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Ritualizing Abortion: A Qualitative Study on Ritual and Its Meanings in The Netherlands

Department of Chaplaincy, Pro Persona Mental Health Care, 6874 BE Wolfheze, The Netherlands
Department of Emergency Psychiatry and Department of Residency Training, Altrecht Mental Health Care, 3512 PG Utrecht, The Netherlands
Department of Humanist Chaplaincy Studies, University of Humanistic Studies, 3512 HD Utrecht, The Netherlands
Authors to whom correspondence should be addressed.
Religions 2022, 13(7), 592;
Submission received: 13 December 2021 / Revised: 27 May 2022 / Accepted: 14 June 2022 / Published: 25 June 2022


The present study investigates ritualizing abortion in the Netherlands. Explorative, qualitative research was conducted with semi-structured interviews (n = 13) with women who looked for counseling and 43 online personal stories about the abortion from the website of a national care and expertise center. The results reveal three main categories of ritualizing: (1) creating and using symbols privately and online, (2) remembering or honoring the experience and (3) embodied ritualizing. The data reveal that respondents find meaning in the ritualizing through sharing the experience with others, expressing various feelings through symbolic and ritual forms, fostering a connection with the child-to-be, showing respect, seeking closure and transforming the experience in a meaningful way. This research reveals types of ritualizing practices in relation to a meaningful life event such as abortion. For a specific group of women experiencing decision difficulty or existential concerns in relation to the abortion, ritualizing might be an interesting tool to be incorporated into post-abortion care practices.

1. Introduction

While rituals are often associated with tradition and institutionalized religion, there is increasing attention paid towards the active form of ritualizing, referring to the reinvention and redesigning of rituals (Bell 1999; Grimes 2002, 2014). Ritualizing often happens in the margins, is not an established form of ritual and is seen as a way of processing life events characterized by ambiguity (Driver 1997; Grimes 2002; Romanoff and Terenzio 1998). Ritualizing is observed, for instance, when ritual elements are added to the ritual (e.g., clapping during a funeral or choosing a personal symbol for the mourning card) or when an entire ritual is redesigned (e.g., silent or protest march after acts of violence). Ritualizing does not necessarily refer to a “complete” ritual or a ceremony with a clear beginning and end but fits more into intuitive, imaginative, material and embodied dynamics with ritual and ritual-like activities. Ritualizing offers an interesting lens to study lived, embodied religiosity and spirituality (McGuire 2008), as rituals are embodied, active ways of focusing attention on an experience, without “solving” the underlying question of meaning (Moore and Myerhoff 1977).
Abortion is, in the Netherlands, a legal, private life event, which is generally not ritualized. In Japan, for instance, mizuko kuyõ, a ritual for the aborted fetus, is chosen by approximately 15–20% of women after abortion (Grimes 2002, p. 310; Klass and Heath 1996; Yamagata-Montoya 2021). The ritual is embedded into the cultural and spiritual traditions in Japan (Yamagata-Montoya 2021). While in most Western contexts, abortion rituals are not common, in a Swedish study, almost half of the women felt the need to ritualize the abortion experience, such as doing “something special” (Stalhandske et al. 2012, p. 59) or “to mark the abortion as an event, end the process, become reconciled with the situation, let off steam, or ask for forgiveness” (Stalhandske et al. 2012, p. 59). While most women feel relief after the abortion and decision rightness afterwards (Brauer et al. 2019; Rocca et al. 2020) and do not show long-term psychiatric symptoms (van Ditzhuijzen et al. 2018), ritualizing might offer meaningful ways to put one’s emotions into symbolic form before and after the abortion (Stalhandske 2009; Stalhandske et al. 2011a, 2011b). There is a group who experiences decision difficulty, which might be related to questions of meaning, such as “struggling between head and heart” and how women view the abortion (Brauer et al. 2019, p. 1987; Halldén et al. 2005, 2009). The decision making in this group takes a bit longer and is more complex, but finally, the group of women who were experiencing decision difficulty do feel satisfied with the decision (Brauer et al. 2019). What is more, in processes of meaning making, different emotions (e.g., gratitude and sadness) can occur at the same time, as meaning making is a complex, multilayered and ambiguous process (Wojtkowiak 2018). Ritualizing offers an interesting study lens to analyze how women cope with abortion.
In this article, we want to study the notion of ritualizing in more detail by focusing on a specific sample of women in the Netherlands who have sought counseling during the abortion process and have contacted a national expertise center. The aim is to investigate what role ritualizing plays after abortion. The present study addresses the research question: What kind of ritualizing after abortion can be found, and what meanings are ascribed to the ritualizing? The question will be answered by explorative, empirical research with women who have experienced abortion and who have sought counseling and/or were looking for some ritual closure. This means that the sample is by no means representative of all women who experience abortion but specifically focuses on women who experienced some existential concerns or need in relation to the abortion and who dealt with the experience in a symbolic and ritual way. It is not our intention to judge or stigmatize the experience in any way but rather to explore and investigate what rituals have to offer when dealing with embodied life events, such as abortion.

