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Beyrer C, Kamarulzaman A, Isbell M, Amon J, Baral S, Bassett MT, Cepeda J, Deacon H, Dean L, Fan L, Giacaman R, Gomes C, Gruskin S, Goyal R, Mon SHH, Jabbour S, Kazatchkine M, Kasoka K, Lyons C, Maleche A, Martin N, McKee M, Paiva V, Platt L, Puras D, Schooley R, Smoger G, Stackpool-Moore L, Vickerman P, Walker JG, Rubenstein L. Under threat: the International AIDS Society-Lancet Commission on Health and Human Rights. Lancet 2024; 403:1374-1418. [PMID: 38522449 DOI: 10.1016/s0140-6736(24)00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | | | - Joseph Amon
- Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary T Bassett
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Harriet Deacon
- Treatied Spaces Research Group and Centre of Excellence in Data Science, Artificial Intelligence and Modelling, University of Hull, Hull, UK
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Carolyn Gomes
- UNAIDS HIV & Human Rights Reference Group, Kingston, Jamaica
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Vera Paiva
- Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucy Platt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robert Schooley
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Kumsa H, Mislu EK, Arage MW, Kidie AA, Hailu T, Tenaw LA. Prevalence and determinants of pregnancy termination in Ethiopia: a systematic review and meta-analysis. BMJ Open 2024; 14:e073799. [PMID: 38485172 PMCID: PMC10941161 DOI: 10.1136/bmjopen-2023-073799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia. DESIGN Systematic review and meta-analysis. DATA SOURCES Relevant articles were retrieved from databases such as PubMed, EMBASE, Medline and other search engines. ELIGIBILITY CRITERIA FOR SELECTING STUDIES The research design for this study had no restrictions, allowing for the inclusion of cross-sectional and case-control studies that examined the prevalence or determinants of pregnancy termination. However, case reports, case series, reviews, editorials and studies published as abstracts only were excluded from the analysis. DATA EXTRACTION AND SYNTHESIS The review was precisely in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and the quality of the review was assessed using the Joanna Briggs Institute critical appraisal checklist. Heterogeneity was indicated by the p value for I2 statistics less than 0.05. Data were entered into Microsoft Excel, and the analysis was conducted by using Stata V.16. RESULTS The pooled prevalence of pregnancy termination in Ethiopia was 21.52% (95% CI 15.01% to 28.03%). Women who had their first sexual initiation before the age of 18 (OR 1.78; 95% CI 1.13 to 2.82, p=0.14), had irregular menstrual bleeding (OR 1.86; 95% CI 1.25 to 2.77, p=0.76), being a student (OR 4.85; 95% CI 1.98 to 11.91, p=0.20) and had multiple sexual partners (OR 4.88; 95% CI 3.43 to 6.93, p=0.33) were significantly associated with pregnancy termination. CONCLUSIONS One in five women terminated their pregnancies, which is higher than in other sub-Saharan countries. Being a student, irregular menstrual bleeding, early initiation of sexual intercourse and multiple sexual partners were determinants of pregnancy termination. Special attention is needed in avoiding early sexual initiation and in reducing sexual risk behaviours.
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Kumari S, Sharma KA, Ghosh S, Suman BA, Bhardwaj A, Puri M, Chaudhary P, Chatterjee T, Dubey S, Karna P. Respectful Abortion Care initiative: How a large-scale virtual training for providers in India increased knowledge of the new 2021 Medical Termination of Pregnancy Act. Int J Gynaecol Obstet 2024; 164 Suppl 1:42-50. [PMID: 38360033 DOI: 10.1002/ijgo.15335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND In a historic move to ensure comprehensive abortion care, India amended the 1971 Medical Termination of Pregnancy (MTP) Act in 2021, creating an unprecedented opportunity for accelerating safe, respectful, and rights-based abortion services. The Federation of Obstetric and Gynecological Societies of India (FOGSI), together with World Health Organization (WHO) India and the Ministry of Health and Family Welfare, set up a flagship initiative "Respectful Abortion Care" (RAC) to provide training to obstetricians and gynecologists on the new Act, and also address their values and biases. METHODS Virtual training sessions were organized during the COVID-19 pandemic to disseminate the amendments made under the MTP Act and address provider values and biases. The primary focus was on private providers as they account for more than half of all abortion services in India (52.9%). The RAC modules were systematically designed and delivered by 690 Master Trainers, trained by FOGSI and WHO. RESULTS A total of 9051 FOGSI members (22%, with 50% from private clinics) completed the RAC trainings. Pretests and post-tests were conducted for impact assessment. Significant improvement was seen on knowledge of criteria for termination of pregnancy for significant birth defects (52%-83%). The post-training survey showed a high level of commitment to promote RAC: >95% were strongly motivated to perform or assist in abortion; 89% reported that the WHO value clarification exercises were helpful in facilitating open discussions on sensitive topics in a comfortable manner; 96% expressed a strong commitment to addressing the issue of respect and confidentiality in abortion care. CONCLUSION RAC was a unique initiative around the MTP Act amendment 2021 in India, which demonstrated that collaboration and leadership by professional associations can help motivate providers and lead to improved knowledge and commitment from public and private sector providers.
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Affiliation(s)
- Shantha Kumari
- Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Kandala Aparna Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sumita Ghosh
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Barru Aruna Suman
- Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Ajey Bhardwaj
- Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Pushpa Chaudhary
- World Health Organization, Country Office for India, New Delhi, India
| | - Tapas Chatterjee
- World Health Organization, Country Office for India, New Delhi, India
| | - Sapna Dubey
- World Health Organization, Country Office for India, New Delhi, India
| | - Priya Karna
- World Health Organization, Country Office for India, New Delhi, India
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Elomrani S, Utz B, De Brouwere V, Kajjoune I, Assarag B. Avortement au Maroc et virage au drame : femmes et professionnels de santé en parlent ! Une étude transversale mixte à Agadir. Sex Reprod Health Matters 2024; 31:2279371. [PMID: 38198585 PMCID: PMC10860688 DOI: 10.1080/26410397.2023.2279371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
RésuméLes avortements à risque constituent une problématique majeure de santé publique, responsable de la mortalité et de la morbidité maternelles et absorbant les ressources des systèmes de santé publique à l'échelle mondiale. Malgré l'ampleur très probable du problème de l'avortement non sécurisé au Maroc, peu de données sont accessibles sur cette question. Cette recherche vise à analyser la situation de l'avortement du point de vue des femmes et des professionnels de santé dans la préfecture d'Agadir Idaoutanane au Sud du Maroc. Nous avons conduit une étude transversale mixte. De janvier à septembre 2018, 266 femmes ont été recrutées pour répondre à un questionnaire, et 45 entretiens avec les femmes et les professionnels de la santé impliqués dans la santé sexuelle et reproductive (SSR) ont été menés. Nous avons procédé à une analyse descriptive des données quantitatives et à une analyse de contenu thématique des données recueillies par les entretiens individuels. Les résultats de l'étude révèlent que les avortements sont la conjugaison de plusieurs facteurs multidimensionnels. Le manque d'informations en SSR et l'échec de la contraception sont les facteurs majeurs de grossesses non désirées. L'avortement provoqué est un sujet tabou, fortement stigmatisant, portant à l'image sociale de la personne. L'accessibilité aux services d'avortement est marquée de grandes disparités et de trajectoires différentes. Cette étude apporte une contribution à l'analyse du phénomène de l'avortement au Maroc et appelle à une action politique urgente sur plusieurs niveaux: l'accès aux programmes d'éducation sexuelle et à la contraception appropriée, l'élargissement des indications d'avortement préconisées dans le projet de loi, la mise en place des stratégies de lutte contre la stigmatisation de l'avortement par les professionnels de santé et l'accès à des soins post-avortement de haute qualité.
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Affiliation(s)
- Sanae Elomrani
- Doctorante, Public Heath Department, Ecole Nationale de Santé Publique, Rabat, Morocco
| | - Bettina Utz
- Visiting Scientist, Faculty of Medicine, Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Vincent De Brouwere
- Professeur émérite, Institute of Tropical Medicine, Antwerp, Belgium; Professeur associé, École Internationale de Santé Publique, Université Mohamed VI des Sciences de la Santé, Casablanca, Maroc; Visiting Professor, School of Tropical Medicine & Global Health, University of Nagasaki, Nagasaki, Japon
| | - Imane Kajjoune
- Lauréate, École Nationale de Santé Publique, Rabat, Maroc; Chef du Service du réseau des Etablissements de Santé à la Délégation Provinciale de Rhamna, Ministère de la Santé et de la Protection Sociale, Rabat, Morocco
| | - Bouchra Assarag
- Chercheure en DSSR, Directrice Adjoint chargée des études, École Nationale de Santé Publique, Rabat, Maroc
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Makenzius M, Rehnström Loi U, Otieno B, Oguttu M. A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya: a quasi-experimental study. Sex Reprod Health Matters 2023; 31:1881208. [PMID: 36846933 PMCID: PMC9980036 DOI: 10.1080/26410397.2021.1881208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
This study assessed the effectiveness of a school-based stigma-reduction intervention focusing on stigmatising attitudes towards girls associated with abortion and contraceptive use. In February 2017, two gender-mixed secondary schools (n = 1368) in peri-urban areas of Kisumu County, Kenya, were assigned to receive either an 8-hour stigma-reduction intervention over four sessions (intervention school: IS) or standard comprehensive sexuality education (control school: CS). A classroom survey entailing two five-point Likert scales - the 18-item Adolescents Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale, which measures abortion stigma, and the seven-item Contraceptive Use Stigma (CUS) scale - was conducted to collect data at baseline, 1-month and 12-months after the intervention. The intervention was to be considered effective if a mean score reduction of 25% was achieved for both the ASABA (primary outcome) and the CUS (secondary outcome) at the IS between baseline and 12-month follow-up. 1207 (IS = 574; CS = 633) students were included in analyses at 1-month follow-up, and 693 (IS = 323; CS = 370) at 12-months (the final-year students had left school). A decrease in mean score on both scales was observed at 1-month at both schools. At 12-months, the score decrease was 30.1% at the IS and 9.0% at the CS for ASABA, and 27.3% at the IS and 7.9% at the CS for CUS. At the IS, the score decrease for ASABA between baseline and 12-months was 23.3% among girls and 31.2% among boys; for CUS, the decrease was 27.3% and 24.3%, respectively. ASABA and CUS were positively correlated (r = 0.543; p < 0.001), implying a broader perspective on reproductive stigma. A four-session, school-based stigma-reduction intervention could lead to transformed values and attitudes towards gender norms among adolescents regarding abortion and contraceptive use. Stigma associated with abortion and contraception should become a priority for high-quality CSE programmes.
