Journey Mapping of Chinese Women Undergoing Termination Due to Fetal Abnormalities: A Thematic Content Analysis Based on Social Media Diaries

Introduction

With the increase in older pregnant women, changes in living environments, advancements in prenatal diagnostic technologies, and improvements in birth defect surveillance systems, the incidence and detection rates of fetal abnormalities have been on the rise.^1–4 Annually, over two million pregnancies are terminated due to fetal anomalies,⁵ with many women opting for termination upon diagnosis of fetal malformations. In the United Kingdom, approximately 37% of pregnant women choose termination following a diagnosis of fetal abnormalities, whereas this figure reaches up to 90.7% in China.^6,7

For mothers, choosing to terminate a pregnancy due to fetal anomalies is a significant source of psychological stress. The experience of this process, from initial diagnosis to post-abortion recovery, is often complex and dynamic. In traditional Chinese culture, pregnancy is regarded as an important family event, and fetal abnormalities are frequently accompanied by social stigma.^8,9 Furthermore, cultural restrictions on emotional expression and insufficient communication within families contribute to the substantial psychological pressure faced by women who undergo termination due to fetal deformities.¹⁰ Additionally, the traditional practice of “zuo yue zi”(confinement after childbirth) limits postpartum women’s activities, which may exacerbate their feelings of loneliness and psychological burden.^11,12

Current studies primarily employ questionnaires or interviews to explore the negative emotions and experiences of these women.^6,13 Findings indicate that such stressors can lead to psychological reactions, including grief and loss.¹⁴ The likelihood of depression among women who undergo termination is four times greater than that of women with normal pregnancies, while the incidence of post-traumatic stress disorder is seven times higher.¹⁵ This negative emotional experience is not transient; it may persist for two to six years following termination.¹⁶ However, existing research tends to focus on specific stages of women’s experiences. Moreover, due to the cultural sensitivity surrounding induced abortion due to fetal anomalies, many women may be reluctant to openly discuss these issues with healthcare providers, potentially limiting the information available to researchers.¹⁰ Consequently, the generalizability of these findings is restricted, and they may not fully represent women’s experiences throughout the entire process.

Social media has become a crucial platform for women to express themselves, obtain information, and seek emotional support.^17,18 Through posting and writing online diaries, women generate user-generated content that captures personal experiences and facilitates self-reflection,¹⁹ thus becoming an important data resource for research on women’s issues. For instance, Feng et al conducted sentiment analysis on pandemic diaries shared on Weibo, finding a negative correlation between women’s emotional valence and comment behavior.²⁰ Sormunen et al analyzed content from Swedish infertility blogs to explore the life experiences of infertile women.²¹ Helen M. Jones et al examined pregnancy and postpartum posts on Instagram, emphasizing the need for diverse body representation in media to reduce weight stigma.²² For women choosing to terminate pregnancies due to fetal abnormalities, the anonymity and convenience of social media diaries allow for more authentic and continuous emotional expression. Thus, online diaries provide researchers with a novel perspective to explore the complete experiences of these women from the diagnosis of fetal abnormalities to postpartum recovery.

Journey mapping originated from market research and service design, aiming to integrate multiple data sources to optimize customer experience and achieve profit growth.²³ Its distinct advantage lies in effectively organizing complex, multi-source data and exploring interactive events across different contexts and time frames, leading to its increasing recognition and application in the healthcare field.²⁴ Researchers typically employ methods such as thematic analysis, observation, and interviews to construct patient journey maps for a deeper understanding of patient experiences. For instance, Fennelly et al²⁵ conducted semi-structured interviews with ten patients suffering from rheumatic diseases and used thematic analysis to extract data, visually illustrating patients’ experiences and perspectives after receiving therapy. Similarly, Ciria-Suarez²⁶ performed semi-structured interviews with 21 breast cancer patients and 21 breast cancer survivors, employing thematic analysis to create journey maps depicting patients’ healthcare experiences at various stages. Therefore, journey maps offer significant advantages in exploring and presenting the experiences of women undergoing termination due to fetal abnormalities at different stages.

