in the interior of the State of Sao Paulo.

Subjects and Method
This was a cross-sectional, descriptive surveys, carried out among civil servants from a large Municipality in the state of São Paulo, Brazil. A questionnaire for self-completion which included information on age, sex, marital status, years of schooling, family income, personal history of unwanted pregnancy and induced abortion, religion, and the importance of religion in their lives. In addition, the respondents were asked questions related to their agreement that any woman and women whom they know, who had an induced abortion, should be punished with prison, according to the law.
The questionnaire and a covering letter, together with a pre-paid response envelope, were sent out to 15,800 employees along with their salary statement. The response rate was 11%, 72 of which were sent back blank, and one participant sent back two questionnaires in the same envelope; only one was counted. Therefore, the number of questionnaires included in the study was 1,660.
The answers on the questionnaires were reviewed, numbered and double entered. The dependent variable analyzed for this paper was their agreement that any woman and women whom they know, who had an induced abortion, should be punished with prison.
The predictor variables investigated for all models were age (in years), sex (male/female), marital status (single/living in union); years of schooling (up to secondary school\college or university); family income in number of minimum wages (up to 10\ more than 10 minimum wages); whether the respondent, if female, or his partner, if male, has ever had an absolutely unwanted pregnancy and had aborted (never had or had and not aborted\aborted an unwanted pregnancy); religiosity evaluated by two questions: if the responded classify him\ herself as religious, intermedian or non-religious and importance of religion in the participant's life (very important/less important, unimportant or not religious). All predictor variables were initially included in all models, and backward elimination criteria were used to retain only the significant ones. When a predictor variable was not significant, it was excluded, and a new model was calculated without it.
Poisson regression models were constructed to study the association between the dependent and predictor variables while controlling for other predictors [6]. Prevalence ratios are presented for the predictors that were statistically significant.
These studies were carried out in compliance with Brazilian norms for research on human beings. The protocols were evaluated and approved by the Ethical Committee on Research, Faculty of Medicine, University of Campinas, SP, Brazil.

Results
The socio-demographic characteristics of the sample are shown on Table 1.
Just over 60 percent of the respondents (943 of 1555 or 60.6%) declare that women who had an induced abortion should NOT be punished with prison. Sixty four percent or 1,059 out of 1,651 respondents knew at least one woman who had an induce abortion and 86.1% (833 of 968) of them said that those women they know should not be punished with prison after having an induced abortion (data not shown in tables).
The factor with strongest association to the opinion that any woman who have an induce abortion should not be punished with prison was a history of having an induced abortion. A higher socio-economic level as shown by level of education and income, was also independently associated with the opinion that those women should not be punished with prison. Finally, being a female was significantly associated with that opinion. (Table 2). Interestedly, the religiosity of the respondent was not significantly associated with the opinion about punishing with prison a woman who have an induced abortion.
When the question was related to punishing a woman the respondent knows who had an induced abortion, the factors associated changed a bit, maintaining the association with years of schooling and personal history of having an induced abortion, but in this case participants who gave much importance to religion approved the punishing with prison in a much larger proportion than those who gave low or no importance to religion or did not have a religion.
Another important factor that appears in this condition was the age of the pregnant woman, with lower proportion approving punishing when the woman having the abortion was younger than 18 years old. (Table 3)

Discussion
The results of these analysis showed that most of the respondents are not in favor of punishing with prison a woman who had an abortion and that such majority is overwhelming when dealing with a woman they know who had an induced abortion.
In relation to the factors which appeared associated to that opinion, it called our attention that religiosity, which I such a prominent factor  on the people's opinion about abortion and abortion law [7], was not associated with agreeing that a woman who had an induced abortion is punished with prison, meaning that even those who give great relevance to religion do not approved the imprisonment of woman who abort. Only when the analysis was limited to women the respondents knew, one of the two indicator of religiosity appears as associated with agreeing that such woman was punished with prison.
A higher level of education was one of the two factors which were independently associated to be against punishing any woman or women they know who had an abortion, is in agreement with other studies carried out in Latin America, showing that people with higher education are generally more in favor of less restrictive abortion laws [8,9]. What we did not found in the literature was any study that considered the personal history of unwanted pregnancy and previous abortion as a factor affecting people attitude toward abortion in general, or to punishing a woman who abort, in particular. It is not a surprise, however, that people attitude changes after going to the experience of an unplanned pregnancy and having to decide to terminate the pregnancy.
The main limitation of this study is that we had a low response rate of 11% with a high proportion of people with higher education different than the general population of Brazil. It means that the percentages of respondents who are against punishing with prison women who had an induced abortion may not represent the opinion of the Brazilian population at a whole, but of a segment with better education. On the other hand, as almost two thirds of the sample had a family income up to 10 minimum wages indicated that it was not the wealthiest segment of Brazilian society.
This limitation, however, does not reduce the value of the findings on factors associated to the opinion about punishing with prison women who abort. In that sense, one important finding was that religiosity loose a large part of its relevance when people have to think of the real effect of criminalizing abortion over the women who goes through that experience, it also confirms that people with greater formal education have a more reasonable view of the problem of abortion, which is not solved by criminalization as shown by the available evidences [10]. Our study adds to the current knowledge the relevance of having the experience of an unplanned, unwanted pregnancy, which make people realize that nobody likes to have an abortion, but there are circumstances when they do not see any other alternative. Had and aborted 0,23 (0,07-0,75) - Table 3. Poisson regression models for having an opinion in favor of punishing with prison a known woman who had an induced abortion. (n=746) Copyright: ©2018 Faundes A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.