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Affiliation(s)
- Marlene Makenzius
- Researcher, Department of Women’s and Children’s Health, and the Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Correspondence:
| | - Ulrika Rehnström Loi
- Researcher, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Beatrice Otieno
- Project Officer, Kisumu Medical Education Trust (KMET), Kisumu, Kenya
| | - Monica Oguttu
- Executive Director, Kisumu Medical Education Trust (KMET), Kisumu, Kenya
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Hall C, Daire J, Hendrie D. A scoping review considering the processes involved in changing abortion laws in low- and middle-income countries. Health Policy Plan 2023; 38:1181-1197. [PMID: 37702199 DOI: 10.1093/heapol/czad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023] Open
Abstract
Providing legal and safe abortion is promoted as one of the key global strategies for reducing maternal mortality. Following the landmark 1994 International Conference on Population and Development, low- and middle-income countries (LMICs) are shifting towards more liberal abortion legislation. Whilst the existing literature has predominantly focused on agenda setting and individual country contexts, there is a need to understand the universal policy process of changing abortion laws. Drawing on the heuristic policy stages model and policy analysis triangle, this paper explores the processes involved in changing abortion laws in LMICs and discusses the influencing factors. We conducted a search for peer-reviewed literature in ProQuest, Scopus, Global Health (Ovid), PubMed and CINAHL. Initially, the search was conducted in February 2021 and was then re-run in May 2023. A total of 25 studies were included in the analysis. Following a descriptive, thematic and interpretive analysis of the extracted data, we have drawn out the key stages involved in changing abortion laws in LMICs: (1) establishing the need for changing abortion laws in a local context; (2) generating local evidence to support changes in abortion laws; (3) drafting of new and/or amendments of existing abortion laws; (4) adoption and enactment of changes in abortion laws; (5) translating the legal provisions into services and (6) assessing the impact of changes in abortion laws on maternal health. Our analysis explores the influence of actors and contextual factors, and we also discuss the policy solutions and decisions made by governments. The findings demonstrate that while the timing of change in abortion law was found to be dependent on the context of individual settings, the process and factors that influenced the change were remarkably consistent across geographies. Further research is required to evaluate the link between changes in abortion laws and maternal health outcomes.
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Affiliation(s)
- Carmen Hall
- School of Population Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
| | - Judith Daire
- School of Population Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
| | - Delia Hendrie
- School of Population Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
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Topcu EG, Ramirez A, Ubom AE. A global study on the abortion views and knowledge of trainee obstetrician-gynecologists. Int J Gynaecol Obstet 2023; 163:453-460. [PMID: 37694673 DOI: 10.1002/ijgo.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To assess the knowledge and views of trainee obstetrician-gynecologists (ObGyn) on abortion. METHODS A cross-sectional study of trainee ObGyn was conducted by the World Association of Trainees in Obstetrics and Gynecology. A study-specific questionnaire designed using Google Forms® was utilized for the study. The questionnaire was distributed electronically to study participants, to gather information on their sociodemographic characteristics, opinions, knowledge, and training on abortion. Collected data were analyzed using the IBM SPSS, version 25. RESULTS Most (140, 74.8%) trainee ObGyn reported that abortion was legal in their countries and most (171, 91.4%) supported the legalization of abortion. Eleven (5.9%) trainees who did not support the legalization of abortion cited religious concerns as their most common reason (5/11, 45.5%). Nearly three-quarters (133, 71.1%) of the trainees would perform an abortion on request. Most of the trainees reported that abortion education was included in the medical school curricula (131, 70.1%) and the ObGyn residency training programs (155, 82.9%) in their countries. Notwithstanding, 36.4% (68) either did not know or did not correctly know the legal status of abortion in their countries. CONCLUSION There is some disparity between ObGyn trainees' knowledge of safe abortion and their awareness of the legality of the same in their countries. There is a need for all countries to include abortion education in the curricula of medical schools and all ObGyn residency programs should offer abortion training to all residents. There is a need for increased advocacy for the legalization of abortion in countries where abortion remains criminalized.
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Affiliation(s)
- Elif G Topcu
- Istanbul Health and Technology University, Istanbul, Turkey
| | | | - Akaninyene E Ubom
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Howard SA, Benhabbour SR. Non-Hormonal Contraception. J Clin Med 2023; 12:4791. [PMID: 37510905 PMCID: PMC10381146 DOI: 10.3390/jcm12144791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.
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Affiliation(s)
- Sarah Anne Howard
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Soumya Rahima Benhabbour
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Kayondo SP, Kaye DK, Nabatanzi SL, Nassuuna S, Musana O, Namagembe I, Nsanja JP, Morris J, Fawzi H, de Koning K, Kaur J, Pretty M. Challenges and opportunities from using abortion harm reduction and value clarification and attitude transformation engagements for safe abortion advocacy in Uganda. Reprod Health 2023; 20:97. [PMID: 37381001 DOI: 10.1186/s12978-023-01637-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND From 2018, the International Federation of Gynecologists and Obstetricians (FIGO) implemented the Advocating Safe Abortion project to support national obstetrics and gynecology (Obs/gyn) societies from ten member countries to become leaders of Sexual and Reproductive Health and Rights (SRHR). We share experiences and lessons learnt about using value clarification and attitude transformation (VCAT) and abortion harm reduction (AHR) as strategies for our advocacy engagements. METHODS The advocacy goal of ending abortion-related deaths followed predefined pathways from an extensive needs assessment prior to the project. These pathways were strengthening capacity of the Obs/gyn society as safe abortion advocates; establishing a vibrant network of partners; transforming social and gender norms; raising awareness of the legal and policy environment regarding abortion, and promoting the generation and use abortion data for evidence-informed policy and practice. Our advocacy targeted multiple stakeholders including media, policy makers judicio-legal, political and religious leaders, health workers and the public. RESULTS During each engagement, facilitators required audiences to identify what roles they can play along the continuum of strategies that can reduce maternal death from abortion complications. The audiences acknowledged abortion complications as a major problem in Uganda. Among the root causes for the abortion context, audiences noted absence of an enabling environment for abortion care, which was characterized by low awareness about the abortion laws and policy, restricted abortion laws, cultural and religious beliefs, poor quality of abortion care services and abortion stigma. CONCLUSION VCAT and AHR were critical in enabling us to develop appropriate messages for different stakeholders. Audiences were able to recognize the abortion context, distinguish between assumptions, myths and realities surrounding unwanted pregnancy and abortion; recognize imperative to address conflict between personal and professional values, and identify different roles and values which inform empathetic attitudes and behaviors that mitigate abortion harms. The five pathways of the theory of change reinforced each other. Using the AHR model, we delineate strategies and activities which stakeholders could use to end abortion deaths. VCAT enables critical reflection of views, beliefs and values versus professional obligations and responsibilities, and promotes active attitude and behavior change and commitment to end abortion-related deaths.
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Affiliation(s)
- Simon Peter Kayondo
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Dan Kabonge Kaye
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda.
| | | | - Susan Nassuuna
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Othiniel Musana
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Imelda Namagembe
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - John Paul Nsanja
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Jessica Morris
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
| | - Hani Fawzi
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
| | | | - Jameen Kaur
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
| | - Matthew Pretty
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
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Rugema L, Uwase MA, Rukundo A, Nizeyimana V, Mporanyi T, Kagaba A. Women leaders perceived barriers and consequences of safe abortion in Rwanda: a qualitative study. BMC Womens Health 2023; 23:205. [PMID: 37118784 PMCID: PMC10148505 DOI: 10.1186/s12905-023-02366-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Between 2010 and 2014, approximately 25 million unsafe abortions were performed annually across the globe. Africa alone accounted for 29% of all unsafe abortions, and 62% of the related deaths. Women living in poverty, especially adolescents, lack information about where and how to access safe abortion services. They often lack adequate insight to make informed decisions. The purpose of this study was to explore the empowered perspectives of women leaders in Rwanda about the recent policy change for safe abortion. The study identifies women leaders' perceived barriers and their attitudes about resulting consequences toward safe abortion. METHOD In this qualitative study, seven focus group discussions and eight key informant interviews were performed in October 2019. A total of 51 women leaders participated, their age ranging from 38 to 60 years. Participants were drawn from three districts, namely Gasabo, Kicukiro, and Nyarugenge. For variability of data, participants came from parliament, government ministries, government parastatals, and civil society organizations. All interviews were conducted in Kinyarwanda and later translated into English. Data were analyzed using qualitative content analysis. RESULTS The emerging theme Strong barriers and numerous consequences of safe abortion illustrates how women leaders perceive barriers to safe abortion and its related consequences in Rwanda. The theme is divided into two categories: (1) Perceived barriers of safe abortion and (2) Consequences of providing safe abortion. The sub-categories for the first category are Reluctance to fully support safe abortion due to perceived unjustified abortions", Abortion-related stigma, Abortion is against cultural and religious beliefs, Emotional attachment to the unborn and Lack of awareness of abortion. The sub-categories for the second category are Perceived physiological trauma, Cause for barrenness/infertility, Increase in services abuse by adolescents/women, Increase of workload for healthcare providers, "Increase in sexual activities and STIs, and Abortion-related physiological trauma. CONCLUSION The subject of safe abortion evokes mixed reactions among participants, and is entangled with unsafe abortion in most cases. Participants stress that the word 'abortion' disturbs, regardless of whether it relates to being safe or unsafe. Participants believe the word 'abortion' outweighs the word 'safe'. Societal expectations play a major role in the decision-making process of any adolescent or a family member faced with a pregnant adolescent regardless of the existing safe abortion law. Community mobilization and sensitization are crucial if safe abortion in accordance with abortion law is to be embraced. Messages that reinforce safe abortion as acceptable and address stigma, fears of trauma, and barrenness should be developed to educate adolescents, parents, and women leaders about safe abortion, to mitigate unsafe abortion-related complications.