2. Methods

2.1. Population and Sampling

The research population consisted of women who contacted Fiom1, which is the Dutch center of care and expertise in unintended pregnancy. Fiom is not religiously affiliated and states as its mission that “every woman being unintendedly pregnant must be able to make an informed choice that is in line with her life, values and future.” Fiom provides information and counseling in the decision-making process and after the abortion. The women in this sample sought some form of care or platform to share their experiences. The sample existed of three subsamples: (1) eleven interviews with women who participated in an online abortion care module in 2016, (2) two interviews with women who participated in a womb healing ritual, and (3) 43 personal accounts posted anonymously by women on the website of Fiom. Three different subsamples were chosen due to the exploratory character of this research. As there is little research on ritualizing abortion in Western societies, it was not known beforehand if the women who were contacted through Fiom were likely to ritualize their experience.
The three subsamples were collected in different ways (see Table 1). The respondents in Subsample 1 were recruited through an invitation e-mail to 163 women having participated in an online abortion care module developed by Fiom. The online abortion care module is developed to help women who experience psychosocial concerns after the abortion (e.g., sadness, anger or feelings of emptiness). Women participating in the online module write assignments and receive feedback from professional abortion care specialists. It is worth noting that the module contains a writing assignment asking questions about symbolic ways of saying goodbye and therefore encourages women to ritualize. The respondents in Subsample 2 were invited through a ritual counselor who organizes womb healing rituals. The aim of this ritual is to heal painful experiences in relation to womanhood. Finally, Subsample 3 consisted of 43 personal accounts about the abortion that were selected from the databank of 158 accounts uploaded on the Fiom website, stemming from 2013 to 2018.
Subsamples 1 and 2 included women aged eighteen to sixty-three, with diverse educational backgrounds and life orientations. Eleven women had a first-trimester abortion, and two women had a second-trimester abortion. Respondents2 were asked about their life orientation during the interviews, as this information is relevant to the study of rituals. Most of them did not fit one religious or spiritual category but described themselves as searching in matters of life orientation. A majority mentioned their dislike of dogmatic moral values. Two respondents came from a strict protestant and two from devoted catholic backgrounds. All four had stopped going to church on a regular basis but still practiced religious rituals, such as lighting candles on significant occasions. About two-thirds of the respondents had an interest in spirituality. Some practiced yoga or meditation. Three of these respondents had interests in paranormal manifestations, modern witchery or shamanism. About one-third of the respondents said to have a “no-nonsense” (“nuchter” in Dutch) mentality in spiritual matters and described their outlook on life in terms of humanist moral values. Some had a partner and/or children. Most of the interviews took place within a few months after the abortion. Some respondents had had contact with mental health care specialists following the abortion care module. The women in Subsamples 1 and 2 all had a Dutch background.
Subsample 3, the online personal accounts, does not allow a complete description of social backgrounds. In some accounts, references to age, education, family situation, mental state, spirituality, gestational age or time lapse between the abortion and publishing the account were found. In general, the women seemed younger and more often following some sort of education. Some women mentioned having other children. In two personal accounts, women wrote about suffering, respectively, from AD(H)D and depression. Four women referred to their religious faith (three Islamic and one Christian). There were more references to first-trimester abortions but also a few to second-trimester abortions. The time frame between the abortion and writing the personal account seemed to vary from a few days to more than ten years.
Eleven of the thirteen interview respondents (Subsamples 1 + 2) expressed that the choice for abortion was the best choice in the given situation. One woman explicitly stated regretting her abortion. In Subsample 3, 9 women out of the 43 accounts selected for this study stated regretting their decision about the abortion. Frequently, women spoke of the choice for abortion in terms of an internal conflict of emotion and rationality or “ head“ and “hart“. Rationally the choice for abortion was the right choice, but on the emotional side, there were also feelings of attachment to the embryo/fetus or to the idea of becoming a mother. Reasons for abortion mentioned were missing support, financial problems, care for other children, physical violence, psychological problems, other life plans, not wanting children and feeling unprepared.
Women also had diverse feelings and representations of the embryo or fetus. In line with ambiguous feelings about the pregnancy, they also had complex feelings towards the “peanut/life/child/heap of cells/soul/pea” inside of them. Some women, for example, were sure that the aborted fetus had not been a child but still struggled with the responsibility of having stopped the process of growing it into a child, wondering how it would have been.
The sample is thus not representative of all women undergoing abortion but specifically those who seek out help, counseling or some ritual closure. The aim of this research is not to give a representative analysis of all abortion experiences but rather to specifically focus on those possibly having existential concerns and seeking some form of ritualizing.