Therefore, this study aims to gain an in-depth understanding of the overall experiences of women who undergo termination of pregnancy due to fetal abnormalities by analyzing their diaries documented on social media. The findings will be presented in the form of journey maps, providing valuable insights for healthcare professionals to develop comprehensive care plans tailored to the needs of these women throughout their journey.

Materials and Methods

Study Design

An interpretative phenomenological thematic content analysis was used for this exploratory study to analyze social media diaries. IPA is an ideographic approach that emphasises the personal sense-making of the experiences. IPA is a helpful approach many healthcare researchers adopt to allow others to learn from individuals’ experiences whilst also acknowledging the subjectivity of interpretation, that the researcher’s experiences may impact interpretation.²⁷

Sample and Data Collection Methods

In the initial phase of this study, the keywords “abortion diary” and “abortion record” were systematically searched via the Baidu search engine. These terms were selected based on preliminary observations of user-generated content on Chinese social media platforms, where women explicitly employed phrases such as “A Record of Induced Labor at 37 weeks in a Woman of Advanced Maternal Age”, “38 weeks + Induced Abortion Diary”, or “An Expectant Mother’s Diary: Induced Abortion at 8 weeks” to title or categorize their personal narratives.

Search results indicated that such diaries were primarily published on three social media platforms: Douban, Zhihu, and Jianshu. These platforms not only host a significant number of diaries but also exhibit high continuity and quality of content.²⁸ Zhihu, with over 400 million registered users, is one of China’s most influential knowledge-sharing platforms. Douban, with seven million daily active users, serves as a major hub for opinion leaders and cultural exchange. Although smaller and less active, Jianshu is renowned for its high-quality original content and creative contributions. Therefore, Douban, Zhihu, and Jianshu were selected as the primary data sources for this study. The researchers then conducted text searches on the selected platforms using the same keywords, independently evaluated the results, and collected all publicly available diaries, covering the period from December 26, 2018, to May 26, 2023, related to “abortion” from eligible user profiles.

Inclusion and Exclusion Criteria

Inclusion required posts to (a) explicitly self-identify as “abortion diary or abortion record”, (b) describe termination due to fetal abnormalities and (c) document all four clinical phases (diagnostic, inpatient, puerperium, post-puerperium). Exclusion applied to: (a) Non-medical reasons: Terminations for unplanned pregnancy, divorce, or maternal health issues (b) Incomplete descriptions: Posts omitting ≥1 critical phase.

Data Coding and Analysis

We categorized the diaries into four phases before analysis, based on the clinical care continuum: diagnostic, inpatient abortion, puerperium, and post-puerperium. Users typically disclose details such as age when posting their diaries. Therefore, we first conducted a descriptive analysis of user characteristics (age, gestational age, diagnosis). Relevant information regarding the duration of each phase, locations, and involved personnel is depicted in the journey map to enhance understanding of the experiences. Missing information is labeled as “unknown.” Subsequently, the text data were imported into NVivo 15, where thematic content analysis was conducted using a realist, inductive, and semantic approach. The first and second authors independently performed in-depth reviews and initial coding. Prior to formal analysis, both coders conducted multiple rounds of pilot coding on randomly selected posts, refining the codebook through iterative discussions to align interpretations of key themes. During the open coding phase, texts were segmented into sentences or paragraphs to identify similarities and categorize them. Axial coding followed, examining and synthesizing relationships between codes to construct more complex themes. Discrepancies in coding were resolved through iterative team discussions, wherein the first and second authors revisited raw data, refined code definitions, and applied consensus-based decision-making. For persistent disagreements, the third author reviewed the data to arbitrate, ensuring interpretive rigor. A detailed audit trail was maintained, documenting how conflicting codes were reconciled through contextual re-examination of the data. Cross-validation and peer debriefing further strengthened coding consistency. Cohen’s kappa coefficients were calculated to assess inter-rater reliability for two coders. The Cohen’s kappa coefficient was 0.83 (range 0.81–1.00) indicating perfect agreement.²⁹

Ethical Considerations

This study was approved by the Ethics Committee of Gansu Health Vocational College (Approval No. 2024–457). Additionally, we adhered to the guidelines set forth by the Association of Internet Researchers,³⁰ collecting only publicly available data and ensuring the anonymity of the information.