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Affiliation(s)
- Lawrence Rugema
- School of Public Health, University of Rwanda, Kigali, Rwanda.
| | | | | | | | | | - Aflodis Kagaba
- Health Development Initiative, PO Box 3955, Kigali, Rwanda
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Qaderi K, Khodavirdilou R, Kalhor M, Behbahani BM, Keshavarz M, Bashtian MH, Dabir M, Irani M, Manouchehri E, Farahani MF, Mallah MA, Shamsabadi A. Abortion services during the COVID-19 pandemic: a systematic review. Reprod Health 2023; 20:61. [PMID: 37055839 PMCID: PMC10098996 DOI: 10.1186/s12978-023-01582-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/13/2023] [Indexed: 04/15/2023] Open
Abstract
Evidence suggests that COVID-19 may impair access to sexual and reproductive health services and safe abortion. The purpose of this systematic review was investigating the changes of abortion services in the COVID-19 pandemic era. We searched PubMed, Web of Science and Scopus for relevant studies published as of August 2021, using relevant keywords. RCT and non-original studies were excluded from the analysis and 17 studies of 151 included in our review. Requests to access medication abortion by telemedicine and demand for self-managed abortion were the main findings of identified studies. Women requested an abortion earlier in their pregnancy, and were satisfied with tele-abortion care due to its flexibility, and ongoing telephone support. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced based on the severity of the restrictions, and abortion clinics had less revenue, more costs, and more changes in the work style of their healthcare providers. Telemedicine was reported safe, effective, acceptable, and empowering for women. Reasons for using tele-abortion were privacy, secrecy, comfort, using modern contraception, employing of women, distance from clinics, travel restrictions, lockdowns, fear of COVID-19, and political reasons (abortion prohibition). Complications of women using tele-abortion were pain, lack of psychological support, bleeding, and need to blood transfusions. The results of this study showed that using telemedicine and teleconsultations for medical abortion in the pandemic conditions may be extended after pandemic. Findings can be used by reproductive healthcare providers and policy makers to address the complications of abortion services.Trail registration This study is registered in PROSPERO with number CRD42021279042.
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Affiliation(s)
- Kowsar Qaderi
- Midwifery Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasa Khodavirdilou
- Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehri Kalhor
- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Morshed Behbahani
- Reproductive Health Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Keshavarz
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahsa Dabir
- USERN Office, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Morvarid Irani
- School of Nursing and Midwifery, Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh, Iran
| | - Elham Manouchehri
- Department of Midwifery, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Maryam Farmahini Farahani
- Department of Midwifery, Faculty of Nursing and Midwifery, Tehran Medical Science, Islamic Azad University, Tehran, Iran
| | - Manthar Ali Mallah
- College of Public Health, Zhengzhou University, 100 Kexue Ave, Zhongyuan District, Zhengzhou, 450001, China
| | - Ahmadreza Shamsabadi
- Department of Health Information Technology, Esfarayen Faculty of Medical Science, Esfarayen, Iran.
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12
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Dixit N, Braaten KP, Taylor C, Nekhlyudov L. Reproductive choice is supportive care in cancer. Support Care Cancer 2023; 31:249. [PMID: 37017781 DOI: 10.1007/s00520-023-07715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Kari P Braaten
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
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13
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Inzama W, Kaye DK, Kayondo SP, Nsanja JP. Gaps in available published data on abortion in Uganda and the missed opportunity to inform policy and practice. Int J Gynaecol Obstet 2023; 161:1-7. [PMID: 36436881 DOI: 10.1002/ijgo.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/12/2022] [Accepted: 10/28/2022] [Indexed: 11/29/2022]
Abstract
Globally, 25% of pregnancies end up in induced abortion, the majority of which are unsafe. Abortion is safe when conducted according to WHO recommendations. The objective of the present study was to identify gaps in the data published on abortion and make recommendations to the Ministry of Health, Uganda. The search strategy included PubMed, Google Scholar articles (from October 2020 to May 2021) on unsafe abortion in Uganda, reviewed data from the Association of Obstetricians and Gynecologists of Uganda (AOGU) members' baseline survey (2019), Health Management Information System (HMIS) summary data (2015-2016 to 2019-2020), and the Uganda Demographic and Heath Survey (DHS) report (2011, 2016). From the 200 articles and national health surveys identified, 37 articles and two national representative surveys met our criteria: prevalence, factors, estimating cost of induced abortion, and complications associated with safe and unsafe abortion in both low- and high-income countries. There are many unsafe abortions in restrictive environments. Abortion is one of the leading causes of maternal and morbidity. Physicians favor dilatation and curettage over manual vacuum aspiration and medical methods for the evacuation of retained products. Several gaps still exist in the published articles, HMIS data, and DHS data, leading to missed opportunities for data to inform policy and practice.
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Affiliation(s)
| | - Dan K Kaye
- Association of Obstetricians & Gynaecologists of Uganda, Kampala, Uganda
| | - Simon P Kayondo
- Association of Obstetricians & Gynaecologists of Uganda, Kampala, Uganda
| | - John P Nsanja
- Association of Obstetricians & Gynaecologists of Uganda, Kampala, Uganda
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14
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Aronoff DM, Marrazzo JM. Infections caused by Clostridium perfringens and Paeniclostridium sordellii after unsafe abortion. THE LANCET. INFECTIOUS DISEASES 2023; 23:e48-e55. [PMID: 36155670 DOI: 10.1016/s1473-3099(22)00590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
After the legalisation of abortion in the USA in 1973, the risk of infectious morbidity and mortality from this procedure notably decreased. With increasingly restrictive legislation targeting access to safe abortion services, reviewing infectious complications of unsafe pregnancy termination is crucial, particularly the diagnosis and management of life-threatening clostridial (and related anaerobic bacterial) infections that can complicate unsafe abortion. This Review deals with two especially devastating infections that are well-documented causes of septic abortion: the anaerobic, spore-forming pathogens Clostridium perfringens and Paeniclostridium sordellii. We seek to familiarise the reader with these bacteria, the clinical syndromes they can cause (with a focus on toxic shock syndrome), and provide a review of diagnosis and treatment options.
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Affiliation(s)
- David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Jeanne M Marrazzo
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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15
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Kefale B, Damtie Y, Arefaynie M, Yalew M, Adane B, Dilnesa T, Zewdie S, Wasihun Y, Adane M. Induced abortion among female students in higher education institutions in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0280084. [PMID: 36662902 PMCID: PMC9858066 DOI: 10.1371/journal.pone.0280084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 12/12/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Female students in institutions of higher education are at higher risk of abortion and its consequences. There is no nationally representative data on induced abortion among students in higher education institutions in Ethiopia. Hence, this study aimed to estimate the pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia. METHODS This study used a systematic review and meta-analysis of studies conducted from January 1, 2010, to June 30, 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health electronic databases were searched. The analysis was performed using STATA 14 software. Heterogeneity and publication bias were assessed using I2 statistics and Egger's test, respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled prevalence with a 95% confidence interval (CI) of meta-analysis using the random effect model. RESULTS This systematic review and meta-analysis included a total of 10 studies and 4656 study participants. The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was 5.06% (95%CI: 2.16, 7.96). The rate of induced abortion was 51 per 1000 women. CONCLUSIONS The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was high. Thus, concerned bodies should design and implement an effective strategy to realize friendly and non-judgmental family planning and comprehensive abortion care service to curb the problem.
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Affiliation(s)
- Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tenagnework Dilnesa
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Segenet Zewdie
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitbarek Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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16
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Suh S, McReynolds-Pérez J. Subversive Epidemiology in Abortion Care: Reproductive Governance from the Global to the Local in Argentina and Senegal. SIGNS 2023. [DOI: 10.1086/722315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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17
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Arshad A, Aziz H, Shabbir G, Shakya S, Munir Z. Improving safe post-abortion care practices: A study on interventions implemented by Ipas Pakistan. Front Public Health 2023; 11:1004381. [PMID: 36950099 PMCID: PMC10025320 DOI: 10.3389/fpubh.2023.1004381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/26/2023] [Indexed: 03/08/2023] Open
Abstract
An estimated 50 million induced abortions occur in developing countries annually, and an estimated 7 million women are treated for complications associated with unsafe abortions. According to a 2012 estimate, 15 per 1,000 women aged 15-49 years seek treatment for abortion-related health complications in both private and public sectors. A high unmet need for family planning in Pakistan and a low percentage of women adopting a contraceptive method in the post-partum period led to unwanted pregnancy becoming one of the reasons for unsafe abortion. Post-abortion care (PAC) is an integrated service delivery model that includes both maternal health and family planning interventions. The study aims to examine improvement in abortion-related practices through the implementation of the PAC model at all tiers of public health service delivery systems in the two most populous provinces-Punjab, Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory (ICT) region-of Pakistan. The improvement model comprises clinical training of healthcare providers, community engagement, and counseling of community women on safe post-abortion practices. It was a descriptive study utilizing data of 27,616 PAC clients recorded and reported by the service providers on the logbooks from 104 selected public health facilities from March 2018 to December 2021 in ICT, Punjab, Sindh, and Khyber Pakhtunkhwa provinces of Pakistan. Women who received PAC services were older than 25 years, 22,652 (82%), with a mean age of 29 years. Most of these women were in their first trimester, 26,110 (95%), and the majority diagnosed with PAC (incomplete, missed, or threatened abortion), 26,838 (97%). The majority of women, 25,324 (92%), received safe methods for post-abortion care that included the use of misoprostol, 15,804 (58%), and manual vacuum aspiration, 8,898 (32%). In total, 17,105 (72%) of women opted for a contraceptive method that included long-acting reversible contraceptives, 2,313 (10%); short-term excluding condoms, 3,436 (27%); and condoms, 8,113 (34%). The key predictors identified for uptake of the post-abortion family planning method indicated that women more than 25 years of age, in the early second trimester, and who were counseled on post-abortion family planning were more likely to adopt the contraceptive method than others. Increased access to post-abortion care and family planning could potentially reduce the incidence of unsafe abortion, unintended pregnancies, and associated maternal mortality. The experience of Pakistan suggests that the integrated post-abortion care service delivery model can be effectively implemented across the public health systems.