2.2. Data Collection and Analysis

The interviews lasted between 60 and 120 min (mean = 95 min) and were conducted in the home of the respondents or on location at Fiom. Most of the respondents mentioned during or after the interview that sharing their stories was not easy for them and that they needed to be sure that their stories would be treated anonymously. The interviewer paid great attention to informing respondents about the research procedure, especially ways to guarantee anonymous data processing and to create a safe environment for the conversation. One respondent asked the researchers not to publish quotes from her story in the research report. All respondents signed an informed consent form.
During the interviews, a topic list was used to investigate possible ritualizing. After a section on the abortion experience, the perception of the potential child and existential concerns, respondents were asked whether they had enacted some symbolic or ritual processing or had felt the need to. They were asked to describe their ritualizing experiments, how they had experienced them and whether they had intentions or expectations in relation to the ritual.
The interviews (Subsamples 1 and 2) were transcribed verbatim and uploaded together with the personal accounts (Subsample 3) in the qualitative data analysis and research software Atlas.ti. Consequently, the data were read and coded by deductive and inductive coding, which, respectively, refers to coding from theory and intuitive coding from the data (Boeije 2005; Corbin and Strauss 2008). In the first round, the interview subsamples were deductively coded, using pre-established codes from a provisionary code list. In the second inductive coding round, the data were reread several times in order to find forms and meanings of ritualizing that emerged from the data. These were added to the code list. This list was used to analyze the personal accounts. The abortion stories were not included in the first two rounds because it was initially hard to recognize concepts of ritualizing in them.
Ritualizing was coded in the data on the basis of the following inclusion criteria: (1) the description refers to an active form/action, (2) it includes a symbolic element that translates the experience, and (3) it includes at least two ritual elements as described by Grimes (2014), such as ritual actions, ritual actors, ritual places, ritual times, ritual objects, ritual languages and ritual groups. When, for example, a woman kept the image of the ultrasound, put it in a special box in her room and looked at it on the due date, we counted a ritual actor (the woman), a ritual act (safe-keeping), a ritual object (the ultrasound image), a ritual place (the box) and a ritual time (the due date). Two elements were chosen as minimum because ritual actor “alone” does not count as a ritual, and there needs to be at least some ritual action involved (Grimes 2014). Quotes about the intentions and needs of women related to their ritualizing and about its outcomes were coded to analyze possible ritual meanings. In this round, the elements of ritualizing and meanings were sorted into three main categories that will be discussed in the following section.

3. Results

Three main categories were found that summarize the various forms of ritualizing: (1) creating and sharing symbolic expressions privately and online, (2) remembering or honoring the experience and (3) specific embodied ways of ritualizing. These categories are not exclusive and show considerable overlap but were chosen to reveal the central aspect of the ritualizing. In Table 2, the main categories and examples of these categories’ meanings are listed. In the result section below, quotes stemming from the interviews (Subsamples 1 and 2) are referred to by R1, R2, R3, etc., while quotes from the personal accounts (Subsample 3) are referred to by 1/2016, 2/2017, etc., indicating the year in the Fiom database from which they were collected.

3.1. Creating and Sharing Symbolic Expressions

The most common way of ritualizing was creating and using various symbolic expressions. Some of these symbolic expressions are shared in public, digital space (the website of Fiom), while others remain private.