Results

Basic Information Concerning the Diaries

A total of 291 diaries written by 38 women were collected. After excluding diaries with incomplete descriptions (specifically referred to posts missing documentation of ≥1 critical phase, as these phases were essential for understanding the holistic experience), 278 diaries from 35 women were analyzed (81 from the diagnostic phase, 73 from the in-patient abortion phase, 57 from the puerperium, and 67 from the post-puerperium phase). These diaries documented experiences from the initial diagnosis of fetal anomalies through the post-puerperium period, with the longest record extending to 462 days after the puerperium. Each participant contributed between 3 and 54 diary entries, with a total of 124,678 Chinese characters. Detailed demographic and medical information for the women is provided in Table 1.

Table 1 Specifc Demographic and Medical Information of the Women (n = 35)

Journey Mapping of Women Undergoing Termination Due to Fetal Abnormalities

Figure 1 illustrates the experiences of women undergoing induced abortions due to fetal abnormalities, detailing the duration, location, related personnel, primary tasks, and theme names for each phase. We also calculated the number of subthemes at each phase and created numerical trend graphs to visually represent the evolution of these themes. Three main themes emerged across all phases: psychological experience, coping strategies, and post-traumatic transformation; however, the names and quantities of subthemes and sub-subthemes under the same main theme varied by phase. Table 2 lists the identified theme names, their quantities, and representative examples for each phase.

Table 2 Theme Summary

Figure 1 Journey mapping of women undergoing termination for fetal abnormalities.

Diagnostic Phase

In this phase, women typically undergo repeated examinations over a period of 2 to 7 days to confirm fetal abnormalities, frequently traveling between hospitals and their homes. The primary tasks during this time are to confirm the diagnosis and decide whether to proceed with an induced abortion. The thematic distribution for this phase is as follows:

Main Theme 1: Psychological Experience

Grief

During this period, women’s grief primarily manifested as “anticipatory loss grief” and “fetal attachment grief.” The revelation of fetal abnormalities that may lead to pregnancy termination abruptly ended mothers’ hopes for their child’s future, resulting in mourning. Furthermore, despite the child not yet being born, a significant emotional bond exists between mothers and the fetus, and the severing of this bond elicits profound sorrow.

General Emotional Responses

This subtheme included a wide spectrum of emotions, such as “psychological shock”, “anger”, and “anxiety”. Initially, the mothers often experienced profound psychological shock following the diagnosis, characterized by immediate and intense emotional turmoil. It was typically accompanied by anger and anxiety.

Self-Blame and Guilt

Self-blame and guilt encompassed two key sub-subthemes: “guilt” and “self-blame”. When a fetus was diagnosed with an abnormality, the women often found themselves engulfed by intense feelings of guilt and self-reproach.

Main Theme 2: Coping Strategy

Cognitive Adjustment

This theme encompassed three aspects: “denial, fatalistic attribution, and rational compromise”. Faced with a diagnosis of fetal abnormalities, the women often initially refused to accept it, suspecting a diagnostic error. However, when the diagnosis was repeatedly confirmed and the specific cause remained unidentified, they attributed it to fate and believed that their connection with the child was not meant to be. After struggling between reality and emotions, they typically made a rational decision to terminate their pregnancy.

Avoidance Behavior

The women’s avoidance behavior manifested as “fetal topic avoidance”, where they steered clear of conversations or cues related to their pregnancy.

Social Support Seeking

Women often engage with peers who share similar experiences online to seek information and emotional support. Additionally, they obtain medical information regarding fetal abnormalities from friends and healthcare providers to inform their decision-making.

Main Theme 3: Post-Traumatic Transformation

Post-Trauma Recovery

During diagnosis, the women gradually achieved psychological acceptance of the fetal abnormalities, signifying the onset of recovery from trauma.

Post-Trauma Growth

Faced with diagnoses of fetal abnormalities, some women cultivated greater maturity and resilience through continuous self-encouragement.