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Affiliation(s)
- Amna Arshad
- Ipas, Islamabad, Pakistan
- *Correspondence: Amna Arshad
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18
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Rossier C, Owolabi O, Kouanda S, Bangha M, Kim CR, Ganatra B, Feehan D, Breen C, Zan M, Compaoré R, Baguiya A, Ouédraogo R, Oduor C, Bagnoa V, Athero S. Describing the safety of abortion at the population level using network-based survey approaches. Reprod Health 2022; 19:231. [PMID: 36575489 PMCID: PMC9795788 DOI: 10.1186/s12978-022-01518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the negative impact of unsafe abortions on women's health and rights, the degree of abortion safety remains strikingly undocumented for a large share of abortions globally. Data on how women induce abortions (method, setting, provider) are central to the measurement of abortion safety. However, health-facility statistics and direct questioning in population surveys do not yield representative data on abortion care seeking pathways in settings where access to abortion services is highly restricted. Recent developments in survey methodologies to study stigmatized / illegal behaviour and hidden populations rely on the fact that such information circulates within social networks; however, such efforts have yet to give convincing results for unsafe abortions. OBJECTIVE This article presents the protocol of a study whose purpose is to apply and develop further two network-based methods to contribute to the generation of reliable population-level information on the safety of abortions in contexts where access to legal abortion services is highly restricted. METHODS This study plans to obtain population-level data on abortion care seeking in two Health and Demographic Surveillance Systems in urban Kenya and rural Burkina Faso by applying two methods: Anonymous Third-Party Reporting (ATPR) (also known as confidantes' method) and Respondent Driven Sampling (RDS). We will conduct a mixed methods formative study to determine whether these network-based approaches are pertinent in the study contexts. The ATPR will be refined notably by incorporating elements of the Network Scale-Up Method (NSUM) to correct or account for certain of its biases (transmission, barrier, social desirability, selection). The RDS will provide reliable alternative estimates of abortion safety if large samples and equilibrium can be reached; an RDS multiplex variant (also including social referents) will be tested. DISCUSSION This study aims at documenting abortion safety in two local sites using ATPR and RDS. If successful, it will provide data on the safety profiles of abortion seekers across sociodemographic categories in two contrasted settings in sub-Saharan Africa. It will advance the formative research needed to determine whether ATPR and RDS are applicable or not in a given context. It will improve the questionnaire and correcting factors for the ATPR, improve the capacity of RDS to produce quasi-representative data on abortion safety, and advance the validation of both methods.
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Affiliation(s)
- Clémentine Rossier
- Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d'Arve, 1211, Geneva, Switzerland. .,Institut National d'Etudes Démographiques, Paris, France.
| | - Onikepe Owolabi
- grid.417837.e0000 0001 1019 058XGuttmacher Institute, New York, USA
| | - Seni Kouanda
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | - Martin Bangha
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Caron R. Kim
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bela Ganatra
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Dennis Feehan
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Casey Breen
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, Berkeley USA
| | - Moussa Zan
- grid.8591.50000 0001 2322 4988Institute of Demography and Socioeconomics, University of Geneva, 40 Bd du Pont d’Arve, 1211 Geneva, Switzerland
| | | | - Adama Baguiya
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
| | | | - Clement Oduor
- grid.413355.50000 0001 2221 4219APHRC, Nairobi, Kenya
| | - Vincent Bagnoa
- grid.457337.10000 0004 0564 0509IRSS, Ouagadougou, Burkina Faso
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Physical Violence during Pregnancy and Its Implications at Birth: Analysis of a Population Survey, 2019. Healthcare (Basel) 2022; 11:healthcare11010033. [PMID: 36611493 PMCID: PMC9818880 DOI: 10.3390/healthcare11010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Physical partner violence is widely recognized as a global health problem, especially in pregnant women. This study determines the association between physical violence during pregnancy in Peruvian women aged 15 to 49 years with low birth weight and abortion according to the Demographic and Family Health Survey (ENDES) 2019. An analytical cross-sectional observational study was carried out based on the data from the ENDES 2019. Two dependent variables referring to birth outcomes were included: abortion and low birth weight. The independent variable was physical violence during pregnancy by her current or former husband/partner. A total of 15,305 women were included in the study. The prevalence of physical violence during pregnancy was 6.43%. Regarding the adverse outcomes of pregnancy, the prevalences of abortion and low birth weight were 20.84% and 6.01%, respectively. Women suffering physical violence during pregnancy were more likely to have an abortion but not low birth weight. In conclusion, it was found that 6 in 100 Peruvian women of childbearing age were victims of violence during pregnancy. Likewise, it was observed that women who were victims of violence during pregnancy had a higher probability of having an abortion but not low birth weight.
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20
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Hailegebreal S, Enyew EB, Simegn AE, Seboka BT, Gilano G, Kassa R, Ahmed MH, Haile Y, Haile F. Pooled prevalence and associated factors of pregnancy termination among youth aged 15-24 year women in East Africa: Multilevel level analysis. PLoS One 2022; 17:e0275349. [PMID: 36548267 PMCID: PMC9778526 DOI: 10.1371/journal.pone.0275349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Most of unwanted pregnancies among adolescent girls and young women (AGYW) in Africa result in pregnancy termination. Despite attempts to enhance maternal health care service utilization, unsafe abortion remains the leading cause of maternal death in Sub-Saharan Africa (SSA), there is still a study gap, notably in East Africa, where community-level issues are not studied. Therefore, this study aimed to assess pooled prevalence pregnancy termination and associated factors among youth (15-24 year-old) women in the East Africa. METHODS The study was conducted based on the most recent Demographic and Health Surveys (DHS) in the 12 East African countries. A total weighted sample of 44,846 youth (15-24) age group women was included in this study. To detect the existence of a substantial clustering effect, the Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR)-test were used. Furthermore, because the models were nested, deviance (-2LLR) was used for model comparison. In the multilevel logistic model, significant factors related to pregnancy termination were declared using Adjusted Odds Ratios (AOR) with a 95%Confidence Interval (CI) and p-value of 0.05. RESULT The pooled prevalence of pregnancy termination in East African countries was 7.79% (95% CI: 7.54, 8.04) with the highest prevalence in Uganda 12.51% (95% CI: 11.56, 13.41) and lowest was observed in Zambia 5.64% ((95% CI: 4.86, 6.41). In multilevel multivariable logistic regression result, age 20-24 [AOR = 1.93; 95% CI: 1.71, 2.16], media exposure [AOR = 1.22; 95% CI: 1.12, 1.34], married [AOR = 1.32, 95% CI: 1.21, 1.43], had working [AOR = 1.13; 95% CI: 1.04, 1.23],no education[AOR = 3.98, 95% CI: 2.32, 6.81], primary education [AOR = 4.05, 95% CI: 2.38, 6.88], secondary education [AOR = 2.96, 95% CI: 1.74, 5.03], multiparous [AOR = 0.85; 95%CI: 0.79, 0.93], sexual initiation greater or equal to 15 [AOR = 0.82; 95%CI: 0.74, 0.99] were significantly associated with pregnancy termination. CONCLUSION The pooled prevalence of pregnancy termination in East Africa was high in this study. Maternal age, marital status, education status, parity, age at first sex, media exposure, working status and living countries were significantly associated with pregnancy termination. The finding provides critical information for developing health interventions to decrease unplanned pregnancies and illegal pregnancy termination.
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Affiliation(s)
- Samuel Hailegebreal
- Department of Health Informatics, College of Medicine and Health Science, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Ermias Bekele Enyew
- Department of Health Informatics, Institute of Public Health, Mettu University, Metu, Ethiopia
| | - Atsedu Endale Simegn
- Department of Anesthesia, College of Medicine and Health Science, Wachemo University, Hosaena, Ethiopia
| | - Binyam Tariku Seboka
- Department of Health Informatics, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Girma Gilano
- Department of Health Informatics, College of Medicine and Health Science, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Reta Kassa
- School of public health, Dilla University, Dilla, Ethiopia
| | | | - Yosef Haile
- Arba Minch University, College of Medicine and Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Firehiwot Haile
- Arba Minch University, College of Medicine and Health Sciences, School of Public Health, Arba Minch, Ethiopia
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Galli B, Dillon J. Challenges to the implementation of telemedicine in abortion care for victims of sexual violence in Brazil. Front Glob Womens Health 2022; 3:902390. [PMID: 36568727 PMCID: PMC9768028 DOI: 10.3389/fgwh.2022.902390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
The article focuses the recent dynamics resulting from state institutions adding more legal and regulatory barriers to abortion care access, particularly against the use of telemedicine for sexual violence victims in Brazil. It presents a case study from a lawsuit targeting a pioneer public health service on the city of Uberlandia to ban telemedicine in abortion care. The case study highlights human rights violations of women's right to health as well as the recent threats to the right to safe legal abortion care. It also provides legal arguments-based on scientific evidence and international human rights standards-that support the use of telemedicine for abortion care.
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Affiliation(s)
- Beatriz Galli
- Senior Policy and Advocacy Consultant Ipas, Chapel Hill, NC, United States,Correspondence: Beatriz Galli
| | - Jina Dillon
- Technical Excellence Director Ipas, Chapel Hill, NC, United States
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22
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Postabortion Contraceptive Utilization, Preferences, and Associated Factors among Women Receiving Abortion Care Services in Health Facilities of Ambo Town, Ethiopia. Int J Reprod Med 2022; 2022:2681478. [DOI: 10.1155/2022/2681478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background. The World Health Organization recommends the use of effective contraception for the prevention of unintended pregnancy and unsafe abortion. The main aim of postabortion contraceptive services is to prevent recurrent pregnancy and ultimately mitigate the associated maternal mortality. Objective. To assess postabortion contraceptive utilization (PACU) and postabortion contraceptive preferences (PACP) and the associated factors among women receiving abortion care services in Ambo town, Oromia Region, Western Ethiopia. Methods. A cross-sectional study was conducted at the health facilities in Ambo town from 22 July to 24 September 2021. The data was collected using a structured questionnaire. Bivariate and multivariable logistic regression was done to determine the factors associated with postabortion contraceptive utilization and preferences. Results. Out of 388 participants who were included in the final analysis, 262 (67.5%) had utilized postabortion contraceptives of which 173 (66%) received contraceptive methods of their primary preference. The multivariate logistic regression showed that cohabiting couples showed lower utilization (
; 95% CI: 0.06-0.21;
value = 0.004) than married ones and planning to have an additional child within 1-3 years (
; 95% CI: 2.18-11.41;
value = 0.005) or after 3-5 years (
: 95% CI: 5.12-10.18;
value = 0.033) was identified to be significantly associated with postabortion contraceptive utilization. Having a secondary education level (
; 95% CI: 1.54-6.07;
value = 0.001) and having experience of domestic violence (
; 95% CI: 1.27-3.81;
value = 0.005) were significantly associated with unsatisfied postabortion contraceptive preference. Conclusions and Recommendations. About two-thirds of the women who were given abortion services received postabortion contraceptives whereas almost two-thirds of them received a contraceptive method of their primary preference. Marital status, duration before additional child planned, and being counseled on contraceptive determined postabortion contraceptive utilization. Having a secondary education level and having experienced domestic violence were significantly associated with unsatisfied PACP.