3.1.1. Privately Acknowledging through Symbolic Expression

Research participants ritualized in private ways, such as giving a name to the imagined child or using creative expression (drawings or collages). Some women engaged in internal conversations with an imagined child-to-be (more than thirty times). One important aspect of this is to imagine the child-to-be in a symbolic way as an angel, butterfly, star or flower.
It is now a little star in the sky, or a butterfly, or an angel on my shoulder, or something like that. That’s how I see Jonas.
Research participants also addressed the potential child, internally or spoken out loud, and often transmitted messages. After the abortion, some women had internal images of the potential child, even seeing it growing up. Frequently women connected these images to a form of reincarnation or paradise or experienced the presence of the potential child in their lives.
My daughter says many times: ‘That is my little sister’. And then she gestures towards the chair. And that is fantasy. But she does that since a few months; suddenly she speaks about her little sister (…) ‘Does your little sister want to eat with us?’. I join her in her play thinking it is fantasy. But it keeps crossing my mind: could it work like that, is that possible?
Related to these efforts to continue, the bond was the gesture of giving a name to the potential child. About one-fourth of the research participants named the potential child. This could be a name that could be given to a baby or a more symbolic name, as in the following citation:
Hope, that is what I called you.
Name giving occurred during pregnancy or after the abortion. Among those who came up with a name, some did this intentionally, hoping for it to have a healing effect on their coping process. Frequently, they chose a boy’s or a girl’s name in accordance with their intuitive feeling about the sex of the child-to-be. Some women gave a name together with their partner and used the name in their communication about it. However, there were research participants who explicitly mentioned not wanting to name the potential child for diverse reasons.
Furthermore, it is worth noting that some women acknowledged their experiences in artistic ways. In the online personal accounts, this showed mostly in poems. The interview respondents also spoke about expressing their feelings in drawings, collages, videos and even more complex art projects.
Other ways of symbolically acknowledging the abortion experience were found in the use of symbols that the research participants discovered during the broader abortion process that they found appealing or helpful. One woman chose to have her abortion in a clinic next to the sea because she associated her experience with the ebb and flow of the ocean and liked the thought that she symbolically gave her child to the sea. Another woman felt a strong connection with the logo of the clinic, a magnolia blossom. Searching for and retaining symbols from music lyrics occurred as well:
I had to wait for the abortion lying down in a bed and listened to ‘Kiss from a rose’ from Seal. That was the last song we were able to listen to together. And it was so right. ‘You became the light on the dark side of me.’ After that I was called to the operation room.
A final way of symbolizing the experience found was that of caring for a pet as a symbolic substitute for the child-to-be. One respondent did this in a dedicated way. She described how she adopted a kitten and adapted all the rituals that are usually respected with child delivery. She made a birth card, sent it to family and friends and invited them to visit. A few friends and relatives did so and brought presents. Another woman adopted a pup. She experienced the coming of this new family member as a fresh start after hard times.
Ritualizing with forms of imagining, naming, addressing and symbolically substituting the child-to-be possibly mean that women need to connect and foster connections with the potential child. Seventeen quotes in the online personal accounts showed this fostering of connection. Affirmations of love and longing were frequently found.
Her name would be Jip, and dear Jip, I love you.
My unborn child is called Butterfly and I see her every day in my sleeping room. I have a frame with a butterfly in it. When I smoke a cigarette outdoors, I look at the sky and choose the most beautiful star. That is my Butterfly. Even if I never met you … I love you & I shall never forget you. In my heart I take you along with me until we hopefully see each other again.
In the interviews, research participants mentioned eleven times how they seek to foster connection with the potential child through ritualizing.
And I don’t believe that it just stops here. I believe that there is another side, another life, how must I explain it? (…) We burn a candle to show that we did not forget. That we still think about it.
In both public and private ritualizing, the ritual enabled women to express diverse feelings. For most of the research participants, the abortion appeared to be a complex experience. The intense and often ambiguous feelings were difficult to understand, let alone be shared sufficiently with other people. Ritualizing can in that case offer a space where these women can express feelings and help them to process the experience.
Some research participants also tried to connect to the potential child to express their remorse:
From time to time I think about it and then I address that child mentally: ‘I am sorry that I took your life, because you were there’. I’ve seen it with my own eyes huh. That is awful, yes.
Affirmations of love and longing for the potential child should not be assimilated with regretting the abortion, as the following quote clearly shows:
I don’t regret my decision, I am still firmly convinced that it was the best thing to do for all of us. But regret is not necessary to feel pain (…) But the pain will have a place in my life, just as you. We have to move on, we can’t linger on. I need to enjoy carefree life and fulfill my dreams, for you. (…) I would have loved to meet you, dear little one. But it could not be. I love you, and I will. Take care.