In-Patient Abortion Phase

During the hospitalization for induced abortion, women undergo a process lasting 3 to 8 days, which includes preoperative preparation, the procedure itself, and postoperative observation. Their interactions primarily occur in the hospital with family members, obstetricians, nurses, and other patients, with the main focus on the induction procedure.

Main Theme 1: Psychological Experience

Grief

During this stage, women confront various forms of grief, including experiential grief, grief due to fetal movement loss, ritualistic mourning, and comparative grief. They are particularly vulnerable in the hospital, where even minor issues can trigger profound sorrow. The cessation of fetal movement not only signifies the end of the fetus’s life but also represents the shattering of future hopes, further exacerbating their pain. Additionally, the inhumane handling of stillborn fetuses, such as wrapping them in plastic bags, intensifies their anguish. The contrasting scenes of other mothers with their newborns starkly highlight their own plight, deepening their grief.

General Emotional Responses

During this stage, women commonly exhibit emotional reactions such as anger, helplessness, pain, and fear. Their anger, akin to their responses upon receiving a diagnosis, stems from a sense of injustice. Navigating unfamiliar medical environments, combined with the intense physical pain of induced labor, leaves them feeling isolated and vulnerable. Additionally, witnessing the suffering of other women in labor or learning about such experiences online further heightens their fear of pain.

Self-Blame and Guilt

Similar to the diagnostic phase, women’s self-blame and guilt persisted during this period.

Main Theme 2: Coping Strategy

Emotional Regulation

The women used two emotion-regulation mechanisms: emotional suppression and emotional farewell. Emotional suppression involved avoiding the expression of emotions to prevent burdening their families or through fear of external judgments. Emotional farewell allowed the women to achieve emotional release and calmness by mentally expressing goodness to their unborn child, thereby alleviating their grief.

Cognitive Adjustment

The women employed three cognitive regulation mechanisms: fetal idealization, fatalistic attribution, and sustaining hope. In fetal idealization, they imagined the fetus as a flawless being with positive traits to alleviate their suffering. Fatalistic attribution involved perceiving the loss as destined, a higher power’s decision beyond their control, which helped them accept reality. Sustaining hope meant imagining future reunions with children and creating a positive outlook.

Avoidance Behavior

During this period, women primarily exhibited avoidance behaviors by refraining from viewing stillborn infants. This avoidance stemmed from fear of confronting the stillborn, guilt over the abortion decision, and a desire to alleviate the pain of losing a child. Consequently, mothers often requested family members to view the child’s body on their behalf as an indirect coping mechanism.

Social Support Seeking

These women sought emotional support by sharing their experiences with fellow patients facing similar situations and utilized online resources to gather information about abortion, thereby enhancing their understanding of their circumstances.

Main Theme 3: Post-Traumatic Transformation

Post-Trauma Recovery

The women experienced positive transformations following their trauma. This primarily manifested as “psychological acceptance”, where they gradually moved from fear and tension to relief and acceptance.

Post-Trauma Growth

Regarding post-traumatic growth, women experienced “psychological maturity.” Observing others’ childbirth or abortion and their own experiences deepened their understanding of the significance of childbirth and the essence of life. This insight helped them face life challenges with a more peaceful mindset, and strengthened their courage to face difficulties.

Puerperium Phase

According to the guidelines, the recovery time for the puerperium period is 42 days.³¹ They spent most of their time with their families, but occasionally visited the hospital for follow-up appointments with obstetricians and nurses. The main task of this stage was to regain health and gradually return to normal life.

Main Theme 1: Psychological Experience

Grief

The women’s grief involved “externally triggered grief” and “intrinsic reflective grief.” Externally triggered grief was sparked by events and caused intense sorrow. Intrinsic reflective grief stemmed from the deep contemplation and memories of loss originating from within themselves.

General Emotional Responses

The women’s emotional responses were exceptionally complex. “Physical discomfort-induced emotional distress” was common, with postpartum discomfort worsening emotional difficulties, making vulnerable women feel more despondent. The unexpected loss of a child resulted in profound emptiness and heartache. The women also experienced emotional numbness and fluctuations, showing little interest in their surroundings, and alternating between calm and negative states. The fear of becoming pregnant again, filled with the dread of further disappointment and pain, was another issue. In extreme cases, a continuous struggle with emotions and psychological pain led to suicidal thoughts.