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Samuels-Kalow ME, Agrawal P, Rodriguez G, Zeidan A, Love JS, Monette D, Lin M, Cooper RJ, Madsen TE, Dobiesz V. Post-Roe emergency medicine: Policy, clinical, training, and individual implications for emergency clinicians. Acad Emerg Med 2022; 29:1414-1421. [PMID: 36268814 PMCID: PMC9772035 DOI: 10.1111/acem.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state-level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giovanni Rodriguez
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer S Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Lin
- Department of Emergency Medicine, Stanford University, Palo Alto, California, USA
| | - Richelle J Cooper
- Department of Emergency Medicine, University of California Los Angeles, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medial School of Brown University, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Valerie Dobiesz
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Trapani VF, Feuerschuette OHM, Júnior AT. Legal Pregnancy Interruption due to Sexual Violence in a Public Hospital in the South of Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:945-952. [PMID: 36446561 PMCID: PMC9738043 DOI: 10.1055/s-0042-1755457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To analyze the cases of all women who attend to a service of legal termination of pregnancy in cases of sexual violence in a public reference hospital and to identify the factors related to its execution. METHODS Cross-sectional observational study with information from medical records from January 2014 to December 2020. A total of 178 cases were included, with an evaluation of the data referring to the women who attended due to sexual violence, characteristics of sexual violence, hospital care, techniques used, and complications. The analysis was presented in relative and absolute frequencies, medians, means, and standard deviation. Factors related to the completion of the procedure were assessed using binary logistic regression. RESULTS Termination of pregnancy was performed in 83.2% of the cases; in 75.7% of the cases, the technique used was the association of transvaginal misoprostol and intrauterine manual aspiration. There were no deaths, and the rate of complications was 1.4%. Gestational age at the time the patient's sought assistance was the determining factor for the protocol not being completed. Pregnancies up to 12 weeks were associated with a lower chance of the interruption not occurring (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.12-0.88), while cases with gestational age > 20 weeks were associated with a greater chance of the interruption not happening (OR: 29.93; 95%CI: 3.91-271.50). CONCLUSION The service studied was effective, with gestational age being the significant factor for resolution.
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Affiliation(s)
| | | | - Alberto Trapani Júnior
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil,Address for correspondence Alberto Trapani Júnior, PhD, MD Rua Esteves Júnior,458/802, CEP 88015-130. Florianópolis, SCBrazil
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Sigdel A, Angdembe MR, Khanal P, Adhikari N, Maharjan A, Paudel M. Medical abortion drug dispensing practices among private pharmacy workers in Nepal: A mystery client study. PLoS One 2022; 17:e0278132. [PMID: 36417473 PMCID: PMC9683563 DOI: 10.1371/journal.pone.0278132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pharmacies are the first point of contact for women seeking medical abortion (MA) and act as important sources of information and referral in Nepal. Over the counter sale of MA drugs is not currently allowed in Nepal. This study aimed to assess the MA drug dispensing practices of pharmacy workers using mystery clients in Nepal. METHODS A cross-sectional study using the mystery client approach was conducted in 266 pharmacies in September-October 2019. These pharmacies had either received harm reduction training or medical detailing visits. A total of 532 visits were conducted by six male and six female mystery clients. Mystery clients without prescription approached the sample pharmacy and filled out a standard digital survey questionnaire using the SurveyCTO application immediately after each interaction. RESULTS Pharmacy workers dispensed MA drugs in 35.7% of the visits while they refused to provide MA drugs to the mystery clients in 39.3% of visits. Lack of evidence of prior consultation with a physician (27.5%), referral to other health facilities (21.8%), unavailability of MA drugs in the pharmacy (21.3%) and lack of prescription (16.4%) were the main reasons for refusal. Seventy percent of the pharmacy workers inquired clients about last menstrual period/months of pregnancy while 38.1% asked whether the pregnancy status was confirmed. During 65.1% of the visits, mystery clients were told about when to take the MA drugs while in 66.4% of visits, they were told about the route of drug administration. Similarly, mystery clients were briefed about what to expect during the abortion process in half of the visits, and information about the possible side effects of the MA drug was provided in 55.9% of the visits. Pharmacy workers provided correct information on taking MA drugs to mystery clients in 70.7% of visits. CONCLUSION Despite legal provision of sale of MA drugs only on prescription, pharmacy workers dispensed MA drug in one out of three visits. As pharmacies are the initial contacts of women for abortion services in Nepal, correct supplementary information through pharmacy workers can be an effective strategy to expand access to quality safe abortion services.
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Affiliation(s)
- Anil Sigdel
- Population Services International, Lalitpur, Nepal
| | | | - Pratik Khanal
- Population Services International, Lalitpur, Nepal
- * E-mail:
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Szpot P, Wachełko O, Jurek T, Zawadzki M. Determination of Mifepristone (RU-486) and Its Metabolites in Maternal Blood Sample after Pharmacological Abortion. Molecules 2022; 27:molecules27217605. [PMID: 36364430 PMCID: PMC9657224 DOI: 10.3390/molecules27217605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
The aim of the study was the development and validation of the UHPLC-QqQ-MS/MS method for the determination of mifepristone in human blood as well as the identification and quantification of its metabolites after self-induced pharmacological abortion. The metabolic pathway in humans was proposed after examination of an authentic casework. The fast and simple preanalytical procedure was successfully applied (pH9, tert-butyl-methyl ether). The validation parameters of the method were as follows: limit of quantification: 0.5 ng/mL; coefficients of determination: >0.999 (R2), intra- and inter-day accuracy and precision values did not exceed ± 13.2%. The recovery and matrix effect were in the range of 96.3−114.7% and from −3.0 to 14.7%, respectively. Toxicological analysis of the mother’s blood (collected the day after the pregnancy termination) revealed the presence of five compounds: mifepristone (557.4 ng/mL), N-desmethyl-mifepristone (638.7 ng/mL), 22-OH-mifepristone (176.9 ng/mL), N,N-didesmethyl-mifepristone (144.5 ng/mL) and N-desmethyl-hydroxy-mifepristone (qualitatively). To our knowledge, the study presented in this paper is the first report on the concentrations of mifepristone and its metabolites in maternal blood samples after performing a self-induced abortion. The established UHPLC-QqQ-MS/MS method is suitable for forensic toxicological analysis as well as in terms of clinical toxicology in future investigations (examination of pharmacokinetics, bioavailability and metabolism of RU-486).
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Affiliation(s)
- Paweł Szpot
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, 50345 Wroclaw, Poland
- Correspondence:
| | - Olga Wachełko
- Institute of Toxicology Research, 45 Kasztanowa Street, 55093 Borowa, Poland
| | - Tomasz Jurek
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, 50345 Wroclaw, Poland
| | - Marcin Zawadzki
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, 50345 Wroclaw, Poland
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Hans P, Sharma K. Misadventure of an Unsafe Abortion. Cureus 2022; 14:e31131. [DOI: 10.7759/cureus.31131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
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Forensic Toxicological Aspects of Misoprostol Use in Pharmacological Abortions. Molecules 2022; 27:molecules27196534. [PMID: 36235071 PMCID: PMC9572746 DOI: 10.3390/molecules27196534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was establishment of an UHPLC-QqQ-MS/MS method for the deter-mination of misoprostol acid in biological specimens in cases of pharmacological abortions. Forensic toxicological examination was performed in three different biological samples (whole blood, placenta and fetal liver). The validation parameters of the method were as follows: limit of detection: 25 pg/mL; limit of quantification: 50 pg/mL, coefficient of determination: >0.999 (R2), intra- and interday accuracy and precision: not greater than 13.7%. The recovery and matrix effect were in the range of 88.3−95.1% and from −11.7 to −4.9%, respectively. Toxicological analysis of the mother’s blood (collected two days after pregnancy termination) did not reveal any abortifacients; however, misoprostol acid was found in the placenta (793 pg/g) and fetal liver (309 pg/g). The second case involved a fetus found near a garbage container. The concentration of misoprostol acid in the placenta was 2332 pg/g. In the presented study, an extensive literature review of misoprostol pharmacokinetics studies was performed. To our knowledge, the UHPLC-QqQ-MS/MS technique presented in this paper is the first quantitative method applied for forensic toxicological purposes. In addition, postmortem concentrations of misoprostol acid in miscarried fetuses due to illegal abortions were reported for the first time.
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Arora N, Singh N. Medical abortion in India - An imperative need for task sharing. J Family Med Prim Care 2022; 11:5473-5478. [PMID: 36505611 PMCID: PMC9730964 DOI: 10.4103/jfmpc.jfmpc_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 12/15/2022] Open
Abstract
Background Over-the-counter (OTC) sale of medical abortion (MA) inducing drugs is a common practice. Exploring its impact on women's health and the barriers to avail free MA services at hospital by these women is essential to improve upon policy decision. Methods A prospective observational study included 112 women following ingestion of MA drugs from nonformal providers. Demography, clinical details, and reasons for not availing free abortion services at hospital were recorded. Results Among 112 women, mean age was 28.63 (SD 4.7) years. Seventy one (63.39%) women were from rural region; 70.54% were educated below high school; 44 (39.28%) had prior induced abortion; 62.5% had never used any contraception. Majority (101; 90%) took two drugs (Mifepristone and Misoprostol), 28 (25%) used correct dosage. Drugs were consumed beyond 9 weeks of gestation by 25 (22.4%) women. Abnormal vaginal bleeding was commonest 105 (93.75%) presentation. Haemorrhagic shock was noted in 21 (18.75%) women, while 21 (18.7%) women required blood transfusion. "Easy and quick availability of these drugs OTC" was the commonest statement for not attending hospital. Conclusion Easy and quick availability of OTC drugs, distance to hospital were major barriers. Incorrect dosage and lack of gestational age calculation were two most common errors in the risk assessment protocol. Expanding provider base, by training midlevel providers, can overcome these and unmask the full potential of MA to make abortion safer.