3.1.2. Sharing One’s Personal Story with Symbolic Expressions Online

The selected online accounts revealed the same symbolic expressions that are discussed in private ritualizing, with the additional dimension that these symbols and symbolic actions were also shared in an online community on the Fiom website. Various symbolic elements were found, such as poems or letters to the imagined child, symbols of significant aspects of the experience and forms of imagining the potential child. Two interview respondents published symbolic accounts of their experiences too.
The online personal accounts also contained a few examples of honoring or embodying rituals, but the focus lies here mainly on the aspect of sharing symbolic expressions in written form, as this relates to the medium of the personal story.
The following poem was published by one of the interview respondents on the web. It shows an aesthetic translation of the ambiguous feeling of loss as a result of the conscious choice for abortion.
You knew you had to choose
But actually had no choice
Had to lose a piece of yourself
So small, is now a gaping hole
By publishing symbolized accounts of the experience, research participants found ways to share their stories outside of the private environment. However, the personal stories are published anonymously, remaining a private layer within these public accounts. All here selected online accounts, the blogs and published poems were social acknowledgments of the ritualizing, as they were shared in an online community. They were expressions of the need to share and bring the abortion experience up for discussion. Sometimes these publications were meant to sensitize and educate the public by sharing the feelings and considerations behind an abortion experience, as the following quote shows:
Look, if only one person thinks ‘ah, so it is not that simple’, then that is already something.
In other cases, research participants stated wanting to break the taboo that lies in talking about abortion:
And then I started to write for myself. And at a certain moment, I thought maybe I have to publish it online, break through. I had read on the Fiom website that there are 30,000 a year (…). I felt this taboo must be broken, I have to do something about it. I want to do something because I want to help others as well and we have to be able to talk about this.
By sharing their stories, the research participants also created a network of support:
Dear ladies please ask for help on time. Nobody deserves to feel like this. You are not alone!
In the online accounts, advice and support for others frequently occurred in addition to showing others that they are not alone. Both women who participated in the womb healing ritual especially appreciated the connection they felt to other women in the same situation. The community aspect of online sharing seems of importance to those who want to publish their stories online.

3.2. Rituals of Remembering and Honoring

Many research participants expressed the need to “do something“ to remember and honor the potential child-to-be and/or the abortion experience with its ambiguous meanings, such as keeping meaningful objects as a reminder and in many cases giving them a special place. Of all 56 research participants, 22 (personal accounts and interviews) kept the image of the ultrasound made before the abortion. Most of these women asked for it in the clinic. Others were asked by a medical professional if they wanted to have it or just simply had received it from the staff:
I was allowed to look at the ultrasound and saw a real little wonder. We took the image home and since then I keep it in my purse. It is a part of me and that’s why I carry it with me.
Most of these women kept the image in a meaningful place and looked at it on special occasions. Some interview respondents spoke about their “memory box“: a nice box where they kept the ultrasound image together with other objects reminding them of the pregnancy or the potential child, such as the positive pregnancy test, drawings of the potential child, letters and cards from friends. In the following quote, a woman described how she experienced creating a memory box.
- Can you tell me something about how you arranged that box? How was it to do that?
- It was less bad than I expected. I expected that I would do it in tears and so. But actually it was peaceful and quiet. Sort of, I give you a place to be.
Another way of remembering or honoring the abortion experience that women used, was to mark symbolic data by paying special attention to certain dates relating to the pregnancy and abortion. For some women, this was the date of the abortion, and for others, the due date or the date they discovered that they were pregnant. Of the 56 research participants, 15 underlined that these dates had a special meaning to them. These dates were also frequently chosen for their ritual actions. For some, choosing the day had a specific symbolic meaning as shown in the following citation:
I really wanted to do something, and I wanted to celebrate life, because I experienced it that way. The pregnancy was also some kind of sign and confirmation of my body, that manifested to me, do not worry, you can become pregnant (…) That is why I didn’t celebrate or commemorate on the day of the abortion, but on the due date.
Some rituals of remembering or honoring are examples of more complex ritualizing. Nine women described how they invented rituals to honor and remember what had been. One interview respondent recounted how she sang and offered white flowers into a lake on a yearly basis. Sometimes women were joined by their partners who participated in the ritual. One respondent went to the beach with her partner, and, together, they released a balloon with a wish for the child-to-be. Together with their partners, two others developed the habit of burning candles and making wishes for the potential child, in churches or at home.
A final and specific way of honoring that was found was that of burying the embryo. In the following quote, an interview respondent described her burying ritual:
My mama had a white stone shaped like a star. We buried it together in the flowerbed in the garden, and the white star lays there, on top of it.
When it comes to the meaning of the honoring rituals, different aspects were mentioned. One of them was showing respect for the existence of the embryo/fetus or child-to-be:
I made those photos and had them printed (…) and also that stick that shows that I am pregnant. Those kinds of things I kept, they make me think that it really existed (…) so the memory, but also to honor it, that it had really been.
Two respondents explicitly mentioned that they experienced their rituals as celebrations for the pregnancy.
I wanted to celebrate the birthday. Weird, huh? (…) On the day that I was due, I invited all my friends for dinner. And I wrote a letter to thank them for their support.
It is gone and it is hard, and I feel guilty (silence). No, I want to ponder on the positive side (…) That gives me a warm feeling and makes me feel like a mother (laughs) and then I can connect to how I want to be a mother (…) and what I like about life. Yes.
Research participants also expressed feelings of appreciation or gratitude for the support they received. One woman described how she read a letter to her friends:
I wrote down mostly that I was really grateful for them, and how I experienced that period and that I am processing it all now. And that it will probably take some time. But also that I am so grateful for the support they’ve been back then.
Another possible meaning of honoring the experience is establishing closure.
That is what I experienced as the most difficult task. How can you say farewell to something you‘ve never seen?
Some research participants expressed a need for closure. This need was expressed through ritualizing and put into words. In the personal account below, a woman narrated how she burned the stick showing the positive test result and a letter to her potential child that helped her to move on with her life.
And there I stood. Crying, watching how my letter and the test faded slowly. Only after the last burning flames I went inside again. It was weird. But I felt relief. This had been a nice farewell. After that I felt a little better every week and I was able to put up the thread of my life again. With the three of us, but nevertheless very happy.
Abortion also brought up the realization of not wanting to have children at all. One woman described her emotional response to the closure she experienced in relation to her abortion during the womb healing ceremony:
And there were heaps of emotion during the ceremony. That was some kind of farewell, some kind of grief for a part of yourself or a kind of life that will not be realized.

