The Obstetrics and Gynecology and Genetic Counseling of Mother With Legal Abortion Had Been Referred to in Fars Province Center Since 2007 - 2013


Saeid Gholamzadeh 1 , Fatemeh Godrati 2 , Narges Saadatmand 3 , Marzieh Akbarzadeh ORCID 4 , *

1 Legal Medicine Research Center, Legal Medicine Organization, Tehran, IR Iran

2 Department of Theology, Faculty of Literature and Humanities Science College, Yasouj University, Yasouj, IR Iran

3 Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran

4 Department of Midwifery, Maternal Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran

How to Cite: Gholamzadeh S, Godrati F, Saadatmand N, Akbarzadeh M. The Obstetrics and Gynecology and Genetic Counseling of Mother With Legal Abortion Had Been Referred to in Fars Province Center Since 2007 - 2013, Shiraz E-Med J. 2016 ; 17(2):e35271. doi: 10.17795/semj35271.


Shiraz E-Medical Journal: 17 (2); e35271
Published Online: February 21, 2016
Article Type: Letter
Received: December 20, 2015
Revised: January 17, 2016
Accepted: February 14, 2016

Dear Editor,

One reason for the 21 percent mortality rate in newborn infants is congenital deficiency of the fetus (1). Caring for these children after birth often leads to financial and family problems (2, 3).

Discovering the presence of fetal disorders during pregnancy often pushes women into emotional crisis. Thus, it is essential to prepare them for such eventualities and address their anxiety and sadness after they have been informed of fetal abnormality (4).

Pregnancy with an abnormal fetus is a challenge for families, society, and physicians (5). Some researchers emphasize the potentially negative psychological effects for women of aborting an abnormal fetus. To avoid this eventuality, preparing parents to meet a baby with an abnormality and acquainting them with the diagnosis and the options for treating children with disabilities can improve the family’s quality of life, possibly even paving the way for the prevention of such defects in future pregnancies (6).

Fetal abnormalities place severe strain on parents. In considering pregnancy termination for fetal abnormality (TFA), it is vital that psychological compatibility and the promotion of adaptive coping strategies be taken into account (7). It is also recommended that advice be given by a team of gynecologists, psychologists, and religious counselors. Awareness of the necessity for consultation is important for several reasons, including the provision of sufficient and necessary information about the type of birth defect, the prognosis for future pregnancy for both mother and fetus, and the deadline by which the mother can apply to have an abortion (8, 9), since legal abortion can be performed in Iran with the approval of religious jurisprudence when the fetus is less than four months old (10).

On the other hand, some studies consider that abortion is stressful and improper, and has psychological consequences for families. Many pregnant women may want to avoid even legal abortion (11-14).

Bearing in mind the importance of consultation for families faced with compulsory abortion, a study was carried out in Shiraz on a sample of legal medical files relating to the seven-year period from 2007 to 2013. The sample size was 1,664 and sampling was based on the census. The variables for the study included demographic information, midwifery, maternal and fetal diseases, reasons for authorization to abort, and genetic consultations.

The results showed that 26.75% of the mothers within the age range 20 - 25 (445), 31.5% of those within the age range 25 - 30 (524), 18.6% (309) within the age range 30 - 35, 8.5% (142) aged under 20, and 4.15% (69) aged over 40 received authorization to have an abortion.

Of the respondents, 67% (1,115) were homemakers and the remainder held different roles. In total, 55% (915) of them had consulted with a specialist and 45% (749) had not, while 25.73% (428) of them had done genetic consulting and 74.27% (1,236) had not. Also, 71.99% of them had been referred in person to forensic medical centers to get authorization, while 28.6% had received judicial permission.

In the present investigation, most of the parents had received no genetic counseling and half of them had undergone no obstetric consultations. The most common fetal abnormality leading to permitted legal abortion is thalassemia. However, the majority of families are against abortion and even show their disagreement (10), believing that their religious beliefs prevent them from taking such an action. Since they would often prefer the alternative, namely, to give birth to a malformed baby with a condition like thalassemia (15), some families even avoid diagnostic pre-natal tests and decide to go ahead with pregnancy. Although educational measures have limited the number of deficiencies, and births of children with thalassemia have decreased from 39.38% in 2005 to 2.68% in 2010, it is still a problematic issue in Iran (16).

Some studies have shown that a number of parents would prefer to have a child with thalassemia than have an abortion performed using modern therapies (17, 18). For this reason, they should receive support and counseling from the people around them (19). It is necessary to provide an opportunity for such parents to express their opinions so that they can be directed in the right way.

Regarding other birth defects (trisomy types, and chromosomal and neurological defects, etc.), depending on the severity of the defect, as well as the psychological and economic burden on families and society, families accept legal abortion more readily; however, there is a need for timely guidance before and after the abortion.

For the consultation, it is essential to have a team that includes specialists, a religious consultant, a medical ethics expert, a psychotherapist, a clinical psychologist, etc. (20-22).

Parents should also be provided with some information in terms of the advantages and disadvantages of abortion (9). Moreover, they may be subjected to blame and criticism by others (21), so they should be protected mentally in the long term.

In conclusion, regarding the importance of consultation during marriage before abortion, the professional team should be prepared to recognize the necessity for abortion (before the twentieth week). Also, families should be provided with consultation services, especially those of a consultant psychologist, within the first week of receiving the news about the fetal anomaly (and if necessary thereafter).

There is a need to have individuals who are familiar with religious issues in consultation centers to advice parents. Also, the use of a person with disabilities succeeds in the centers to talk and consult with parents so that they become aware of how susceptible they are to the consequences of their failure to engage in consultation.