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Affiliation(s)
- Nalini Arora
- Department of Obstetrics and Gynaecology, ESI-Post Graduate Institute of Medical Sciences and Research and ESIC Medical College, Kolkata, West Bengal, India,Address for correspondence: Dr. Nalini Arora, Department of Obstetrics and Gynaecology, ESI-PGIMSR and ESIC Medical College, Kolkata - 700 104, West Bengal, India. E-mail:
| | - Nita Singh
- Department of Obstetrics and Gynaecology, ESI-Post Graduate Institute of Medical Sciences and Research and ESIC Medical College, Kolkata, West Bengal, India
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Áinle FN, Donnelly J, Eogan M. Response to: "Are women equal? Considering impact of therapeutic abortion bans on science". Res Pract Thromb Haemost 2022; 6:e12754. [PMID: 35833171 PMCID: PMC9265638 DOI: 10.1002/rth2.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Fionnuala Ní Áinle
- School of Medicine University College Dublin (UCD) Dublin Ireland.,Department of Haematology Rotunda Hospital Dublin Ireland.,Department of Haematology Mater Misericordiae University Hospital Dublin Ireland
| | - Jennifer Donnelly
- Department of Obstetrics Rotunda Hospital Dublin Ireland.,Department of Obstetrics and Gynaecology Royal College of Surgeons in Ireland Dublin Ireland
| | - Maeve Eogan
- Department of Obstetrics Rotunda Hospital Dublin Ireland.,Department of Obstetrics and Gynaecology Royal College of Surgeons in Ireland Dublin Ireland
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Ponnusankar S, Vishwas HN, Kumar SM, Balasubramaniam V. Assessment of the Attitude and Knowledge About Abortion and Its Consequences in Women Attending Obstetrics Unit at A Public Hospital: A Prospective, Descriptive Survey-Based Study. EURASIAN JOURNAL OF FAMILY MEDICINE 2022. [DOI: 10.33880/ejfm.2022110107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: This study aimed at assessing the attitude and knowledge about abortion and its consequences in women attending obstetrics units at a public hospital.
Methods: This was a prospective, descriptive survey-based study with a purposive sampling technique involving women above 18 years attending obstetrics and gynecology unit at a public hospital.
Results: A total of 209 females were approached, finally 127 respondents agreed to participate in the study. About 85.04% (n=108) of them knew about abortion. 61.42% (n=78) of respondents indicated that they did not know the methods of abortion, and among them, 63.75% (n=49) were aware of unsafe abortion practices; very few of the respondents preferred the traditional practice for abortion. 56.69% (n=72) of the respondents were not aware of the possible dangers of abortion; and 85.83% (n=109) of the respondents would seek advice on abortion (if necessary) from a qualified doctor.
Conclusion: The study participants demonstrated good knowledge and attitudes towards abortion and its consequences. The study also showed the maximum number of respondents who had heard about abortion but had less knowledge of the consequences of unsafe practices. The study revealed that respondents' age, number of children, religion, and educational level had no significant influence on their knowledge and attitude.
Keywords: health surveys, complications, knowledge, spontaneous abortion
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Affiliation(s)
- Sivasankaran Ponnusankar
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research
| | - Hunsur Nagendra Vishwas
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research
| | - Siva Manoj Kumar
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research
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McLean KE. Contemplating abortion: a qualitative study of men and women’s reactions to unplanned pregnancy in Sierra Leone. CULTURE, HEALTH & SEXUALITY 2022; 25:444-458. [PMID: 35297735 DOI: 10.1080/13691058.2022.2052186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Globally, millions of unintended pregnancies result in unsafe abortions each year. In Sierra Leone, abortion-related complications are a major driver of maternal mortality. Despite these costs, women continue to seek unsafe abortions, yet how individuals understand the risks and benefits of pregnancy termination remains under-researched. This study seeks to understand perceptions of abortion by women and men experiencing unplanned pregnancy and to highlight factors that inform their abortion trajectories. Findings indicate that abortion was contemplated in response to anxieties regarding caring for a child, interruptions to schooling, and stigma associated with extra-marital pregnancy. While many women and men preferred not to abort-due to cultural values tied to parenthood-others faced obstacles stemming from lack of knowledge of and access to services. Findings can be used to inform interventions to support women and men in realising their fertility preferences in the face of unplanned pregnancy.
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Zhang Q, Wang N, Hu Y, Creedy DK. Prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China: a cross-sectional study. Reprod Health 2022; 19:64. [PMID: 35264193 PMCID: PMC8906361 DOI: 10.1186/s12978-022-01366-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China. Methods A cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0. Results A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18–54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39–6.29), had low social support (aOR = 2.95, 95% CI 1.39–6.29), were non-local residents (aOR = 2.51, 95% CI 1.15–5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15–5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18–3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67–47.09), had completed higher education (aOR = 12.28, 95% CI 1.24–121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37–8.32). Conclusions The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01366-1. Abortion is a stressful life event. Understanding how women perceive having an abortion and their psychosocial responses will enable health providers to understand women’s needs and provide high-quality care. This study aims to determine the frequency of stress and depression among women seeking an induced abortion in early pregnancy in China and associated factors Around 25.3% of women reported high stress and 22.5% reported depression. Women were more likely to suffer high stress if they reported low resilience, were not-using contraceptives, had low social support, were non-local residents, were unhappy with their intimate relationship, or held pro-life attitudes towards abortion. High perceived stress, high education level, and non-local status were associated with depression. The findings indicate stress and depression are quite common among women seeking an abortion in China, especially those with high-risk factors. It is necessary to evaluate and promote the mental health of women seeking an abortion.
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Affiliation(s)
- Qiuxiang Zhang
- Department of Gynaecology and Obstetrics, Peking University People's Hospital, 11 Xizhimen Nan Street, Xicheng District, Beijing, 100044, China
| | - Na Wang
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing, 100069, China.
| | - Yinchu Hu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University Logan Campus, University Drive, Meadowbrook, QLD, 4131, Australia
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“I just have to hope that this abortion should go well”: Perceptions, fears, and experiences of abortion clients in Nigeria. PLoS One 2022; 17:e0263072. [PMID: 35130269 PMCID: PMC8820635 DOI: 10.1371/journal.pone.0263072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/10/2022] [Indexed: 01/23/2023] Open
Abstract
This qualitative study aimed to examine how abortion clients in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers. Abortion is severely legally restricted in Nigeria but remains common. We conducted in-depth interviews with 25 people who obtained abortion services through three distinct models of care. We coded interview transcripts and conducted thematic analysis. Clients perceived negative attitudes toward abortion in their communities, though clients’ own beliefs were more nuanced. Clients recounted a range of fears, and nearly all mentioned worrying that they might die as a result of their abortion. Despite their concerns, clients relied on social networks and word-of-mouth recommendations to identify providers they perceived as trustworthy and safe. Kind and non-judgmental treatment, clear instructions, open communication, and reassurance of privacy and confidentiality by providers alleviated client fears and helped clients feel supported throughout their abortion process. Within restrictive contexts, the mobilization of information networks, provision of high-quality care through innovative models, and personalization of care to individual needs can assuage fears and contribute to reducing stigma and increasing access to safe abortion services.
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Namagembe I, Nakimuli A, Byamugisha J, Moffett A, Aiken A, Aiken C. Preventing death following unsafe abortion: a case series from urban Uganda. AJOG GLOBAL REPORTS 2022; 2:100039. [PMID: 35252906 PMCID: PMC8883508 DOI: 10.1016/j.xagr.2021.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Maternal deaths from unsafe abortion continue to occur globally, with particularly high rates in Sub-Saharan Africa where most abortions are classified as unsafe. Maternal death reviews are an effective part of cohesive strategies to prevent future deaths while abortion remains illegal. OBJECTIVE This study aimed to conduct maternal death reviews for all deaths occurring following unsafe abortion during the study period, to assess preventability, and to synthesize key learning points that may help to prevent future maternal deaths following unsafe abortions. STUDY DESIGN Full case reviews of all maternal deaths (350 cases from Jan 2016 to Dec 2018) at the study center (a national referral hospital in urban Uganda) were conducted by specially trained multidisciplinary panels of obstetricians and midwives. We extracted the reviews of women who died following unsafe abortions (13 [2.6%]) for further analysis. RESULTS Most maternal deaths owing to unsafe abortion were found to be preventable. The key recommendations that emerged from the reviews were (1) that clinicians should maintain a high index of suspicion for delayed presentation and rapid decompensation in cases where unsafe abortion has occurred, (2) that a low threshold for early intravenous antibiotic therapy should be applied, and (3) that any admission with complications following an unsafe abortion merits review by an experienced clinician as soon as possible. CONCLUSION Postabortion care is part of essential emergency medical care and should be provided with high standards, especially in areas where there is limited or no legal access to abortion care. Implementing the recommended learning points is likely to be feasible even in low-resource obstetrical settings and, given the high rates of preventability found in maternal deaths owing to unsafe abortion, is likely to be effective.
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Receiving abortion services at nongovernmental health facilities as a significant variable for postabortion family planning utilization: a comparative cross-sectional study. AJOG GLOBAL REPORTS 2022; 2:100047. [DOI: 10.1016/j.xagr.2021.100047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Otsin MNA, Taft AJ, Hooker L, Black K. Three Delays Model applied to prevention of unsafe abortion in Ghana: a qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:e75-e80. [PMID: 34272209 DOI: 10.1136/bmjsrh-2020-200903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although mostly used in explaining mortality associated with perinatal care, recent calls for research on induced abortion in Africa suggest that the Three Delays Model could be used to enhance understanding of women's experiences and access to induced abortion care. METHODS We conducted 47 face-to-face interviews with women who had experienced unsafe abortions, with formal abortion providers (abortion providers in hospitals) and with informal and non-legal abortion providers (pharmacy workers and herb sellers). Study participants were recruited from selected hospitals, community pharmacies and markets within the Ashanti region of Ghana. We drew on phenomenology to analyse the data. FINDINGS The first delay (in seeking care) occurred because of women's poor knowledge of pregnancy, the influence of religion, and as a result of women underestimating the seriousness of abortion complications. Factors including cost, provider attitudes, stigma, and the proximity of pharmacies to women's homes delayed their access to safe abortion and resulted in their experience of the second delay (in reaching a healthcare facility). The third delay (in receiving appropriate care) was a result of hospitals' non-prioritisation of abortion complications and a shortage of equipment, resulting in long hospital waiting times before treatment. CONCLUSION This study has shown the value of the Three Delays Model in illustrating women's experiences of unsafe abortions and ways of preventing the first, second and third delays in their access to care.