3.3. Embodied Ritualizing

Abortion is a physical intervention with an impact on the body. Some research participants were searching for ways to involve their bodies in the rituals they came up with. A frequent form of embodied ritualizing was getting a tattoo with a symbolic meaning. The tattoo is a painful but aesthetic way of marking the body and a way of showing visibly the transition women went through. Four of the thirteen interviewed women took a tattoo after their abortion, and in the personal accounts, this form of ritualizing was mentioned once. Two other women considered the possibility of getting a tattoo but decided against it to avoid questions about its meaning. In the following quote, one woman described how the tattoo symbolizing the abortion experience had become a symbol of mental strength to her:
That’s what this tattoo stands for. (…) When I look at it, when life is hard, then I think, if I made it through the abortion, then I can do this as well, you know.
Another way of ritualizing in an embodied way was to wear jewels with a symbolic link to the experience. Two interview respondents and one woman in her personal account discussed receiving or choosing necklaces or bracelets that symbolize some aspect of their experience.
I got a necklace as a present. I wear it every day. (…) I got it from my mother on the 20th of august, the day that I was due. (…) I didn’t take it off for one day, since then.
A few women described how they ritualized the abortion in a directly physical way. Two interview respondents had participated in a womb healing ritual, which is not necessarily aimed at abortion experiences but at the female body more generally. In this ritual, women are led into a guided meditation to mentally and emotionally explore their womb and to consider with self-compassion what they experience. Other physical forms of ritualizing found were the touch of the belly or the conscious attempt to sense the potential child in one’s womb before the abortion. In the following quote, a woman described how she experienced a pregnancy massage as a farewell ritual:
- They really gave me a pregnancy massage. I lay down on my side, and they treated all the spots where you experience backpain in pregnancy. It was good too.
- And how was that? To receive such a massage, the day before?
- I don’t know. Maybe, our moment together. I enjoyed it too, you know.
The embodied ritualizing contained many references towards transforming the experience. This might translate the need of research participants to integrate the abortion experience into their lives. Through this specific womb healing, ritually transforming the experience, women emphasized the positive aspects of the abortion experience, such as their appraisal of the experience of being pregnant or the support they received but also the personal growth they experienced through getting to know themselves and their desires and goals in life.
For some research participants, transforming the experience meant better self-care. The pondering over and carefully choosing a nice bracelet became for this woman a symbol of self-compassion and new chances for happiness in life:
It goes through my head a lot these last weeks. (…) Allowing myself to move on and that jewel (…) That is very symbolic. I don’t know why I keep thinking about that, but that is what I want really badly.
Next to transformation, there was also evidence of a sense of healing. Some women discuss recognizing the abortion as an event with an impact on the body. Both women who participated in the womb healing ritual gave this meaning a central role. They characterize the abortion as a physical intervention that asks for healing on a mind–body level. According to them, this cannot happen through cognitive coping such as talking or rituals such as writing letters. The embodied component is necessary here to heal one’s body and mind.
Something has been removed in an aggressive way. I felt that there is something that really needs healing. And that has more impact than you would think sometimes. Because I usually think: no remorse.
These women talked about their rational attitude towards the abortion: they wanted it, it was their right, and it was just a small beginning of life. However, on the level of their bodies, that had invested in feeding and letting the embryo grow, they still experienced an impact.