  • 1.

    Sadler TW. Langman's Medical Embryology. 2010; : 149 -50

  • 2.

    Abbasi M, Shamsi Gooshki E, Allahbedashti N. Abortion in Iranian legal system: a review. Iran J Allergy Asthma Immunol. 2014; 13(1) : 71 -84 [PubMed]

  • 3.

    Kamali M. The review on rights of disabled children. Soc Welf . 2003; 7(2) : 93 -110

  • 4.

    Sommerseth E, Sundby J. Women's experiences when ultrasound examinations give unexpected findings in the second trimester. Women Birth. 2010; 23(3) : 111 -6 [DOI][PubMed]

  • 5.

    Brown SD, Donelan K, Martins Y, Sayeed SA, Mitchell C, Buchmiller TL, et al. Does professional orientation predict ethical sensitivities? Attitudes of paediatric and obstetric specialists toward fetuses, pregnant women and pregnancy termination. J Med Ethics. 2014; 40(2) : 117 -22 [DOI][PubMed]

  • 6.

    Taksande A, Vilhekar K, Chaturvedi P, Jain M. Congenital malformations at birth in Central India: A rural medical college hospital based data. Indian J Hum Genet. 2010; 16(3) : 159 -63 [DOI][PubMed]

  • 7.

    Lafarge C, Mitchell K, Fox P. Termination of pregnancy for fetal abnormality: a meta-ethnography of women's experiences. Reprod Health Matters. 2014; 22(44) : 191 -201 [DOI][PubMed]

  • 8.

    Legendre CM, Herve C, Goussot-Souchet M, Bouffard C, Moutel G. Information and decision-making process for selective termination of dichorionic pregnancies: some French obstetricians' points of view. Prenat Diagn. 2009; 29(1) : 89 -94 [DOI][PubMed]

  • 9.

    France EF, Hunt K, Ziebland S, Wyke S. What parents say about disclosing the end of their pregnancy due to fetal abnormality. Midwifery. 2013; 29(1) : 24 -32 [DOI][PubMed]

  • 10.

    Mahmoodi Nesheli H, Nakhjavani N, Eshraghi P. Insight of minor thalassemia couples on abortion of major thalassemia fetus. J Mashhad Uni Med Sci. 2013; 3(12) : 177 -81

  • 11.

    Abolghasemi H, Eshghi P. Comprehensive textbook of thalassemia. 2004; : 32 -50

  • 12.

    Farra C, Nassar AH, Usta IM, Salameh P, Souaid M, Awwad J. Acceptance of preimplantation genetic diagnosis for beta-thalassemia in Lebanese women with previously affected children. Prenat Diagn. 2008; 28(9) : 828 -32 [DOI][PubMed]

  • 13.

    Chamayou S, Guglielmino A, Giambona A, Siciliano S, Di Stefano G, Scibilia G, et al. Attitude of potential users in Sicily towards preimplantation genetic diagnosis for beta-thalassaemia and aneuploidies. Hum Reprod. 1998; 13(7) : 1936 -44 [PubMed]

  • 14.

    Alsulaiman A, Hewison J. Attitudes to prenatal and preimplantation diagnosis in Saudi parents at genetic risk. Prenat Diagn. 2006; 26(11) : 1010 -4 [DOI][PubMed]

  • 15.

    Ahmed S, Green JM, Hewison J. Attitudes towards prenatal diagnosis and termination of pregnancy for thalassaemia in pregnant Pakistani women in the North of England. Prenat Diagn. 2006; 26(3) : 248 -57 [DOI][PubMed]

  • 16.

    Haghpanah S, Nasirabadi S, Rahimi N, Faramarzi H, Karimi M. Sociocultural challenges of beta-thalassaemia major birth in carriers of beta-thalassaemia in Iran. J Med Screen. 2012; 19(3) : 109 -11 [DOI][PubMed]

  • 17.

    Palomba ML, Monni G, Lai R, Cau G, Olla G, Cao A. Psychological implications and acceptability of preimplantation diagnosis. Hum Reprod. 1994; 9(2) : 360 -2 [PubMed]

  • 18.

    Kolnagou A, Kontoghiorghes GJ. Advances in the prevention and treatment are changing thalassemia from a fatal to a chronic disease. experience from a Cyprus model and its use as a paradigm for future applications. Hemoglobin. 2009; 33(5) : 287 -95 [DOI][PubMed]

  • 19.

    Garcia E, Timmermans DR, van Leeuwen E. Women's views on the moral status of nature in the context of prenatal screening decisions. J Med Ethics. 2011; 37(8) : 461 -5 [DOI][PubMed]

  • 20.

    Jotkowitz A, Zivotofsky AZ. The ethics of abortions for fetuses with congenital abnormalities. Eur J Obstet Gynecol Reprod Biol. 2010; 152(2) : 148 -51 [DOI][PubMed]

  • 21.

    Shaw A. 'They say Islam has a solution for everything, so why are there no guidelines for this?' Ethical dilemmas associated with the births and deaths of infants with fatal abnormalities from a small sample of Pakistani Muslim couples in Britain. Bioethics. 2012; 26(9) : 485 -92 [DOI][PubMed]

  • 22.

    Benute GR, Nomura RM, Liao AW, De Lourdes Brizot M, De Lucia MC, Zugaib M. Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation. Midwifery. 2012; 28(4) : 472 -5 [DOI]

  • Copyright © 2016, Shiraz University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.