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Affiliation(s)
- Mercy Nana Akua Otsin
- Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia
- Health Administration and Education, University of Education, Winneba, Ghana
| | - Angela J Taft
- Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia
| | - Leesa Hooker
- Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Kirsten Black
- The Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Access to Reproductive Healthcare for Persons Who Have Experienced Sexual Violence. JOURNAL OF FORENSIC NURSING 2022; 18:E1-E3. [PMID: 35121685 DOI: 10.1097/jfn.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pregnancy resulting from abuse is a public health concern that millions of persons will experience in their lifetimes. Access to professional and safe reproductive healthcare, including sex education, contraception, and abortion, is essential to protecting the rights of persons to control their reproductive health. Currently, access to safe and timely reproductive healthcare is at particular peril. Affirming a patient's right to choose or, advocating autonomy in healthcare decisions is a key component of trauma-informed care. It is the position of the International Association of Forensic Nurses that access to, and autonomy in decision making about reproductive healthcare, including safe and legal contraception and abortion, is a basic human right.
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Deflaoui T, Jabi R, Derkaoui A, Merhoum A, Kradi Y, Bouziane M. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac235. [PMID: 35665396 PMCID: PMC9156008 DOI: 10.1093/jscr/rjac235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Uterine perforation is a rare complication of abortion. It becomes much rarer when associated with a small bowel incarceration at the uterine breach. Its diagnosis can be suspected clinically, but radiology remains more sensitive for diagnosis. Surgery is the cornerstone in treating this entity as it provides both diagnostic and therapeutic management. A multidisciplinary therapeutic approach should be immediately performed to ensure a good prognosis. In this report, we describe a case of small intestine incarceration in the breach of a uterine perforation that occurred in the weeks following a clandestine abortion.
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Affiliation(s)
- Tarik Deflaoui
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
- Correspondence address. Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco. Tel.: +212644035035; E-mail:
| | - Rachid Jabi
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
- Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
| | - Anas Derkaoui
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
| | - Abdelali Merhoum
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
| | - Yassin Kradi
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
| | - Mohammed Bouziane
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
- Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
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Assis MP. Misoprostol on trial: a descriptive study of the criminalization of an essential medicine in Brazil. CAD SAUDE PUBLICA 2021; 37:e00272520. [PMID: 34730693 DOI: 10.1590/0102-311x00272520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022] Open
Abstract
Misoprostol is a medicine with a "double" social life recorded in several places, including Brazil. Within formal and authorized health facilities, it is an essential medicine, used for life-saving obstetric procedures. On the streets, or in online informal markets, misoprostol is treated as a dangerous drug used to induce illegal abortions. In the Brazilian case, despite a rich anthropological and public health analysis of the social consequences of misoprostol's double life, there are no studies on the legal implications. This article offers such descriptive analysis, presenting and examining a comprehensive dataset of how Brazilian courts have treated misoprostol in the past three decades. It consists of an encompassing mapping of the "when, where, how, and who" of misoprostol criminalization in Brazil, pointing to the unjust consequences of the use of criminal law for the purpose of protecting public health.
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Eboigbe E, Gadama L, Filippi V, Mehrtash H, Adu-Bonsaffoh K, Bello FA, Compaoré R, Dossou JP, Idi N, Kim CR, Msusa AT, Mugerwa KY, Wolomby-Molondo JJ, Tunçalp Ӧ, Calvert C. Adolescents' satisfaction with care for abortion-related complications in 11 Sub-Saharan African countries: A cross-sectional facility-based study. Int J Gynaecol Obstet 2021; 156 Suppl 1:63-70. [PMID: 34676896 DOI: 10.1002/ijgo.13896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess satisfaction with care for abortion-related complications experienced among adolescents compared to older women. METHODS A secondary analysis of the WHO Multi-Country Survey on Abortion-related Morbidity and Mortality-a cross-sectional study conducted in health facilities in 11 Sub-Saharan African countries. Women with abortion-related complications who participated in an audio computer-assisted self-interview were included. Two composite measures of overall satisfaction were created based on five questions: (1) study participants who were either satisfied or very satisfied across all five questions; and (2) study participants who reported being very satisfied only across all five questions. Multivariable general estimating equation analyses were conducted to assess whether there was any evidence that age (adolescents 12-19 years and older women 20+) was associated with each composite measure of satisfaction, controlling for key confounders. RESULTS The study sample consisted of 2817 women (15% adolescents). Over 75% of participants reported being satisfied or very satisfied for four out of five questions. Overall, 52.9% of study participants reported being satisfied/very satisfied across all five questions and 22.4% reported being consistently very satisfied. Multivariable analyses showed no evidence of an association between age group and being either satisfied or very satisfied (OR 1.07; 95% CI, 0.82-1.41, P = 0.60), but showed strong evidence that adolescents were 50% more likely to be consistently very satisfied with their overall care than older women (OR 1.49; 95% CI, 1.13-1.96, P = 0.005). CONCLUSION Both adolescents and older women reported high levels of satisfaction with care when looking at different components of care individually, but the results of the composite measure for satisfaction showed that many study participants reported being less than satisfied with at least one element of their care. Further studies to explore the expectations, needs, and values of women's satisfaction with care for abortion-related complications are needed.
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Affiliation(s)
| | - Luis Gadama
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Zomba, Malawi
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | | | - Rachidatou Compaoré
- Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Nafiou Idi
- Université Abdou Moumouni de Niamey, Niamey, Niger
| | - Caron R Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ausbert Thoko Msusa
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Ӧzge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Moreau C, Shankar M, Glasier A, Cameron S, Gemzell-Danielsson K. Abortion regulation in Europe in the era of COVID-19: a spectrum of policy responses. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:e14. [PMID: 33093040 PMCID: PMC8515109 DOI: 10.1136/bmjsrh-2020-200724] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Unprecedented public health actions restricting movement and non-COVID related health services are likely to have affected abortion care during the pandemic in Europe. In the absence of a common approach to ensure access to this essential health service, we sought to describe the variability of abortion policies during the outbreak in Europe in order to identify strategies that improve availability and access to abortion in times of public health crises. METHODS We collected information from 46 countries/regions: 31 for which country-experts completed a survey and 15 for which we conducted a desk review. We describe abortion regulations and changes to regulations and practice during the pandemic. RESULTS During COVID-19, abortions were banned in six countries and suspended in one. Surgical abortion was less available due to COVID-19 in 12 countries/regions and services were not available or delayed for women with COVID-19 symptoms in eleven. No country expanded its gestational limit for abortion. Changes during COVID-19, mostly designed to reduce in-person consultations, occurred in 13 countries/regions. Altogether eight countries/regions provided home medical abortion with mifepristone and misoprostol beyond 9 weeks (from 9 weeks+6 days to 11 weeks+6 days) and 13 countries/regions up to 9 weeks (in some instances only misoprostol could be taken at home). Only six countries/regions offered abortion by telemedicine. CONCLUSIONS The lack of a unified policy response to COVID-19 restrictions has widened inequities in abortion access in Europe, but some innovations including telemedicine deployed during the outbreak could serve as a catalyst to ensure continuity and equity of abortion care.
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Affiliation(s)
- Caroline Moreau
- Population Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Soins et Santé Primaire, Centre for Research in Epidemiology and Population Health (CESP) INSERM 1018, INSERM, Villejuif, France
| | - Mridula Shankar
- Population Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| | - Sharon Cameron
- Sexual and Reproductive Health Services, NHS Lothian, Edinburgh, Scotland
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Baynes C, Diadhiou M, Lusiola G, O'Connell K, Dieng T. Understanding the financial burden of incomplete abortion: An analysis of the out-of-pocket expenditure on postabortion care in eight public-sector health care facilities in Dakar, Senegal. Glob Public Health 2021; 17:2206-2221. [PMID: 34520330 DOI: 10.1080/17441692.2021.1977972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Timely access to treatment is essential for women when they experience abortion complications. Out-of-pocket (OOP) expenditure is a known barrier to health care access. In 2018, we assessed the financial burden of accessing postabortion care (PAC) borne by women in Dakar, Senegal, where studies estimate that half of poor women with complications obtain PAC. We interviewed 729 women following discharge from PAC. Women reported expenditures on transportation, admission, treatment, family planning, hospitalisation, complementary tests, prescriptions, other medicines and materials. We compare women's OOP on PAC by expenditure category, type of treatment and facility type, and use multiple generalised linear regression analysis to explain variation in overall OOP and forecast it under alternate scenarios. The average OOP was USD $93.84. At health centres it was $65.47 and at hospitals it was $120.47. The average cost of PAC using dilation and curettage was $112.37, manual vacuum aspiration was $99.84, and misoprostol $61.80. Overall OOP on PAC amounts, on average, to 15% of the average monthly salary for women living in Dakar. Strategies that emphasise timely access to misoprostol for treating complications in primary care settings will address the contribution of OOP costs to Senegal's appreciable unmet need for PAC among the poor.
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Affiliation(s)
| | - Mohamed Diadhiou
- Le Centre de Formation, Recherche et de Plaidoyer en Santé de la Reproduction (CEFOREP), Dakar, Senegal
| | | | | | - Thierno Dieng
- Le Centre de Formation, Recherche et de Plaidoyer en Santé de la Reproduction (CEFOREP), Dakar, Senegal
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Cavalari CAA, Veiga-Junior NN, Kajiura BD, Eugeni C, Tavares BVG, Baccaro LF. Factors Associated with Abortion Complications after the Implementation of a Surveillance Network (MUSA Network) in a University Hospital. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:507-512. [PMID: 34461660 PMCID: PMC10303421 DOI: 10.1055/s-0041-1735129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with abortion complications following the implementation of the good-practice surveillance network Mujeres en Situación de Aborto (Women Undergoing Abortion, MUSA, in Spanish). METHODS A cross-sectional study with women who underwent abortion due to any cause and in any age group at UNICAMP Women's Hospital (part of MUSA network), Campinas, Brazil, between July 2017 and Agust 2019. The dependent variable was the presence of any abortion-related complications during hospitalization. The independent variables were clinical and sociodemographic data. The Chi-square test, the Mann-Whitney test, and multiple logistic regression were used for the statistical analysis. RESULTS Overall, 305 women were enrolled (mean ± standard deviation [SD] for age: 29.79 ± 7.54 years). The mean gestational age was 11.17 (±3.63) weeks. Accidental pregnancy occurred in 196 (64.5%) cases, 91 (29.8%) due to contraception failure. At least 1 complication was observed in 23 (7.54%) women, and 8 (34.8%) of them had more than 1. The most frequent complications were excessive bleeding and infection. The factors independently associated with a higher prevalence of complications were higher gestational ages (odds ratio [OR]: 1.22; 95% confidence interval [95%CI]: 1.09 to 1.37) and contraceptive failure (OR: 3.4; 95%CI: 1.32 to 8.71). CONCLUSION Higher gestational age and contraceptive failure were associated with a higher prevalence of complications. This information obtained through the surveillance network can be used to improve care, particularly in women more susceptible to unfavorable outcomes.
