New Series, Vol. 3, No. 2
Although access to abortion is reduced in many states across the country, 2024 saw a 12% increase in secured abortions compared to 2020 and the highest rate since 2012. Among these include parents who had to make the heartbreaking decision to end a wanted pregnancy due to various medical reasons. Previous research demonstrates that parents in these situations experience intense feelings of guilt, anger, and despair, as well as depressive and post-traumatic stress symptoms that can endure for years after the event. This study applied Problematic Integration Theory to the context of pregnancies terminated for medical reasons to more deeply understand the decision-making processes and experiences of these parents.
Problematic Integration Theory is one of several theories of uncertainty, a significant area of theorizing in the field of communication, and is especially useful to researchers interested in the relationship between decision-making and uncertainty. The theory assumes that people form probabilistic orientations and evaluative orientations to the world around them. Probabilistic orientations refer to the level of (un)certainty that a particular outcome will occur, whereas evaluative outcomes assign positive, neutral, or negative value to those outcomes. These orientations are interdependent and must be integrated, which is easy for individuals when positive and/or desired outcomes are (perceived as) likely to occur, but becomes problematic when these two orientations conflict (e.g., a negative outcome is likely) or when one has trouble forming one of these orientations (e.g., there is not enough information to form a probabilistic orientation). When integration of these orientations becomes problematic, individuals experience increased stress and uncertainty in their decision-making and engage in various communication behaviors as they navigate the integrative dilemma(s) that they experience.
The theory states that these integrative dilemmas typically take one of four forms: divergence, impossibility, ambivalence, and uncertainty (originally named ambiguity). When probabilistic and evaluative orientations conflict, individuals experience divergence or impossibility. Divergence occurs when a positive outcome is desired, but certainty that it will actually occur is low, whereas impossibility occurs when negative outcomes feel certain. When individuals have trouble forming either probabilistic or evaluative orientations, ambivalence or uncertainty occur. Ambivalence refers to dilemmas where mixed feelings arise as the result of choosing between two or more relatively certain equally negative outcomes, whereas uncertainty arises as the result of not having enough information to form probabilistic outcomes that feel accurate, particularly in relation to negative outcomes. Moreover, because these forms of problematic integration are interrelated, they may also transform in one of three ways: form (i.e., one type of problematic integration transforms into another type), focal (i.e., the object of the problematic integration itself transforms into something else), and level (i.e., through communication the issue expands, such as from an intrapersonal issue to a interpersonal, organizational, or cultural issue).
The authors of this study conducted a narrative analysis using the constant comparative method (i.e., data are coded in several steps: open coding to identify emergent themes, axial coding to begin grouping the data into categories, and selective coding in which all data are systematically coded and compared based on categories derived in axial coding) of 71 narratives from parents who had terminated their pregnancies for medical reasons across two websites that host online support groups for these parents. The authors sought to understand the forms, foci, and transformation processes evident in these narratives.
Each of the four forms of problematic integration posited by the original theory were evident in these narratives, as was one additional form, perplexity. Parents experienced ambivalence as a result of choosing to terminate their pregnancy, often arguing that they did not feel that they truly had a choice, especially for parents that also held anti-abortion attitudes and felt like the language for their particular situation was insufficient. Parents experienced impossibility, a previously understudied form of problematic integration, when they received their child’s prognosis and learned that the undesired outcome of their child not surviving was all but guaranteed. Parents experienced divergence when desired outcomes of wanting a healthy baby, wanting the ability to terminate (i.e., when access to abortion services limited by state laws and hospital policies), and wanting more children (i.e., they did not know if they would have similar experiences with future pregnancies) were not likely. Problematic Integration Theory also distinguishes between ontological uncertainty (i.e., unanswerable questions such “Why them and their baby?”) and epistemological uncertainty (i.e., questions that can be answered with more or better information, but in this sample questions around the child’s likelihood of surviving the pregnancy and their quality of life after could have only been answered if the pregnancy was not terminated); both were evident in this sample.
The authors extended Problematic Integration Theory after finding evidence of a fifth form of problematic integration, perplexity, in their data. They assert that perplexity occurs when individuals have trouble forming both probabilistic and evaluative orientations (rather than only one or the other, what the authors identified as a conceptual gap in the original theory), making it difficult for them to determine what outcomes they desire and what outcomes they can expect. Perplexity occurred when parents experienced mind-body dissonance as the result of receiving their child’s prognosis when their unborn babies “felt so full of life” and seemed active and healthy inside the womb. Perplexity also occurred when parents considered future social interactions in the wake of their anticipated grief and loss, not being sure how the interactions would go or how these parents even wanted people to respond to their situation.
In regard to the relationships within and between forms of problematic integration, the authors identified three types of transformations: sequential, stack, and snowball. Sequential transformations occurred when information seeking behaviors as a result of one integrative dilemma would lead to another, such as in response to divergence (e.g., genetic testing to learn more about an unborn baby’s health concerns) ultimately leading to impossibility (e.g., results of genetic testing revealing potential risks of future pregnancies). Stack transformations refer to narratives in which there were multiple, concurrent dilemmas, such as divergence about the unborn child’s health paired with ontological uncertainty. Snowball transformations had characteristics of both sequential and stack transformations, but accumulated quickly and multiplied such that the strain of dealing with multiple, additional, and concurrent dilemmas resulted in a whole greater than the sum of its parts. Although this study was both theoretically and practically significant, the authors assert that more research on this subject is warranted, especially regarding the psychosocial impact of the fall of Roe v. Wade for parents who terminate wanted pregnancies for medical reasons.
Communication Currents Discussion Questions
- Have you ever felt pressure to make a decision quickly while still feeling deeply uncertain or conflicted? How did communication with others help or worsen that experience?
- Compare Problematic Integration Theory to other communication theories of uncertainty (e.g., Uncertainty Reduction Theory, Theory of Motivated Information Management). How does Problematic Integration offer something different or more nuanced in high-stakes decision-making contexts?
- After reading this essay, how do you now think about uncertainty differently? If you were to design a follow-up study, what would you want to examine next?
For additional suggestions about how to use this and other Communication Currents in the classroom, see: https://www.natcom.org/publications/communication-currents/integrating-communication-currents-classroom
ABOUT THE AUTHORS
Kami Kosenko is an Associate Professor in the Department of Communication at North Carolina State University.
Yezi He is a Master’s Student in the Department of Communication at North Carolina State University.
This essay, by R. E. Purtell, translates the scholarly journal article, K. Kosenko & Y. He (2025). A heartbreaking choice: The integrative dilemmas of ending a wanted pregnancy. Communication Monographs. Advance online publication. https://doi.org/10.1080/03637751.2025.2579013
The full copyright and private policy link is available at natcom.org/privacy-policy/
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