Fear of Abortion and Emotional Divorce in Women with Thalassemia Minor: A Population-Based Study in Yazd, Iran | BMC Women’s Health

Thalassemia is the most common genetic disease in humans. In patients with thalassemia, the body does not make enough hemoglobin, which is an important part of red blood cells. Around 150 million people carry the beta thalassemia gene worldwide [1]. The disease is more prevalent in the Mediterranean regions, parts of North and West Africa, the Middle East, the Indian subcontinent, the Far East and Southeast Asia. [2, 3].

Iran, like many countries in the region, has a relatively large number of patients with thalassemia. Beta thalassemia major is the most common type of thalassemia in Iran. More than 30,000 people affected and around 2-3 million people are carriers of the disease in Iran [4, 5].

Thalassemia can be controlled and treated with screening, genetic counseling, prenatal diagnosis and termination of pregnancy [6, 7]. Although the level of public awareness has increased (to a good level), the prevalence of marriage between thalassemia carriers shows that the success rate is only 20% in this area and that most couples with thalassemia get married. This is a matter of concern and more action should be taken to influence the attitudes of individuals. People with thalassemia need to have high levels of consciousness, so that they can behave appropriately [8,9,10]. Additionally, most carrier studies and measurements have focused on children with thalassemia major and their problems. In other words, couples with thalassemia were not considered in the absence of a child with beta-thalassemia. [4, 6, 11].

Termination of pregnancy is one of the most important measures to prevent the birth of children with thalassemia major. The results of prenatal diagnostic tests show that the fetus has thalassemia major, the abortion is performed in accordance with legal and religious matters. However, abortion can be a critical issue for many families depending on cultural and religious backgrounds. [12].

A review study found that women with a history of abortion were more likely to experience psychological trauma such as depression and anxiety. [13]. Psychological and physical problems resulting from abortion can reduce the quality of life by affecting different aspects of women’s lives and creating physical and marital problems. Grief, as one of the main risk factors for mental illness, sadness, depression and anxiety, occurs in over 30% of women who have had an abortion. In 5-10% of cases, the severity and persistence of these symptoms lead to major depression [14, 15]. Steinberg and Biggs believe that factors such as pre-abortion mental health status, domestic violence, desire for pregnancy, economic status, etc. are effective in the development of depression and anxiety after abortion. [16, 17]. Other researchers believe abortion is a stressor that causes psychological complications [18].

However, psychological complications can arise after an abortion for any reason. According to Lok, the psychological symptoms of women with a history of abortion are similar to the mental states of mothers who have lost their babies. [19]. Because the prevalence and severity of maternal and fetal interest vary from person to person, some mothers feel interest in the fetus as soon as they become aware of their pregnancy and are afraid of it. abort. Termination of pregnancy can be a painful decision with consequences [20, 21]. Study in Iran found that all mothers were afraid of having a legal abortion, and 35% of participants expressed their fears by crying [22].

Pregnancy and fear of abortion in women with thalassemia causes marital conflict and emotional reactions, which in turn can lead to emotional divorce. [23].

Emotional divorce, also known as silent divorce, is a very important type of divorce that is not recorded anywhere. Emotional or latent divorce almost twice as common as formal divorce [23]. In an emotional divorce, the woman seeks isolation, does not see herself as a wife and continues to live only because of social, family and cultural conditions. The dimensions of conflict can be categorized into physical, verbal, psychological and sexual challenges [24]. Emotional divorce symbolizes the existence of a problem in a healthy and mature relationship between couples. This small-scale communication challenge can turn into a complicated problem and disrupt human relationships. As a result, the foundation of the family is shaken, the moral and social foundations of the entire social system are shaken, and the society is directed towards different problems. [25].

Few studies have focused on couples with thalassemia because these people do not have specific physical problems. In addition, couples with thalassemia face many psychological and emotional issues, especially women who are expected to deal with pregnancy and fear of abortion. [22]. In addition, a large number of couples with thalassemia live in Yazd, who got married despite all the warnings and educations that two carriers should not marry. Therefore, the present study aimed to investigate the association between fear of abortion and emotional divorce in women with thalassemia minor in the city of Yazd, Iran. Later, secondary prevention measures were also discussed.