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Affiliation(s)
- Camila Ayume Amano Cavalari
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP - Brazil
| | - Nelio Neves Veiga-Junior
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP - Brazil
| | - Beatriz Deguti Kajiura
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP - Brazil
| | - Caroline Eugeni
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP - Brazil
| | | | - Luiz Francisco Baccaro
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP - Brazil
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Romero M, Gomez Ponce de Leon R, Baccaro LF, Carroli B, Mehrtash H, Randolino J, Menjivar E, Estevez Saint-Hilaire E, Huatuco MDP, Hernandez Muñoz R, Garcia Camacho G, Thwin SS, Campodonico L, Abalos E, Giordano D, Gamerro H, Kim CR, Ganatra B, Gülmezoglu M, Tuncalp Ö, Carroli G. Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A). BMJ Glob Health 2021; 6:bmjgh-2021-005618. [PMID: 34417270 PMCID: PMC8404437 DOI: 10.1136/bmjgh-2021-005618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women's experiences with abortion care in selected countries of the Americas region. METHODS This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women's characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications. RESULTS We collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity. CONCLUSIONS This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women's experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.
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Affiliation(s)
- Mariana Romero
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina .,CONICET, Buenos Aires, Argentina
| | - Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health, Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | | | | | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Elisa Menjivar
- Pan American Health Organization El Salvador, San Salvador, El Salvador
| | | | | | | | | | - Soe Soe Thwin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | | | | | | | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bela Ganatra
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Özge Tuncalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Bolnga JW, Lufele E, Teno M, Agua V, Ao P, Dl Mola G, Pomat W, Laman M. Incidence of self-induced abortion with misoprostol, admitted to a provincial hospital in Papua New Guinea: A prospective observational study. Aust N Z J Obstet Gynaecol 2021; 61:955-960. [PMID: 34350583 DOI: 10.1111/ajo.13413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Misoprostol is a life-savingmedication in obstetric practice but the prevalence of misoprostol-related self-induced abortion is increasing in many communities. AIMS To investigate the hospital incidence, clinical management, and legal framework of self-induced abortions with misoprostol. MATERIALS AND METHODS This was a prospective observational study conducted over 18 months. All patients <20 weeks pregnant who were admitted with a diagnosis of misoprostol-induced abortion were included in the study. RESULTS Of 186 women with abortion-related admissions during the study period, 51 (27.4%) women reported using misoprostol to induce abortion. The majority were young (27.8 ± 5.5) married women (32/51: 62.7%), particularly educated (27/51: 52.9%) employed women (27/51: 52.9%), who were not on any contraception (46/51: 90.1%). Most abortions were induced in the first trimester (39/51: 76.5%) and patients were admitted because of prolonged bleeding (23/51: 45.1%). A significant proportion of participants who did not receive the correct dose of misoprostol developed sepsis compared to those who received a correct dose (6/18 (33.3%) vs 1/30 (3.3%); P = 0.008). CONCLUSION The use of misoprostol as an abortifacient is increasing in Papua New Guinea, particularly among educated and employed women. A review of the laws to meet the demand for abortion services and to limit complications of unsafe abortion practices is required.
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Affiliation(s)
- John W Bolnga
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang, Papua New Guinea.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Elvin Lufele
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Mitilam Teno
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang, Papua New Guinea
| | - Vero Agua
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang, Papua New Guinea
| | - Paula Ao
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang, Papua New Guinea
| | - Glen Dl Mola
- Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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Juma K, Ouedraogo R, Mwoka M, Ajayi AI, Igonya E, Otukpa EO, Ushie BA. Protocol for a scoping review of research on abortion in sub-Saharan Africa. PLoS One 2021; 16:e0254818. [PMID: 34264992 PMCID: PMC8282029 DOI: 10.1371/journal.pone.0254818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/02/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Unsafe abortion is a leading cause of maternal mortality, and access to safe abortion services remains a public health priority in sub-Saharan Africa (SSA). A considerable amount of abortion research exists in the region; however, the spread of existing evidence is uneven such that some countries have an acute shortage of data with others over-researched. The imbalance reflects the complexities in prioritization among researchers, academics, and funders, and undeniably impedes effective policy and advocacy efforts. This scoping review aims to identify and map the landscape of abortion research in SSA, summarize existing knowledge, and pinpoint significant gaps, both substantive and geographic, requiring further investigation. This review will provide direction for future research, investments, and offer guidance for policy and programming on safe abortion. Materials and methods We utilize the Joanna Briggs Institute’s methodology for conducting scoping reviews. We will perform the search for articles in 8 electronic databases (i.e., PubMed, AJOL, Science Direct, SCOPUS, HINARI, Web of Knowledge, CINAHL, and WHO Regional Databases). We will include studies written in English or French language, produced or published between January 1, 2011, and July 31, 2021, and pertain directly to the subject of abortion in SSA. Using a tailored extraction frame, we will extract relevant information from publications that meet the inclusion criteria. Data will be analyzed using descriptive statistics and thematic analysis in response to key review questions. Ethics and dissemination Formal ethical approval is not required, as no primary data will be collected. The findings of this study will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Kenneth Juma
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Meggie Mwoka
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Emmy Igonya
- African Population and Health Research Center, Nairobi, Kenya
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Ishola F, Ukah UV, Nandi A. Impact of abortion law reforms on women's health services and outcomes: a systematic review protocol. Syst Rev 2021; 10:192. [PMID: 34183064 PMCID: PMC8240208 DOI: 10.1186/s13643-021-01739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A country's abortion law is a key component in determining the enabling environment for safe abortion. While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, with the majority of them moving away from an absolute ban. However, the implications of these reforms on women's access to and use of health services, as well as their health outcomes, is uncertain. First, there are methodological challenges to the evaluation of abortion laws, since these changes are not exogenous. Second, extant evaluations may be limited in terms of their generalizability, given variation in reforms across the abortion legality spectrum and differences in levels of implementation and enforcement cross-nationally. This systematic review aims to address this gap. Our aim is to systematically collect, evaluate, and synthesize empirical research evidence concerning the impact of abortion law reforms on women's health services and outcomes in LMICs. METHODS We will conduct a systematic review of the peer-reviewed literature on changes in abortion laws and women's health services and outcomes in LMICs. We will search Medline, Embase, CINAHL, and Web of Science databases, as well as grey literature and reference lists of included studies for further relevant literature. As our goal is to draw inference on the impact of abortion law reforms, we will include quasi-experimental studies examining the impact of change in abortion laws on at least one of our outcomes of interest. We will assess the methodological quality of studies using the quasi-experimental study designs series checklist. Due to anticipated heterogeneity in policy changes, outcomes, and study designs, we will synthesize results through a narrative description. DISCUSSION This review will systematically appraise and synthesize the research evidence on the impact of abortion law reforms on women's health services and outcomes in LMICs. We will examine the effect of legislative reforms and investigate the conditions that might contribute to heterogeneous effects, including whether specific groups of women are differentially affected by abortion law reforms. We will discuss gaps and future directions for research. Findings from this review could provide evidence on emerging strategies to influence policy reforms, implement abortion services and scale up accessibility. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126927.
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Affiliation(s)
- Foluso Ishola
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
| | - U. Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
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Ishola F, Ukah UV, Alli BY, Nandi A. Impact of abortion law reforms on health services and health outcomes in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 36:1483-1498. [PMID: 34133729 DOI: 10.1093/heapol/czab069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 11/14/2022] Open
Abstract
While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, expanding the grounds on which abortion can be performed legally. However, the implications of these reforms on women's access to and use of health services, as well as their health outcomes, are uncertain. This systematic review aimed to evaluate and synthesize empirical research evidence concerning the effects of abortion law reforms on women's health services and health outcomes in LMICs. We searched Medline, Embase, CINAHL and Web of Science databases, as well as grey literature and reference lists of included studies. We included pre-post and quasi-experimental studies that aimed to estimate the causal effect of a change in abortion law on at least one of four outcomes: (1) use of and access to abortion services, (2) fertility rates, (3) maternal and/or neonatal morbidity and mortality and (4) contraceptive use. We assessed the quality of studies using the quasi-experimental study design series checklist and synthesized evidence through a narrative description. Of the 2796 records identified by our search, we included 13 studies in the review, which covered reforms occurring in Uruguay, Ethiopia, Mexico, Nepal, Chile, Romania, India and Ghana. Studies employed pre-post, interrupted time series, difference-in-differences and synthetic control designs. Legislative reforms from highly restrictive to relatively liberal were associated with reductions in fertility, particularly among women from 20 to 34 years of age, as well as lower maternal mortality. Evidence regarding the impact of abortion reforms on other outcomes, as well as whether effects vary by socioeconomic status, is limited. Further research is required to strengthen the evidence base for informing abortion legislation in LMICs. This review explicitly points to the need for rigorous quasi-experimental studies with sensitivity analyses to assess underlying assumptions. The systematic review was registered in PROSPERO database CRD42019126927.
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Affiliation(s)
- Foluso Ishola
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - U Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - Babatunde Y Alli
- Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC H3A 1G1, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada.,Institute for Health and Social Policy, 1130 Pine Ave West, Montreal, QC H3A 1A3, Canada
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Yanow S, Pizzarossa LB, Jelinska K. Self-managed abortion: Exploring synergies between institutional medical systems and autonomous health movements. Contraception 2021; 104:219-221. [PMID: 34139153 DOI: 10.1016/j.contraception.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Susan Yanow
- Women Help Women, PO Box 15798, 1001 NG Amsterdam, Netherlands.
| | | | - Kinga Jelinska
- Women Help Women, PO Box 15798, 1001 NG Amsterdam, Netherlands.
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