4. Discussion

The present study gives insight into the diversity of ritualizing after abortion in the Netherlands. It must be made clear that the data analyzed here represent a specific group of research participants who actively sought counseling and needed ritualizing. This research is not a representation of all abortion experiences. The examples of ritualizing found here reveal ambiguous feelings. Ambiguity does not mean regret or dissatisfaction with the decision. Only 1 respondent in the interviews and 9 of the 43 online stories mentioned regretting the decision. Many women expressed that they made the right decision but experienced feelings of mourning or loss of a potential child they had wanted under other circumstances. Many research participants also stated feeling gratitude for the chances they received by choosing abortion, such as study, work, opportunities for personal growth or relationships, travel or taking proper care of their children.
The ambiguity that many women experienced might also be related to the fact that many of them were still searching in matters of life orientations, tentatively believing in “something between heaven and earth“, the existence of souls or concepts such as fate or reincarnation. Ritualizing, and especially the form of fostering a connection to the child-to-be, as well as the aspect of honoring, might be an expression of their need to explore these beliefs and to experiment by integrating them into their lives. At the same time, ritualizing can evoke certain spiritual feelings, such as a connection with a transcendent notion. In general, this study does not allow theorizing about the link between spirituality and ritualizing. The variety in life orientations in Subsamples 1 and 2 shows that women with different outlooks on life might be inclined to ritualize.
While for some research participants in this sample, sharing their personal stories in the public space was important, others preferred to privately ritualize the abortion (e.g., celebrating specific dates and keeping memorial objects). In both cases, symbolic, creative or aesthetic translations were found and ritually enacted, such as using keepsakes, imaginative conversations with the potential child or writing down letters. Finally, the more “literal“ embodied ritualizing, such as taking a tattoo or participating in the womb healing, shows more complex ritual meanings that seem to refer to ritual transformation. The ritual meanings are, again, not related to regret but a need to pay special attention to one’s body after the abortion and to mark the event as meaningful. The ritualizing found here shows a symbolic and ritualistic negotiation of one’s own narrative and body. The meanings of the womb healing ceremony differ from the Japanese mizuko kuyō in the sense that the “Dutch” ritual focuses on the woman’s body and the processes involved, while the rituals in Japan focus more on the fetus and the relationship with its “mother” and, in the past, have added to the normalization of abortion in Japan (see Yamagata-Montoya 2021).
Ritualizing the abortion experience seems a fitting way to deal with this life event in a secular context such as the Netherlands, at least for some, as ritualizing is a new, explorative way of giving attention and marking significant experiences. In ritual, various meanings are accepted and expressed in the chosen symbols and symbolic language, as symbols communicate more than one meaning at the same time (Cupchik 2002; Moore and Myerhoff 1977; Scheff 1977; Wojtkowiak 2018). Symbolic figures were used in addressing or describing the fetus, for instance, angels, stars or butterflies. All these symbols have beautiful attributes and, at the same time, are out of reach, far away or of short existence. Even the two mentioned pets became “liminal beings” in the sense that they were associated with human-like or child-like characteristics and treated as such (e.g., birth card for pet).
Some of the ritual and symbolic expressions found here show striking similarities with other life events, such as grief after stillbirth and grief interventions more generally (Manfredi 2022; Romanoff and Terenzio 1998; Wojtkowiak et al. 2021). The use of tattoos and the symbols used here (star, butterfly), as well as keeping the bond with the imagined child, has been repeatedly found in other research on grief (see, for instance, Manfredi (2022)). While the ritualizing reveals sad, difficult emotions (such as loss and guilt), it also reveals positive emotions (during and after the ritualizing), as well as relief afterwards. Our study is in line with previous research, showing that images about the fetus influence how the abortion experience is interpreted. Imagining the fetus as a child can lead to temporal feelings of loss, but generally, afterwards, the abortion is not considered an experience of loss (Brauer et al. 2019; Stalhandske et al. 2012).
Ritual and ritualizing seem to offer interesting forms of materializing and representing abortion (Hurst 2021), which might be useful in abortion (after) care for those who are looking for meaningful ways to address the experience. While the women in this sample sought counseling and ways to find closure, the ritualizing stimulated positive emotions as well. It must be made clear that these ritualizing forms arose within a specific sample and cannot be generalized to all abortions. Our study is small and not representative, as the interview data result from a sample of women who looked for counseling, and Fiom offers care where various emotions are addressed, and a symbolic and ritual approach is given as an example. Ritual and ritualizing might be meaningful to specific women, while others might appreciate a neutral care approach.
More research is needed on private and public forms of ritualizing, as well as how ritualizing is related to decision difficulty and rightness. The social and cultural context needs also to be considered in abortion studies. The Netherlands is a liberal, secularized country, where abortion is legal and ritualizing also occurs in other domains, such as spiritual care, collective commemorations and funerals, which might partially explain the openness towards new ritual and spiritual practices found in this sample. We hope that this explorative study contributes to our understanding of embodied spirituality in ritualizing life events, such as abortion.