Self-Blame and Guilt

The sense of shame experienced by the women primarily involved self-blame. They felt disheartened by their perceived inadequacies as mothers and felt deep guilt for not providing their children with a healthy body.

Main Theme 2: Coping Strategy

Cognitive Adjustment

Following childbirth, the women’s cognitive adjustments primarily manifested as “emotional mourning” and “sustaining hope.” They recalled and missed their unborn babies, wishing them peace in heaven. They also believed that their deceased children would return, renewing the mother-child bond.

Shifting Attention

After childbirth, the women diverted their attention through shopping and reading.

Social Support Seeking

The women primarily sought online emotional support. They read posts from people with similar experiences and engaged in conversations to understand and alleviate their distress.

Main Theme 3: Post-Traumatic Transformation

Post-Trauma Recovery

The women began to accept reality, gradually moving beyond their past pain and toward recovery.

Post-Trauma Growth

Self-motivation and psychological maturation were key to the women’s growth after this trauma. They strived to break free from negative emotions and thoughts, thereby motivating themselves to move forward. Additionally, after abortion, they gained a deeper understanding of life, death, and the laws of nature.

Post-Puerperium Phase

After the postpartum period, these women gradually resumed their daily lives and work, primarily engaging with family, friends, and colleagues.

Main Theme 1: Psychological Experience

Grief

Similar to the postpartum period, the women’s grief involved externally triggered and intrinsically reflective grief. External influences or others’ actions reawakened memories and emotions of their loss, immersing them in sorrow. Internally, they continuously revisited and reflected on their losses, which intensified their grief.

General Emotional Responses

The women often felt unfairly treated, which led to anger. In addition, some regretted their decision to undergo an abortion.

Self-Blame and Guilt

The women still harbored feelings of self-blame.

Main Theme 2: Coping Strategy

Cognitive Adjustment

The women adjusted cognitively through emotional mourning, sustaining hope, and anticipation of subsequent conception. They frequently reminisced about their children and sent heartfelt blessings to them. Holding onto the hope that “the child will return to them”, this belief supported their continued life. Over time, this hope transformed into the anticipation of becoming pregnant again, helping them emerge from their sorrow.

Avoidance Behavior

The women engaged in defensive avoidance behaviors to reduce emotional distress. They blocked certain social media content to avoid triggers that reminded them of their abortion experiences.

Social Support Seeking

The women sought others with similar experiences online and gained emotional support by sharing their stories and listening to others.

Main Theme 3: Post-Traumatic Transformation

Post-Trauma Recovery

The women’s recovery after trauma mainly manifested as “psychological recuperation.” They gradually moved from their initial grief and accepted what had happened, and their emotions began to stabilize.

Post-Trauma Growth

The women’s post-trauma growth manifested as “psychological maturation” and “self-motivation”. Induced labor led to a deeper understanding of life, enhancing resilience and problem-solving skills. They also gained profound self-understanding, tapping into their inner strengths to actively improve themselves.

Discussion

This research visualizes the healthcare trajectories of Chinese women undergoing termination due to fetal abnormalities through journey mapping spanning prenatal diagnosis to postpartum recovery. The analysis revealed four distinct phases in pregnancy termination experiences due to fetal abnormalities, with three core themes persisting through each stage: psychological experiences, coping strategies, and post-traumatic transformation, along with ten subthemes: grief, general emotional responses, self-blame and guilt, cognitive adjustment, social support seeking, post-trauma recovery, post-trauma growth, avoidance behaviors, emotional regulation, and shifting attention. Ten subthemes emerged through rigorous qualitative analysis, demonstrating phase-specific variations: avoidance behaviors permeated all phases except the postpartum, while emotion regulation strategies, including suppression and parting, primarily occurred during the inpatient abortion phase, where women often concealed their sadness from family to mitigate distress but experienced breakdowns when alone. This contrasts with Carlsson’s findings,³² which suggest women express emotions to family, highlighting cultural differences in emotional expression. Shifting attention was noted only during the postpartum phase, manifested through distractions like online shopping, differing from Lafarge’s study where women diverted attention by going out or returning to work.³³ This difference may relate to the Chinese tradition of confinement after childbirth. The remaining seven secondary themes were present across all four phases.