Author Contributions

Conceptualization, K.B., A.W.B. and J.W.; Data curation, K.B.; Formal analysis, K.B., A.W.B. and J.W.; Investigation, K.B. and A.W.B.; Methodology, K.B., A.W.B. and J.W.; Project administration, K.B.; Resources, K.B.; Software, K.B.; Supervision, A.W.B.; Validation, K.B., A.W.B. and J.W.; Visualization, K.B. and J.W.; Writing—original draft, K.B. and J.W.; Writing—review & editing, K.B., A.W.B. and J.W. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Institutional Review Board Statement

Ethical review and approval were waived for this study due to close collaboration with certified professionals in the field and written informed consent obtained from all interview respondents.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Standards

Data available on request due to restrictions, e.g., privacy or ethical. The data presented in this study are available on request from the corresponding author. The data are not publicly available due to the concern of keeping respondents’ anonymity.

Conflicts of Interest

The authors declare no conflict of interest.


Fiom Mission Statement. Available online: (accessed on 15 April 2022).
The designation ‘respondents’ or ‘interview respondents’ always includes Subsamples 1 and 2.


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Table 1. Types of data.
Table 1. Types of data.
SubsampleType of DataParticipantsParticipants in Relation to TotalVolume MaterialMaterial in Relation to TotalSelection Based on Ritual Elements
Subsample 1: Fiom respondentsInterview1120%176.583 words76%No
Subsample 2: Womb healing respondents Interview23%21.181 words12.1%Yes
Subsample 3: Online personal accounts Written personal story4377%27.653 words11.9%Yes
Table 2. Types of ritualizing abortion and ritual meanings.
Table 2. Types of ritualizing abortion and ritual meanings.
Main Category of Ritualizing Examples of RitualizingRitual Meanings
Creating and using symbolic expressions privately
Engaging in conversation with imagined child-to-be
Name giving
Referring to imagined child as angel, butterfly, star
Marking symbolic data
Creating artwork
Use of other symbols
Sharing poems or letters to the imagined child
Caring for a pet as symbolic substitute
Fostering connection with the child-to-be
Expressing feelings
Seeking for forgiveness
Creating and using symbolic expressions online
Sharing the above-mentioned symbolic expressions online
Breaking a taboo, finding recognition
Creating support, joining a community
Expressing feelings
Keeping meaningful objects
Complex honoring rituals
Showing respect
Taking a tattoo
Wearing jewels
Transforming the experience
Other physical ritualizing
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Biel, K.; Braam, A.W.; Wojtkowiak, J. Ritualizing Abortion: A Qualitative Study on Ritual and Its Meanings in The Netherlands. Religions 2022, 13, 592.

AMA Style

Biel K, Braam AW, Wojtkowiak J. Ritualizing Abortion: A Qualitative Study on Ritual and Its Meanings in The Netherlands. Religions. 2022; 13(7):592.

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Biel, Kiki, Arjan W. Braam, and Joanna Wojtkowiak. 2022. "Ritualizing Abortion: A Qualitative Study on Ritual and Its Meanings in The Netherlands" Religions 13, no. 7: 592.

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