Women experienced the highest levels of grief during hospitalization for termination, which subsequently dropped to the lowest levels in the postpartum phase. In the diagnostic phase, the presence of fetal movement intensified grief, consistent with findings by Andersson³⁴ and DiMiceli-Zsigmond.³⁵ This study indicates that the loss of fetal movement during hospitalization triggers profound sadness, a sentiment echoed in Aydin’s research,³⁶ which highlights feelings of loneliness and pain following the cessation of movement. DiMiceli-Zsigmond’s study noted a woman who felt traumatized by receiving congratulations while holding her deceased daughter;³⁵ similarly, our findings revealed that women experienced acute distress upon hearing a newborn cry. The inhumane practice of placing stillborn fetuses in plastic bags exacerbates maternal trauma. In the postpartum phase, grief is often influenced by both internal and external factors, leading to persistent negative thinking, as also observed in Patrício’s study.³⁷

Notably, the women’s general emotional responses gradually increased, peaked during the postpartum phase, and then rapidly declined. During the diagnostic phase, women predominantly experience intense psychological shock and anger, reflecting the significant psychological trauma resulting from the loss of expectations for a healthy baby, consistent with the findings of Wilpers.³⁸ During hospitalization for labor induction, women commonly express fear of the induction process; Lafarge³³ and Andersson³⁴ noted that interactions with other patients and online information exacerbate this fear. In the postpartum phase, women frequently exhibit complex emotional responses due to physical discomfort, such as breast engorgement, bleeding, and weakness, leading to feelings of helplessness and emotional numbness, questioning their fertility, and even contemplating suicide. Research indicates that women who undergo abortion due to fetal abnormalities are four times more likely to experience postpartum depression compared to those with normal pregnancies,¹⁵ highlighting the need for targeted psychological support and suicide prevention during this vulnerable period. Furthermore, this study found that some women continue to experience anger in the postpartum phase, a sentiment also observed in Gopichandran’s research.³⁹

Women’s self-blame and guilt primarily manifests as guilt and self-blame. Within the Chinese cultural context, fetal abnormalities are not only perceived as personal tragedies but also often evoke negative public reactions, leading to feelings of shame that exacerbate guilt.⁴⁰ During hospitalization for pregnancy termination, women frequently feel as though they have “killed” their child, resulting in heightened levels of guilt and self-blame. These emotions tend to decline in the postpartum phase, likely as women gradually come to terms with their experiences. Additionally, women often attribute fetal abnormalities to their own dietary or behavioral choices, reinforcing feelings of self-blame, which aligns with findings from Maguire’s study.⁴¹

Women’s cognitive coping strategies remain relatively stable across all phases, indicating their key role in addressing the challenges posed by fetal abnormalities. During the diagnostic phase, women primarily employ denial, fate attribution, and rational decision-making to cope with traumatic events.^14,42 Many women attribute fetal abnormalities to the predetermined short lifespan of the fetus, which aligns with Lafarge’s findings.⁴³ After repeated medical examinations, despite feelings of helplessness, the majority of women ultimately choose to terminate the pregnancy after careful consideration. During hospitalization, their cognitive coping strategies include fatalistic attributions, fetal idealization, and hopes for continuity. Women derive psychological comfort by attributing compassionate traits to the fetus and harbor hopes of reuniting with their child in the future, thereby alleviating the pain of loss.¹⁴ This strategy continues into the postpartum phase, where women still hope that the “lost child” may return in a healthy form.^39,41 In China, women often find it difficult to publicly mourn the “lost child”; however, social media provides them with a private platform to share their emotions and express their longing, helping to alleviate the pain of losing their child.⁴⁴

During hospitalization for pregnancy termination, women’s avoidance behaviors peaked, primarily manifesting as the avoidance of stillborn infants. Studies by DiMiceli-Zsigmond³⁵ and Lotto⁴⁵ indicate that some women choose not to see or hold the deceased infant to mitigate emotional distress and grief, which aligns with our findings. However, other research suggests that direct contact with the infant’s body can aid in processing grief and provide comfort regarding the decision to terminate the pregnancy.^35,45 In the diagnostic and postpartum phases, women typically avoid topics related to infants; although this avoidance may temporarily lessen emotional burdens, it could prolong the grieving process.^14,43 Furthermore, our study found that avoidance behaviors during the postpartum period were not significant, possibly due to the cultural practice of “zuo yuezi” in China. During this period, women often experience social isolation, with sensitive topics being avoided by family members and visitors. Ayebare’s research similarly highlights this phenomenon in postpartum practices in Uganda and Kenya.⁴⁶

In these women’s abortion diaries, seeking social support emerged as a recurring theme. During the diagnostic and hospitalization phases, women frequently sought informational support, reflecting their urgent need for information in the face of the uncertainties and challenges posed by fetal abnormalities. They actively explored various channels to understand the nature of fetal abnormalities and potential solutions.⁴⁷ Notably, this study found that women tend to seek peers with similar experiences through social media, indicating that peers serve as their primary emotional supporters and that they have a strong desire to communicate with others. Qian J’s research also highlights the importance of peers in providing emotional support.¹⁰ Additionally, Maguire’s study reveals that 72% of women who have experienced abortion expressed a desire to communicate with others.⁴¹

Regarding post-trauma recovery, during the first three treatment phases, women primarily exhibited psychological acceptance. During this period, they may experience emotional fluctuations but gradually begin to accept reality. Psychological acceptance is considered a critical step in reducing long-term psychological trauma, as it helps alleviate acute stress responses and prevents the development of chronic psychological issues.⁴⁸ After the postpartum phase, women recover from the negative impacts of abortion and regain their capacity for enjoyment and a sense of purpose. Additionally, this study found that post-traumatic growth in women primarily manifested as self-motivation and psychological maturity. During the diagnostic and postpartum phases, they tackled difficulties by stimulating their inner drive and maintaining a positive mindset, fostering personal growth. Throughout hospitalization for abortion and into the postpartum phase, women demonstrated improved emotional understanding and management abilities, adopting a more mature and rational approach to life, which aligns with the findings of Qian et al.¹⁰

The study has several limitations. Data collection for this study was limited to three social media platforms: Douban, Zhihu, and Jianshu, which may have restricted the diversity and representativeness of the sample. Additionally, the data were primarily derived from online diaries, indicating that participants may possess strong writing and expressive abilities. As a result, the perspectives of individuals who are less skilled in written expression, less inclined to use social media, or unwilling to share personal experiences publicly may not be adequately represented. Furthermore, while this study focused on exploring the shared psychological trajectories among women undergoing termination for fetal abnormalities, the methodological approach did not differentiate between pharmacological and surgical termination methods. The potential variations in decision-making processes, emotional responses, and recovery patterns associated with different termination procedures remain unexplored. Subsequent research could employ comparative design to investigate how termination method selection interacts with psychological adaptation mechanisms, particularly in cultural contexts where medical procedure choices may carry distinct symbolic meanings.

Conclusions

This study visually presented the trajectory of experiences of women undergoing pregnancy termination due to fetal abnormalities using journey maps. Grief, emotional responses, moral introspection, cognitive adjustment, avoidance behaviors, seeking social support, post-trauma recovery, and post-traumatic growth were common throughout the abortion process, although their intensity varied at different phases. Emotion regulation strategies were primarily employed during the in-patient abortion phase, whereas shifting attention strategies were predominantly used during the postpartum phase. This study contributes a novel visual representation of the abortion journey, enriching the understanding of women’s experiences, and aids in designing more targeted and effective interventions. While thematic analysis of diaries provided rich narratives about the experiences of women undergoing termination due to fetal abnormalities, our sampling approach inherently captures digitally active populations who voluntarily disclose health information online, so it may not be representative of the Chinese population. Furthermore, the retrospective narrative structure of diary entries precludes definitive causal attribution between clinical events and psychological outcomes.